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A SYSTEM OF VETERINARY MEDICINE 





A SYSTEM OF 
VETERINARY MEDICINE 


BY VARIOUS WRITERS 


EDITED. BY 


VY Ne bot Oa NV, 


LECTURER IN VETERINARY HYGIENE, UNIVERSITY COLLEGE, CORK 
LATE EXAMINER IN ANATOMY, ROYAL COLLEGE OF VETERINARY SURGEONS 
LATE EXTERNAL EXAMINER IN VETERINARY TOXICOLOGY, JURISPRUDENCE AND SANITARY 
LAW, UNIVERSITY OF LIVERPOOL 


AUTHOR OF '' VETERINARY THERAPEUTICS AND PHARMACOLOGY ”’ 


VOL. II 


GENERAL DISEASES 
INCLUDING A SECTION ON PARASITES 


CHICAGO 
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PREFACE 


In this volume general diseases of the various domestic animals and of 
birds receive consideration. The needs of the clinician have been kept 
in view, and it is hoped that the extensive manner in which the subjects 
have been treated will render the volume useful not only in everyday 
practice, but also as a work of reference. The diseases of the various 
organs in each species are dealt with in separate sections; thus the work 
represents a complete guide to the maladies of the horse, ox, sheep, goat, 
pig, dog, cat, and bird. This plan facilitates reference, and also enables 
the clinical descriptions of the diseases in the various species of animals 
to be considered more fully, and the special characteristics to be more 
clearly defined than by the method usually adopted in textbooks on 
veterinary medicine. 

- Avian diseases have received attention as far as space would permit, 
and, owing to the increased importance of this subject in the present day, 
the sections devoted to the common maladies of birds and their treatment 
should prove of value to practitioners who desire to enlarge their sphere 
of usefulness in this direction. 

The Editor does not consider that any apologyis needed for the large 
amount of space devoted to Diseases of the Digestive Organs. The 
importance of the subject and the fact that it deals with affections which 
form the major portion of the work of the general practitioner are sufficient 
- grounds for the extent of this section. 

The Editor desires to offer his sincere thanks to all the collaborators 
for the time and labour they have expended in rendering this volume a 
fitting companion to Volume I., also for reading the proof-sheets of the 
sections for which he is responsible. 

Mr. Henry Gray, M.R.C.V.S., has written special articles on Tavares 
affections in the dog and cat, and has also read the prootf-sheets of the 
various sections on canine, feline, and avian diseases, and suggested 
many valuable additions. Mr. Hugh Begg, F.R.C.V.S., has undertaken 


Vv 


vl - PREFACE 


the important subject of Diseases of the Digestive System in Cattle, and 
the clear and lucid manner in which he has dealt with these affections 
should prove of marked utility to those engaged in solving what may 
justly be regarded as some of the most difficult problems in bovine 
practice. Mr. H. Caulton Reeks, F.R.C.V.S., has not only read the 
proof-sheets of the section on Diseases of the Digestive System in the 
Horse, but has also placed the results of his large experience and special 
study of these affections at the disposal of the Editor. 

In the preparation of the section on Diseases of the Canale 
Organs, the Editor wishes to acknowledge the valuable assistance of 
Mr. Horace L. Roberts, F.R.C.V.S. He is also indebted to Professor 
G. D. Lander, Royal Veterinary College, London, who has kindly read 
the proof-sheets of the section on Poisons. 

The Editor deeply deplores the death of two valued collaborators—viz., 
the late Mr. G. L. Ingram, M.R.C.V.S., whose early demise was a serious 
loss to veterinary science and to veterimary literature ; and the late 
William Hunting, F.R.C.V.S., whose labours for the advancement of 
clinical veterinary medicine, literature, and in the field of veterinary 
sanitary science and public health, constitute a permanent monument to 
his memory. 

The assistance derived from the various veterinary periodicals men- 
tioned in the preface to Volume I. must also be acknowledged in connec- 
tion with the present volume. 

Owing to lack of space, it was not possible to include Diseases of the 
Skin and Diseases of the Genito-Urinary Organs in this volume. As, 
however, the parasitic diseases of the skin, with the exception of 
Ringworm, are dealt with in the section on Parasites, and as diseases 
of the genito-urinary organs more properly belong to the domain of 
surgery and obstetrics, the omissions cannot be regarded as of any 
serious Importance in a work on veterinary medicine. 

In conclusion the Editor ventures to hope that the present volume will 
merit a similar degree of appreciation to that accorded to Volume I. by 
practitioners in the United Kingdom, the Colonies, and America. If this 
hope be fulfilled, he will feel that the years devoted to its preparation have 
been well spent. | 

lis Wie 


18, Cook STREET, 


ORK, 
November, 1914. 


CONTENTS OF VOL. II. 


PAGE 


DISEASES OF THE DIGESTIVE SYSTEM IN THE HORSE - - 1 


DISEASES OF THE MOUTH: STOMATITIS—CONGESTION OF THE BUCCAL 
MEMBRANE—CONGESTION OF THE HARD PALATE - : -' 9 


DISEASES OF THE TONGUE: GLOSSITIS—WOUNDS OF THE TONGUE— 

. FOREIGN BODIES IN THE TONGUE—GLOSSOPLEGIA (PARALYSIS OF 

THE ToncuE)—NEW GROWTHS IN THE TONGUE—CONGENITAL 
DEFECTS OF THE TONGUE - - - - - - 21 


DISEASES OF THE SALIVARY GLANDS: PAROTITIS—MAXILLITIS (SUB- 
MAXILLARY ADENITIS)—RANULA-— - - - 26 


DISEASES OF THE TONSILS : : 2 a : = 33 


DISEASES OF THE PHARYNX: ACUTE PHARYNGITIS—CHRONIC PHARYN- 
GIPFIS—PARALYSIS OF THE PHARYNX—PARASITES OF THE PHARYNX 
—WoOUNDS AND LACERATIONS OF THE PHARYNX—FOREIGN BODIES 
IN THE PHARYNX—TUMOURS OF THE PHARYNX - - - 34 


DISEASES OF THE CHSOPHAGUS: CHSOPHAGITIS (INFLAMMATION OF THE 
» (HsopHaGus)—(CHsOPHAGISMUS (SPASM OF THE CiSOPHAGUS)—P4aR- 
ALYSIS OF THE (HSOPHAGUS—DILATATION OF THE (HSOPHAGUS— 
CONSTRICTION OF THE (HSOPHAGUS—FOREIGN BODIES IN THE 
(HsopHacus (CHOKING)—TRAUMATIC LESIONS OF THE CHSOPHAGUS 
(PERFORATIONS AND RUPTURES)—FISTULA OF THE (HSOPHAGUS— 
ULCERATION OF THE CiSOPHAGUS—EXPOSED WOUNDS OF THE 
(EsopHAGUS—TUMOURS OF THE (ESOPHAGUS - - - 53 


DISEASES OF THE STOMACH: GASTRIC IMPACTION—GASTRIC IMPACTION 
IN FoatS—AcuTE GastTRIC TYMPANY—RUPTURE OF THE STOMACH 
—GASTRECTASIS (DILATATION OF THE STOMACH)—ULCERATION OF 
THE STOMACH—H /MORRHAGE OF THE STOMACH—ACUTE GASTRITIS 
—CHRONIC GASTRITIS—FOREIGN BODIES IN THE STOMACH— 
TUMOURS OF THE STOMACH—PARASITES OF THE STOMACH - - 86 


DISEASES OF THE INTESTINES: COLIC—INTESTINAL TYMPANY—OB- 
STRUCTIVE CoLIC DUE TO IMPACTION—IMPACTION OF THE SMALL 
INTESTINES—OBSTRUCTIVE COLIC IN FOALS DUE TO IMPACTION OF 
THE COLON OR RECTUM—INTESTINAL OBSTRUCTION DUE TO CALCULI, 
ETC.—INTESTINAL OBSTRUCTION DUE TO FOREIGN SUBSTANCES, 


vil 


vill CONTENTS OF VOL. II. 
PAGE 
SAND, ETC. (SAND COLIC)—INTESTINAL OBSTRUCTION DUE To Dis- 
PLACEMENTS, STRANGULATION, VOLVULUS, ETC.—INVAGINATION 
OF THE INTESTINE—PROLAPSE OF THE RECTUM—ENTERITIS— 
ENTERITIS IN FoaLS—CoLic DUE TO VERMINOUS ANEURISM— 
ULCERATION OF THE INTESTINE—ABSCESS OF THE INTESTINE— 
STRICTURE OF THE INTESTINE—DILATATION OF THE INTESTINE— 
NEOPLASMS OF THE INTESTINE—H HMORRHOIDS—RUPTURE OF THE 
INTESTINE—H HMORRHAGE OF THE IJINTESTINES—DYSENTERY— 
DIARRH@A—DIARRH@A IN F'oALS—SUPERPURGATION—CONSTIPA- . 





TION : - - - - - - Pee 
DISEASES OF THE DIGESTIVE SYSTEM IN CATTLE - : - 308 
DISEASES OF THE MoutH: STOMATITIS” - “ - - - 313 
DISEASES OF THE SALIVARY GLANDS: PAROTITIS—MAXILLITIS” - - 323 
DISEASES OF THE PHARYNX: PHARYNGITIS— PHARYNGEAL TUMOURS AND 
PHARYNGEAL ABSCESS - - - - - - 324 
DISEASES OF THE CHSOPHAGUS: CHSOPHAGEAL OBSTRUCTION—(CHSOPHA- 
GITIS, CHSOPHAGISMUS, PARALYSIS OF THE (HsopHaGus, DILATA- 
TION AND CONSTRICTION OF THE (HSOPHAGUS—T'RAUMATIC LESIONS 
OF THE CHSOPHAGUS (PERFORATIONS AND RUPTURES) - - 329 
DISEASES OF THE STOMACH : DISEASES OF THE RUMEN—DISEASES OF 
THE RETICULUM—DISEASES OF THE OMASUM—DISEASES OF THE 
ABOMASUM—DySsPEPSIA—PIcA—DYSPEPSIA IN CALVES) - - 338 
DISEASES OF THE INTESTINES: COLIC—INVAGINATION OF THE INTES- 
TINE—VOLVULUS—STRANGULATION OF THE INTESTINE—GUT-TIE— 
IMPACTION OF THE COLON—RUPTURE OF THE [NTESTINE—ENTERITIS 
—NEOPLASMS OF THE INTESTINE—DIARRH@A—PROLAPSE OF THE 
RECTUM p : 2 : - - - - 404 
DISEASES OF THE DIGESTIVE SYSTEM IN SHEEP - - - 424 
DISEASES OF THE MoutH, PHARYNX, AND CHSOPHAGUS - - —- 425 
DISEASES OF THE STOMACH : - : - - - 429 
DISEASES OF THE INTESTINES - : - : - - 434 
DISEASES OF THE DIGESTIVE SYSTEM IN GOATS - . - 4386 
DISEASES OF THE DIGESTIVE SYSTEM IN THE PIG - - - 44] 
DISEASES OF THE MoutH, PHARYNX, AND CHSOPHAGUS - - - 444 
DISEASES OF THE STOMACH - . - - . - 449 
DISEASES OF THE INTESTINES” - Sow - - - - 451 
DISEASES OF THE DIGESTIVE SYSTEM IN THE DOG - - 456 


DISEASES OF THE MOUTH AND TONGUE: STOMATITIS—RETENTION CystT— 
GLOSSITIS—PARALYSIS OF THE TONGUE : = . - 456 


CONTENTS OF VOL. II. ix 


PAGE 
DISEASES OF THE SALIVARY GLANDS: PAROTITIS—MAXILLITIS”) - - 462 


DISEASES OF THE TONSILS AND PHARYNX: TONSILLITIS—PHARYNGITIS— 
TUMOURS OF THE PHARYNX - 7 : : = - 466 


DISEASES OF THE “(HSOPHAGUS: CISOPHAGITIS—CESOPHAGISMUS—DILA- 
TATION OF THE (CHSOPHAGUS—STRICTURE OR STENOSIS OF THE’ 
(HsopHacus—ForeEIcN BopIEs IN THE CisopHAGUS (CHOKING)— 
TUMOURS OF THE (HSOPHAGUS - - - - - 467 


DISEASES OF THE StomacH: AcuTE Gastric INDIGESTION—ACUTE 
GastTRic TYMPANY—DILATATION OF THE STOMACH—GASTRITIS— 
ULCERATION OF THE STOMACH—H “MORRHAGE—FOREIGN BODIES 
JN THE STOMACH—TORSION OF THE STOMACH—INVERSION OF THE 
STOMACH—T UMOURS OF THE STOMACH—PARASITES OF THE STOMACH 472 


DISEASES OF THE INTESTINES: ENTERITIS—INTESTINAL CATARRH IN 
Young Dogs—Mycotic Gastro-EntH#RiT1is—MzaAt-PorsoNIne— 
ULCERATION OF THE INTESTINE—F CAL IMPACTION OF THE INTES- 
TINE—ForREIGN BODIES IN THE INTESTINE—STRICTURE OF THE 
INTESTINE—DILATATION OF THE INTESTINE——-STRANGULATION 
OF THE [NTESTINE—VOLVULUS—INVAGINATION OF THE INTESTINE 
—DISEASES OF THE RECTUM AND ANAL REGION— DISEASES OF THE 


ANAL GLANDS—INTESTINAL PARASITES - - - - 489 
DISEASES OF THE DIGESTIVE SYSTEM IN THE CAT - - ae ON) | 
DISEASES OF THE MovuTH - - - - - = O07 
DISEASES OF THE SALIVARY GLANDS - - - - - 609 

. DISEASES OF THE TONSILS AND PHARYNX - - - - 510 
DISEASES OF THE (HSOPHAGUS”) - - : . - - 610 

' DISEASES OF THE STOMACH : ‘ 2 : : coe aL 
DISEASES OF THE INTESTINES - - - - - - 612 
DISEASES OF THE DIGESTIVE SYSTEM IN BIRDS _~ - - - $614 
DISEASES OF THE CROP AND STOMACH - - : - - 616 
DISEASES OF THE INTESTINES - - . - - - 620 


DISEASES OF THE PANCREAS IN THE HORSE, OX, PIG, AND DOG 524 
DISEASES OF THE LIVER IN THE HORSE - : - - 531 


IorERus—IctrERus NEONATORUM—ACUTE YELLOW ATROPHY OF THE 
LIVER—ACUTE CATARRH OF THE BILE-DUCT—CONGESTION OF THE 
LIVER—RUPTURE OF THE LivER—AcUTE HEPATITIS—ACUTE 
PARENCHYMATOUS HEPATITIS—SUPPURATIVE HEPATITIS—GALL- 
Stonrs—Fore8IGN BoDIESIN THE LIVER AND BiLE-DucT—CHRONIC 
INTERSTITIAL Hepatitis—Fatry LivErR—AMyYLorip LivER—CAL- 
CAREOUS DEGENERATION OF THE LIVER—-NEOPLASMS OF THE 

: LIVER—PARASITES OF THE LIVER - - - - - 633 


x CONTENTS OF VOL. II. 


DISEASES OF THE LIVER IN CATTLE - . = : 
DISEASES OF THE LIVER IN SHEEP - - : - - 
DISEASES OF THE ‘LIVER IN THE PIG . - - - 
DISEASES OF THE LIVER IN THE DOG, CAT, AND IN BIRDS - 


DISEASES OF THE PERITONEUM IN THE HORSE - : i 


PERITONITIS—ASCITES—T UMOURS OF THE PERITONEUM—PARASITES OF 
THE PERITONEUM : . z sf i - : 


DISEASES OF THE PERITONEUM IN RUMINANTS - 


DISEASES OF THE PERITONEUM IN THE PIG, DOG, CAT, AND IN 
BIRDS - . : : : : : : ‘ 


METRITIS AND METROPERITONITIS- - - : : : 


AcUTE METRITIS AND METROPERITONITIS—ACUTE (PUERPERAL) METRI- 
TIS IN SMALL ANIMALS—-CHRONIC METRITIS IN THE MARE AND COW 
—CHRONIC METRITIS AND PYOMETRA IN THE BITCH AND CAT : 


DISEASES OF THE URINARY ORGANS IN THE HORSE - - 
DISEASES OF THE KIDNEYS: MORBID CONDITIONS IN CONNECTION WITH 
THE URINE AND THE URINARY SECRETION—GENERAL SYMPTOMS 

OF RENAL DISEASES—CONGESTION OF THE KIDNEYS—INFAROTS 

OF THE KIDNEY—RUPTURE OF THE KIDNEY—NEPHRITIS (INFLAM- 

MATION OF THE KIDNEYS)—PURULENT NEPHRITIS—PYELITIS— 
PERINEPHRIC ABSCESS—AMYLOID DISEASE OF THE KIDNEYS— 
HYDRONEPHROSIS — Cystic DISEASE OF THE KiIpNEY — NEPHRO- 
LITHIASIS—['UMOURS OF THE KIDNEY—PARASITES OF THE KIDNEYS 


DISEASES OF THE URETERS - - - - - - 

DISEASES OF THE BLADDER: PARALYSIS OF THE BLADDER—SPASM OF 
THE BLADDER—H#MORRHAGE OF THE BLADDER—RUPTURE OF 
THE BLADDER—OCYSTITIS—VESICAL CALCULUS—SABULOUS DE- 
POSITS IN THE BLADDER—TUMOURS OF THE BLADDER—INVERSION 
OF THE BLADDER—PROLAPSE OF THE BLADDER—ANOMALIES OF THE 
BLADDER AND CONGENITAL MALFORMATIONS - - 


DISEASES OF THE URETHRA: URETHRITIS (INFLAMMATION OF THE 
URETHRA)—URETHRAL CALCULI—TUMOURS OF THE URETHRA 


DISEASES OF THE URINARY ORGANS IN CATTLE “oat 


DISEASES OF THE KIDNEYS: CONGESTION OF THE KIDNEYS—INFARCTS 
OF THE KIDNEY—NEPHRITIS—PURULENT NEPHRITIS AND Pyo- 


PAGE 


561 
572 
576 
578 


595 


595 


617 


625 


638 


638 


660 


660 
714 


715 


7129 


731 


CONTENTS OF VOL. II. 


NEPHRITIS — PERINEPHRIC ABSCESS — H YDRONEPHROSIS — CYSTIC 
DISEASE OF THE KIDNEY—RENAL CALCULI—TUMOURS OF THE 
KIDNEY—PARASITES OF THE KIDNEYS S - - = 
DISEASES OF THE BLADDER: CySTITIS—CHRONIC H@&MORRHAGIC Cys- 
TITIS—VESICAL CALCULUS—RETENTION OF URINE—PARALYSIS 
-OF THE BLADDER—RUPTURE OF THE BLADDER—T'UMOURS OF THE 
BLADDER—INVERSION AND PROLAPSE OF THE BLADDER~ - - 
DISEASES OF THE URETHRA: URETHRAL CALCULI—PREPUTIAL CALCULI— 
TUMOURS OF THE URETHRA - - - - . 


DISEASES OF THE URINARY ORGANS IN SHEEP - : - 
DISEASES OF THE URINARY ORGANS IN THE PIG - : 


DISEASES OF THE URINARY ORGANS IN THE DOG AND CAT 
DISEASES OF THE KIDNEYS: CONGESTION OF THE KIDNEYS—NEPHRITIS 
— PURULENT NEPHRITIS AND RENAL ABSCESS—PYELITIS—AMYLOID 
DISEASE OF THE KIDNEY—F ATTY DEGENERATION OF THE KIDNEYS 

— HYDRONEPHROSIS — FLoaTING KipNEY — RENAL CALCULI — 
TUMOURS OF THE KIDNEY—PARASITES OF THE KIDNEYS - - 
DISEASES OF THE BLADDER: CYSTITIS—PARALYSIS OF THE BLADDER— 
SPASM OF THE BLADDER—H MORRHAGE OF THE BLADDER—RUP- 

TURE OF THE BLADDER—CySTIC CALCULI—TUMOURS OF THE 
BLADDER—HERNIA OF THE BLADDER—EVERSION OF THE BLADDER 

“a —TORSION OF THE BLADDER—PARASITES OF THE BLADDER - 
DISEASES OF THE URETHRA: URETHRAL CALCULI—STRICTURE OF THE 
URETHRA—URETHRITIS—DISEASES OF THE PROSTATE GLAND— 
PROLAPSE OF THE URETHRA—PARASITES OF THE URETHRA— 
IMPERFORATE URETHRA - : - - - - 


DISEASES OF THE URINARY ORGANS IN BIRDS - - - 


DISEASES OF THE RESPIRATORY ORGANS IN THE HORSE - 
DISEASES OF THE NASAL Cavities: AcuTE Nasal CATARRH—CHRONIC 
Nasa CaTARRH—CHRONIC NASAL DISCHARGES—CROUPOUS RHIN- 
ITIS—EPISTAXIS (HH@MORRHAGE FROM THE NOSE)—NEW GROWTHS 

IN THE NASAL CAvITY - - - - - - 
DISEASES OF THE AIR-SINUSES OF THE HEAD - - - - 
DISEASE OF THE TURBINATED BoNnES: Myxorp DEGENERATION OF THE 
FACIAL AND TURBINATED BONES - - . - - 
DISEASES OF THE GUTTURAL POUCHES: CHRONIC CATARRH OF THE GUT- 

: TURAL PoucHES (COLLECTIONS OF PUS IN THE GUTTURAL POUCHES) 
—CHONDROIDS OF THE GUTTURAL PoOUCH—T'YMPANITES OF THE 
GUTTURAL PouUcH - - - - - - : 


PAGE 


731 


744 


750 
751 
754 


757 


759 


799 
809 


810 


811 


xii CONTENTS OF VOL. II. 


DISEASES OF THE LARYNX: ACUTE LARYNGITIS—CHRONIC LARYNGITIS 
—Crovupous LARYNGITIS—CiDEMA OF THE LARYNX—SPASM OF 
THE LARNYX—NEOPLASMS OF THE LARYNX—WHISTLING—ROARING 
—GRUNTING—THICK WIND—HIGH- BLOWING - - - 

DISEASES OF THE Broncui: AcuTE BRONCHITIS (ACUTE BRONCHIAL 
CATARRH)—CHRONIC BRONCHITIS—CROUPOUS BRONCHITIS (PLASTIC 
oR FIBRINOUS BRONCHITIS AND BRONCHIAL CROUP)—BRONCHIAL 


ASTHMA (SPASMODIC ASTHMA) - - - - cad 


DISEASES OF THE LUNGS: CIRCULATORY DISTURBANCES OF THE LUNGS 
—AouTte PuLtmMonaRy CoNGESTION—H &MOPTYSIS—PNEUMONIA 
(INFLAMMATION OF THE LunGs)—OTHER MoRBID CONDITIONS OF 
THE LuNGS—PULMONARY EMPHYSEMA—TUMOURS OF THE LUNGS 


DISEASES OF THE PLEURA: PLEURISY— PNEUMOTHORAX — HYDRO - 
PNEUMOTHORAX — PYo-PNEUMOTHORAX — HYDROTHORAX (DROPSY 
OF THE PLEURA)—TUMOURS OF THE PLEURA - - ~ 


VACCINE THERAPY AS APPLIED TO DISEASES OF THE RESPIRA- 
TORY ORGANS IN THE HORSE ~ - - - - - 


DISEASES OF THE RESPIRATORY ORGANS IN CATTLE - - 


DISEASES OF THE NasaL Cavitizs: AcuTE Coryza (AcuTE NASAL 
CATARRH)—Crovupous RHINITIS (NASAL CROoUP)—CHRONIC NASAL 
CATARRH—EPISTAXIS—NEOPLASMS OF THE NASAL CAVITIES - 


CATARRH AND EMPYEMA OF THE MAXILLARY AND FRONTAL SINUSES - 


DISEASES OF THE LARYNx: AcUTE LARYNGITIS—CROUPOUS LARYNGITIS 
(PSEUDO - MEMBRANOUS LARYNGITIS)—CHRONIC LARYNGITIS— 
(EDEMA OF THE LARYNX—PARALYSIS OF THE RECURRENT NERVE 
(RoARING)—NEOPLASMS OF THE LARYNX - - - - 


DISEASES OF THE BRONCHI: ACUTE BRONCHITIS—CAPILLARY BRONCHITIS 
—BRONCHIAL CROUP—CHRONIC BRONCHITIS—BRONCHIAL ASTHMA 
—PARASITIC BRONCHITIS’) - . . - . - 


DISEASES OF THE LuNas: AcUTE PULMONARY CONGESTION—THE 
PNEUMONIAS OF CATTLE—INHALATION PNEUMONIA, OR BRONCHO- 
PNEUMONIA DUE TO FOREIGN BODIES—SEPTIC OR INFECTIOUS PNEU- 
MONIA IN CALVES—CHRONIC PNEUMONIA—PULMONARY EMPHYSEMA 
—CHRONIC PULMONARY HMPHYSEMA - - - - 

DISEASES OF THE PLEURA: PLEURISY—EMPYEMA OR PURULENT 
PLEURISY—DRyY OR ADHESIVE PLEURISY—PNEUMOTHORAX—PYO- 
PNEUMOTHORAX . 2 : - = 


DISEASES OF THE RESPIRATORY ORGANS IN SHEEP - - 


DISEASES OF THE RESPIRATORY ORGANS IN SWINE - - 


PAGE 


814 


844 


853 


908 


929 


937 


938 
940 


943 


946 


948 


955 


958 


963 


j CONTENTS OF VOL. II. 


DISEASES OF THE RESPIRATORY ORGANS IN THE DOG AND 
CAT - - 4 : a 


DISEASES OF THE RESPIRATORY ORGANS IN BIRDS 


DISEASES OF THE DIAPHRAGM IN THE HORSE AND OTHER 
ANIMALS. - : : ; . : ; : 


DISEASES OF THE MEDIASTINUM IN THE HORSE, OX, AND 
DOG - - - - - - - - 


DISEASES OF THE CIRCULATORY ORGANS IN THE HORSE 
DISEASES OF THE PERICARDIUM: PERICARDITIS (INFLAMMATION OF THE 
PERICARDIUM)—ACUTE SERO-FIBRINOUS PERICARDITIS—CHRONIC 
ADHESIVE PERICARDITIS — HYDROPERICARDIUM — H#@®MOPERI- 
CARDIUM—PNEUMOPERICARDIUM—RUPTURE OF THE PERICARDIUM 


DISEASES OF THE HEART: FUNCTIONAL AFFECTIONS OF THE HEART— 
AFFECTIONS OF THE MYOCARDIUM—ENDOCARDITIS— VARIOUS FORMS 
OF VALVULAR DISEASE—SPECIAL PATHOLOGICAL CONDITIONS OF 
THE HEART—ANGINA PECTORIS - - - . - 
DISEASES OF THE BLOODVESSELS: CHRONIC ENDOARTERITIS—A NEURISM 
—THROMBOSIS—EMBOLISM—PHLEBITIS (INFLAMMATION OF VEINS) 
—VARIX (VARICOSE VEINS)—PHLEBOLITES—AIR EMBOLISM (EN- 
TRANCE OF AIR INTO THE JUGULAR VEIN)—RUPTURE OF LARGE 
‘VESSELS IN THE THORAX AND ABDOMEN - - - . 


DISEASES OF THE CIRCULATORY ORGANS IN CATTLE - 


DISEASES OF THE CIRCULATORY ORGANS IN SHEEP, GOATS, 
AND SWINE - - - : - . : 


DISEASES OF THE CIRCULATORY ORGANS IN THE DOG AND CAT 
DISEASES OF THE CIRCULATORY ORGANS IN BIRDS - - 


DISEASES OF THE NERVOUS SYSTEM IN THE HORSE - - 


DISEASES OF THE BRAIN AND ITS MEMBRANES: ATAXIA—H EMIPLEGIA— 
Acute MENINGITIS—CHRONIC MENINGITIS—ENCEPHALITIS (IN- 
FLAMMATION OF THE BRAIN)—CHRONIC ENCEPHALITIS—CHRONIC 
HYDROCEPHALUS—CEREBRAL HYPERHZMIA—CEREBRAL ANAMIA— 
CEREBRAL H2MORRHAGE—MENINGEAL H#MORRHAGE—H 42MOR- 
RHAGE INTO THE Pons VAROLII, MEDULLA OBLONGATA, AND CERE- 
BELLUM—EMBOLISM AND THROMBOSIS OF CEREBRAL BLOODVESSELS 
—TUMOURS OF THE BRAIN—COMPRESSION AND CONCUSSION OF THE 
BRAIN—PARASITES OF THE BRAIN—DISEASES OF THE CEREBELLUM 
—DISEASES OF THE PONS VAROLII—DISEASES OF THE CRURA 
CEREBRI—DISEASES OF THE MEDULLA OBLONGATA~ - - e 


Xill 
PAGE 


968 


986 


990 


996 


1000 


1007 


1020 


1073 


1098 


1113 
1116 
1126 


1128 


1128 


X1V CONTENTS OF VOL. II. 


DISEASES OF THE SPINAL CORD AND ITS MEMBRANES: ACUTE SPINAL 
MENINGITIS — MYELITIS — ENZOOTIC SPINAL PARALYSIS — SPINAL 
H#MORRHAGE—CONCUSSION OF THE SPINAL CoRD—INJURIES TO 
THE SPINAL CORD—COMPRESSION OF THE SPINAL CoRD—TUMOURS 
OF THE SPINAL CORD—PARASITES OF THE SPINAL CORD - - 


DISEASES OF THE PERIPHERAL NERVES: AFFECTIONS OF THE CRANIAL 
NERVES—AFFECTIONS OF OTHER PERIPHERAL NERVES - - 


FUNCTIONAL DISEASES OF THE NERVOUS SYSTEM: MEGRIMS—MENIERE’S 


DISEASE— SEA-SICKNESS — EPILEPSY — CATALEPSY — ECLAMPSIA — 


CHoREA — TETANY — LocaL Spasms oF MuscLes — BasEpow’s 
DiISEASE—SPASM OF THE DIAPHRAGM—SHIVERING—STRINGHALT— 
Crip-BITING AND WIND-SUCKING — WEAVING — JIBBING — SuUN- 
STROKE AND HEAT-APOPLEXY—LIGHTNING-STROKE - - 


DISEASES OF THE NERVOUS SYSTEM IN CATTLE - - - 


DISEASES OF THE BRAIN - - - - - - - 
DISEASES OF THE SPINAL CORD - - - - - 

DISEASES OF THE PERIPHERAL NERVES = - : : 
FUNCTIONAL DISEASES OF THE NERVOUS SYSTEM - - - 


DISEASES OF THE NERVOUS SYSTEM IN SHEEP, GOATS, AND 
SWINE - - - - - - . - 


DISEASES OF THE NERVOUS SYSTEM IN THE DOG AND CAT - 


DISEASES OF THE BRAIN AND ITS MEMBRANES - - : - 
DISEASES OF THE SPINAL CoRD AND ITS MEMBRANES - - 

DISEASES OF THE PERIPHERAL NERVES - - - - 
FUNCTIONAL DISEASES OF THE NERVOUS SYSTEM - - - 


DISEASES OF THE NERVOUS SYSTEM IN BIRDS’>- - - 


DISEASES OF THE BLOOD = = = - - - 
Microscopic EXAMINATION OF THE BLOOoOD—AN2ZMIA—LEUK4MIA— 
PsrEuDo-LEUK&MIA—SIMPLE H#MOGLOBIN&MIA—H &MOPHILIA— 
ANIMAL PARASITES IN THE BLOOD - - - 


DISEASES OF THE DUCTLESS GLANDS - - - - 


DISEASES OF THE SPLEEN - - - - - S 
DISEASES OF THE THYROID GLAND - - 

DISEASES OF THE THYMUS GLAND - - - - F 
DISEASES OF THE SUPRARENAL BODIES . - 5 = 


DISEASES OF METABOLISM - : = - - 


DIABETES INSIPIDUS “ s - - . ° 

DIABETES MELLITUS - 

OSTEOPOROSIS: OSTEOMALACIA - - - : 3 

RIcKETS: OSTEOGENESIS [neuen me nn Ce camene rte 

OTHER DisEAsES oF METABOLISM: OBESITy—ScuRvy—GouT— 
—OcHRONOSIS : = : 4 - - a 


PAGE 


1175 


1193 


1207 


1238 
1239 
1242 
1243 
1243 


1246 


1252 
1253 
1260 
1269 
1272 


1280 


1281 


1299 
1299 
1302 
1306 
1307 


1308 
1308 
1313 
1318 
1332 


1342 


CONTENTS OF VOL. II. XV 


PAGE 


DISEASES OF DOUBTFUL ETIOLOGY - - - . - 1348 
AZOTURIA ae : : : : : : - 134656 
Mitk FEVER - - - - - - - - 1368 
LYMPHANGITIS” - - - - - - - - 1381 
RHEUMATISM - - - - - - - - 1388 

PARASITES AND PARASITIC DISEASES - ~ * - 1405 


Bioop-Suckineg FiLrrs—Buiow. FLIgsS—WARBLE AND Bot FirEes— 
FLEAS AND JIGGERS—BrES, Wasps, AND HornetTs—Lice— 
LINGUATULES—ACARIENS : RED Mites, ArGAstIp Tricks, HARVEST 
Buas—Ticks—Fo.LuicuLtaR Mites: FoLuicuLAR MANGE OF THE 
Dog, Ox, Goat, AnD Pia—Manar Mitrres: Sarcopric MANGE, 
Nota@pric Manan, Psoropric Manar,. CHoriorptic Manas, 
OtropEcTIc MAaNGE—LEECHES—BLADDER WORMS : CYSTICERCOSIS, 
CanvuRosis, EcHinococcosis—TAPEWORMS : TAPEWORMS OF THE 
Horst, Ruminants, Doa anp CaTt—FLUKE OR SUCKER WORMS: 
TREMATODES OF THE HorsE, Ox, SHEEP, Pia, Dog anp CatT— 
Hookep Worms—Rounpd WoRrMS: HELMINTHIASIS OF THE 
RESPIRATORY ORGANS, OF THE ALIMENTARY CANAL, AND OF THE 


MuscULAR AND OTHER TISSUES - : : = - 1416 
TABLE OF PARASITES ‘MORE COMMONLY FOUND IN DOMESTICATED | 
ANIMALS - F bie - - - - 1567 
POISONS = - - - = 2 = = - 1572 
MINERAL PorisonsS—ORGANIC Porsons AND Druas—PoIsonous PLANTS 
—PotTato-PoIsONING— POISONING DUE TO Foop - - = 1574 
APPENDIX—SoraPiE L’ : = - F - s - 1585 


INDEX - - - - ; - - - - 1589 


ro ee 

at ota (seg 

cael ih er ey aun ahs 
| te ‘eal pie a 


aa 
X 


static hall i 
meaty wth anen 





LIST OF CONTRIBUTORS TO VOL. II. 


BEGG, HUGH, F.R.C.V.S. 


Gastric Impaction in Foals. Diseases of the Digestive System in the Ox. 


CRAIG, J. F., M.A., M.R.C.V.S. 


Diseases of the Blood. 


ELLIOTT, H. B., M.R.C.V.S. 


Osteoporosis. 


GRAY, HENRY, M.R.C.V.S. 


Diseases of the Anal Glands in the Dog. Chylous Ascites. Chronic Nasal 
Catarrh in the Cat. Rachitis. Urethral Calculi in the Dog and Cat. 


HOARE, E. WALLIS, F.R.C.V.S. 


Diseases of the Digestive System in the Horse, Dog, and in Birds. Diseases of 
the Pancreas in the Horse, Ox, Pig, and Dog. Diseases of the Liver in the Horse, 
Ox, Dog, Cat, and in Birds. Diseases of the Urinary Organs in the Horse, 
Ox, Dog, Cat, and in Birds. Diseases of the Respiratory Organs in the 
Horse, Ox, Dog, Cat, and in Birds. Diseases of the Diaphragm in the 
Horse and Other Animals. Diseases of the Mediastinum in the Horse, Ox, 
and Dog. Diseases of the Circulatory Organs in the Horse, Ox, Dog, Cat, 
- and in Birds. Diseases of the Nervous System in the Horse, Ox, Dog, Cat, 
and in Birds. Diseases of the Blood. Diseases of the Ductless 
Glands. Diabetes Insipidus. Diabetes Mellitus. Osteomalacia. 
Obesity. Scurvy. Gout. Ochronosis. Azoturia. Milk Fever. 
Lymphangi‘tis. Rheumatism. Poisons. 


IMRIE, D., M.R.C.V.S. 


Milk Fever. 


INGRAM, G. L., M.R.C.V.S. 


Diseases of the Urinary Organs in the Horse, Ox, Dog, and Cat. 


VOL. II. XVii b 


sautth LIST OF CONTRIBUTORS TO VOL. II.. 


LIVESEY, G. H., M.R.C.V.S. 
Diseases of the Digestive System in the Cat. 


MARTIN, MAJOR E. E., A.V.C. 
Diseases of the Respiratory Organs in the Horse. 


MAYALL, G., M.R.C.V.S. 


Diseases of the Digestive System in the Sheep, Goat, and Pig. Diseases of the 
Liver in the Sheep and Pig. Diseases of the Urinary Organs in the Sheep and 
Pig. Diseases of the Respiratory Organs in the Sheep and Pig. Diseases of the 
Circulatory Organs in the Sheep, Goat, and Pig. Diseases of the Nervous 
System in the Sheep. Goat, and Pig. Scrapie. 


MELLON, B. HARVEY, F.R.C.V.S. 
Diseases of the Nervous System in the Horse, Ox, Dog, Cat, and in Birds. 


O’CONNOR, J. J., M.R.C.V.S. 


Diseases of the Peritoneum in the Horse, Ox, Sheep, Pig, Dog, Cat, and in 
Birds. 


PILLERS, A. W. NOEL, F.R.C.V.S., F.Z.S. 
Parasites and Parasitic Diseases. 


SCOTT, W. |M., F.R.C.V.S., F.R.M.S. 
Vaccine Therapy as Applied to Diseases of the Respiratory Organs in the Horse. 


WILSON, AINSWORTH, F.R.C.V.S. 
Metritis and Metroperitonitis. 


SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE DIGESTIVE SYSTEM 
IN THE HORSE 


By E. WALLIS HOARE, F.R.C.V.S. 


INTRODUCTORY REMARKS. 


THE importance of diseases of the digestive organs cannot be over- 
estimated, and, although some writers do regard these affections as 
second in importance to those of the respiratory system, such a 
view requires some modification. In the lighter breeds and in young 
horses no doubt respiratory affections are of more frequent occurrence 
than are diseases of the digestive organs, and during epizootic outbreaks 
of influenza and pneumonia the number of respiratory cases in all classes 
of horses will far exceed those depending on digestive troubles. But 
while the adoption of preventive measures, of improved methods of 
diagnosis, and of rational treatment, has succeeded in reducing to a large 
extent the mortality from respiratory affections, it cannot be said that 
equivalent progress has been made in the control of diseases of the 
digestive system. In the heavy breeds of horses especially, the fatalities 
from certain affections of the intestines outnumber those resulting from 
any other cause. 

We must admit that attention to dietetics in the present day, and 
the growing tendency to avail of veterinary supervision in the manage- 
ment of large studs of horses, has succeeded in bringing about a decided 
diminution in the number of serious and fatal gastric and intestinal 
affections. The importance of rational methods of feeding, of the selec- 
tion of foods with a view to the efficiency of the working powers of the 
horse and to economy, and the proper regulation of work, is admitted 
by all horse-owners who have paid any attention to the subject. 

VOL, II. 1 


2 SYSTEM OF VETERINARY MEDICINE 


But in spite of all preventive measures, fatal diseases of the digestive 
organs can and do occur, and the etiology of such cases often baffles 
the skill of the most experienced practitioner. ~The fact of their occur- 
rence in army horses, where the strictest attention is devoted to an ideal 
method of feeding and general management, demonstrates that our 
knowledge of the etiology of.these affections leaves much to be desired. 

And not only must we admit our lack of definite knowledge concern- 
ing the etiological factors, but we must also confess that, in spite of 
clinical observation and careful attention to autopsies, the diagnosis and 
rational treatment of such diseases are still unsatisfactory. To imdi- 
viduals who have not studied the subject, it is a matter for surprise that 
with the advancement of veterinary science in the present day more 
definite information is not forthcoming with reference to the etiology, 
pathology, diagnosis, and treatment of the digestive diseases of the 
horse. It must be remembered, however, that, with the exception of 
treatment, this subject is not one which readily lends itself to experi- 
mental investigation. And even if this method of investigation were 
possible, it by no means follows that experimentally produced conditions 
would correspond with the phenomena that are presented to the clinician. 

In considering the commercial aspect of this subject, we find that the 
widest experience of such cases is possessed by practitioners who have 
professional charge of large studs of horses, but they are not permitted 
opportunities for original research in this work. Owners of horses are, 
as a rule, interested in the prevention of disease, and in the successful 
treatment of affected animals; but the matter is regarded as one of 
commercial and not of scientific importance. Operative interference 
must be the starting-point of any advancement in our knowledge of the 
diagnosis and treatment of abdominal cases that present obscure symp- 
toms, and are not amenable to therapeutical measures. With our im- 
perfect methods of diagnosis, however, few practitioners who value their 
reputation would have the temerity to advise operative measures in cases 
of this nature, for not only would the diagnosis be likely to prove erroneous, 
but surgical interference could scarcely be expected to give successful 
results until this branch of surgery has advanced beyond the experi- 
mental stage. The enormous difficulties in the way of successful results 
in equine abdominal surgery cannot be ignored. Indeed, the symptoms 
presented are often so uncertain, varied, and unreliable, and the means 
of diagnosis at our command so imperfect, that although in a given 
case we may suspect the existence of a fatal lesion, still, it 1s seldom 
that we feel justified in ordering the destruction of the patient. 
No doubt we have ample post-mortem knowledge of the lesions in 


DISEASES OF THE DIGESTIVE SYSTEM: HORSE 3 


such cases, but it is with reference to their etiology, to the symptoms 
indicative of their presence, and to a successful line of treatment, that 
research is urgently needed. 

The thoughtful observer will inquire if advancement of any kind can 
be claimed in the present day with reference to our knowledge of ab- 
dominal affections. As regards lesions such as volvulus, intussusception, 
rupture of the intestine, and rupture of the stomach, we must confess 
that little, if any, progress has been made in our knowledge of their 
etiology, or in diagnosis or treatment. No doubt more careful attention 
to the performance of autopsies has demonstrated the fact that “ twists,”’ 
and displacements of the divisions of the large colon, are far more common 
than was formerly supposed, and account for many of the fatal cases 
that were hitherto ascribed to ordinary enteritis ; and although we can- 
not but admire the diagnostic skill which some authors and practitioners 
claim to possess in the diagnosis of these conditions, we regret that even 
with a fairly extensive clinical experience we have not succeeded in at- 
taining that degree of manipulative dexterity and far-seeing intuition 
which would enable us to differentiate these affections in anything like a 
definite manner. We admit, however, that there are instances in which 
a correct diagnosis may occasionally be made by the observation of 
certain phenomena. But it is when we test the value of the so-called 
diagnostic symptoms on a series of cases, and compare the phenomena 
presented during life with the lesions found at the autopsies, that we are 
inclined to agree with the views of that observant clinician, the late 
Professor Williams, who remarked that the symptoms in this variety of 
cases were “common to all, characteristic of none.” Hence we are 
disposed to regard those brilliant feats in diagnosis which we see 
recorded as depending more on chance than on the possession of a 
superior degree of diagnostic skill. 

In addition to the fatal affections mentioned above, we shall have 
to consider a number of diseases of the stomach and intestines which are 
generally amenable to treatment, provided such is adopted early. But 
even these may furnish fatal cases if the diseased conditions are severe 
and extensive. Here, also, the differential diagnosis presents many 
difficulties, and, curious as it may seem to those who are unacquainted 
with the peculiarities of equine abdominal diseases, the differentiation of 
gastric from intestinal affections cannot always be carried out with 
facility or confidence. 

No doubt, when a definite diagnosis is arrived at, special treatment 
adopted, and a recovery ensues, the practitioner is inclined to con. 
gratulate himself on the correctness of his opinion and the efficacy of 





=f SYSTEM OF VETERINARY MEDICINE 


his therapeutic measures. Such a result, however, by no means proves 
that the diagnosis was correct, because we are perfectly well aware that 
many cases recover without any treatment or in spite of treatment. 
The real value of symptoms must be demonstrated by comparing them 
with the phenomena presented at the autopsy. Conclusions cannot be 
drawn from what is observed in one case, but instead we must make 
observations from several instances. 

When such a course is adopted, we find that the list of symptoms is 
in reality a very limited one from which to differentiate a number of 
different affections. Briefly, it includes evidences of abdominal pain, 
varying in character and intensity ; the various attitudes and postures 
assumed by the animal, presumably to obtain temporary relief from this 
pain and discomfort ; the presence of tympanites and constipation ; the 
revelations obtained from rectal examination; and the presence ot 
phenomena attributable to gastric disorders, such as eructations of gas 
by the nostrils, attempts at vomition, actual vomition, etc. General 
symptoms, such as alterations in the character of the pulse and 
respirations, elevation of temperature, injection of the visible mucous 
membranes, the condition of the skin, and the expression of the coun- 
tenance, although of importance in judging of the gravity of a case, 
cannot be regarded as in any way diagnostic. On considering the 
subject from this point of view, we are led to the conclusion that until 
we possess more reliable means of diagnosis than those mentioned, but 
little advancement is likely to occur in connection with abdominal 
affections in the horse. 

In the human subject, the physician has the advantage of being able 
to deduce important information from the subjective symptoms of his 
patient, and by a physical examination of the abdomen he can obtain 
certain evidence of value as to the condition of the stomach and intestines. 
In the horse, on the contrary, we have to depend altogether on objective 
symptoms. We can learn little by palpation of the abdomen beyond the 
presence of tympanites, and a hard, tense condition of the abdominal 
walls; and though auscultation of the abdominal cavity reveals the 
absence of sounds, indicating the cessation of peristalsis, such symptoms 
are common to many affections. Again, in the human subject much 
has been learned from a diagnostic point of view from abdominal surgery, 
which is now so generally practised. ‘The surgeon is enabled to compare 
the symptoms presented with the existing lesions, and to draw valuable 
deductions therefrom. In the horse there are enormous difficulties in 
the way of abdominal surgery, and the lesions can only be studied at 
autopsies, at which time they are far advanced, so that we know but 


DISEASES OF THE DIGESTIVE SYSTEM: HORSE 5 


little as regards the condition of affairs in the early stages, and the 
views put forward in connection with these are usually mere sur- 
mises. 

Concerning the therapeutical measures at our command, as might be 
expected from the unsatisfactory condition in which the differential 
diagnosis remains, the advancement made has‘not been extensive or 
satisfactory. Indeed, in many instances our knowledge in this direction 
has not increased in the slightest degree. 

It is obvious that certain cases must terminate fatally by reason of 
the nature of the lesions, but, as already remarked, the difficulties in the 
way of diagnosis generally prevent us from being able to state definitely 
that a hopeless condition is present; hence treatment is demanded. 
Such treatment usually consists in the administration of sedatives to 
“smooth the path to death.” But, as we shall point out when con- 
sidering these affections, there is always the probability that, in conse- 
quence of the deceptive nature of the symptoms, we may erroneously 
regard a case as hopeless which in reality is not so, but may be converted 
into an incurable condition by the irrational administration of sedatives. 

(In one direction only can advancement be claimed in the present day, 
and that is with reference to the avoidance of opiates in the treatment ) 
of abdominal affections. To this matter we shall have to direct special 
attention farther on, when dealing with the therapeutics of gastric and 
intestinal affections. Here it will suffice to remark that while in former 
days opium or its derivatives was regarded by many as the sheet-anchor 
in the treatment of such diseases, the indiscriminate employment of seda- 
tives is condemned by all practitioners in the present time who have 
devoted attention to the subject. Although some of the older authorities 
pointed out the contra-indications of opiates in cases of so-called colic 
and allied affections, and advised the employment of purgatives instead, 
these views were by no means universally accepted. The fact that 
sedatives interfered with the normal peristaltic action of the intestines 
and tended to produce paralysis of the intestinal walls, with obstinate 
constipation as a result, was not properly recognised. The dogma laid 
down was that the relief of pain, irrespective of its cause, was the 
primary and important object to be attained by the therapeutist ; that 
such pain, if unrelieved, led to the death of the animal from enteritis 
supervening ; and that the administration of active purgatives would 
accelerate the advent of the latter unfortunate termination. 

The careful and systematic performance of autopsies taught those 
who devoted attention to the matter that intestinal obstruction due to 
impaction by ingesta was in reality the cause of the majority of cases of 


6 SYSTEM OF VETERINARY MEDICINE 


so-called colic that did not tend to recover by simple treatment. To 
Caulton Reeks must be accorded the credit of pointing out to the pro- 
fession the true nature of those cases hitherto vaguely described as colic, 
and of indicating rational methods of treatment. 

The discovery of eserine and allied agents and their judicious employ- 
ment have no doubt exerted an important influence on the views that are 
at present held with reference to the therapeutics of abdominal affections. 
As we shall have occasion to point out later.on, there is a risk that the 
pendulum may swing too far in the opposite direction. In the present 
day, recognising the difficulties in diagnosis, some practitioners tend to 
treat abdominal affections in an indiscriminate fashion by the adminis- 
tration of eserine or arecoline, regardless of any attempt at ascertaining 
the nature of the cases. The excuse given for such an unscientific thera- 
peutic method is that, should there be a fatal lesion present, the above 
powerful agents will only hasten death ; while, if one case be a curable 
one, favourable results will ensue. 

A free-and-easy style of diagnosis and treatment such as this cannot 
be commended on any grounds. Although fully cognisant of the diffi- 
culties presented in the diagnosis of such cases, we are also aware that 
conditions exist which may recover with suitable treatment, and in which, 
if powerful agents such as those mentioned are administered, a fata] 
termination is brought about. Moreover, if attention be paid to the 
clinical aspects of such cases, it will often be found that indications and 
contra-indications for the employment of agents such as eserine and 
arecoline can be. recognised. To administer such drugs when evidences 
suggestive of a fatal lesion are present is simply torturing the animal, 
and cannot be too strongly condemned. If the teachings of clinical 
experience are of so little value that the treatment of these affections 
can only be based on a “rule of thumb” system, then, indeed, all the 
skill required is the ability to administer a hypodermic injection of 
eserine—knowledge which can easily be acquired by any layman. 

To this subject we shall again direct attention when dealing with 
intestinal affections. 

As an example of how views on therapeutics tend to revert, we may 
mention that at present the employment of aloes is again becoming 
general in the treatment of equine intestinal affections. This drug was 
extensively employed in such cases by the older practitioners, but for a 
time, in consequence of the craze for sedative treatment, it fell into disuse, 
while later on the discovery of eserine and allied agents still further tended 
to lessen the faith of practitioners in the virtues of aloes. But, as we 
shall later on point out, the employment of aloes in judicious doses is a 


DISEASES OF THE DIGESTIVE SYSTEM: HORSE 7 


therapeutical measure of the highest importance in properly selected 
cases. 

In addition to the affections mentioned, there are others to which 
attention must be directed in these pages. These include the various 
forms of dyspepsia, which, although not serious or fatal in themselves, are 
of considerable importance, as they may lead the way to diseases of a for- 
midable character. Besides, from an economical point of view they merit 
attention, as they interfere with the general nutrition of the animal, 
render him less fit for work, and thus constitute a source of loss to his 
owner. Moreover, as they do not produce striking symptoms, they are 
liable to be neglected until serious organic changes result in the digestive 
organs. 

Affections of the teeth, although belonging more properly to the 
domain of surgery, cannot be ignored in connection with diseases of the 
digestive system ; indeed, anything which interferes with the efficient 
mastication of the food is of vital importance in relation to the etiology, 
diagnosis, and therapeutics of affections of the stomach and intestines, 

With regard to the etiology of diseases of the digestive system, we 
shall only direct attention to this subject in a general manner at present, 
reserving a consideration of the special etiological factors until we are 
discussing the pathology, symptoms, and treatment of the various organs. 

Experience has taught that errors in diet, also mismanagement, such 
as an insufficient supply of water, neglect of regularity in feeding, long 
fasts succeeded by the allowance of extra large feeds, are responsible for 
a large number of cases of gastric and intestinal affections. These and 
other points in connection with the management of horses have assumed 
an importance in the present day which is in striking contrast with the 
indifference with which they were regarded in former times. As already 
remarked, it is now the general custom for firms who own large studs of 
horses to employ a veterinary surgeon, not only to attend the animals 
when ill, but also to advise as to the feeding and general management, 
and there is no doubt whatever that such supervision has resulted in a 
diminution not only in the number of gastric and intestinal affections, 
but also in the fatalities arising therefrom. Professional supervision 
includes the selection of the most suitable form of diet, and of the com- 
bination of foods, so that efficiency and economy are realised ; also the 
regulation of work and of the hours for feeding. Again, it insures early 
treatment of any cases that occur—a matter of considerable importance 
in many of these affections. Horse-owners now recognise the fact that 
preventive measures cannot be ignored in stable management, and that 
advice which was at one time regarded in the light of “a counsel of 


8 SYSTEM OF VETERINARY MEDICINE 


perfection ” is in reality not only practicable, but, when acted on, proves 
of marked value from an economical point of view. 

But, as already stated, gastric and intestinal affections occur in spite 
of all preventive measures, and even with the most careful inquiries we 
often fail to discover the etiological factors. No doubt, when a series of 
cases are met with in the same stable, an investigation into the feeding 
and management will generally disclose the dietetic errors responsible for 
the occurrence. But it is usually the sporadic cases that baffle all our 
attempts to elucidate their mode of origin. Of course, we must take into 
consideration the difficulty, and often impossibility, of ascertaining the 
correct history of a case. The word of the attendant can seldom be 
relied on, more especially when he has disregarded orders with reference 
to the feeding and watering of the horse under his care. In such instances 
the veterinary surgeon sees the results, but very often he can only make 
a surmise as to the cause. 

Some writers regard the anatomical and physiological peculiarities of 
the stomach of the horse as favourable to the production of those special 
disorders with which we are familiar. It would probably be more correct 
to state that, when subjected to irrational modes of feeding, and to 
erroneous management as regards the working of the animal, the affec- 
tions that arise are likely to assume a very serious aspect In consequence 
of these peculiarities. We can hardly assume that Nature erred when 
she provided the horse with a digestive system which on mechanical 
grounds appears to predispose the animal to certain serious affections. 
It seems more rational to conclude that we are not yet fully acquainted 
with the physiology of digestion in this animal, and that there are etio- 
logical factors at work in the production of diseases of these organs 
which are still unknown and unexplained. 

It is a well-known fact that many horses go through life without ever 
suffering from even a mild attack of so-called colic, and in several in- 
stances we are aware that but little attention has been paid to dietetic 
regulations in connection with their management. If the formation of 
the digestive organs predisposed to disease, then, indeed, we would expect 
affections of this system to be far more common than they are. 

In country districts “colic” cases are by no means so frequently 
met with as in cities. So long as the farmer’s horse is kept at work on 
the farm, and, as generally happens, left on grass during the intervals, 
the animal seldom suffers from digestive troubles. But during periods 
of forced work, with long fasts, and an extra amount of food allowed to 
compensate for these, cases of this kind are not uncommon. Or if a 
country horse, unaccustomed to long journeys, be driven a long distance 


be 


DISEASES OF THE MOUTH: HORSE _ 9 


to town, and there allowed a full measure of food to which he is not 
accustomed, a serious gastric or intestinal affection may occur. 

Sudden changes of diet no doubt contribute largely to diseases of the 
digestive organs. This is exemplified by the frequency of “ colic’ cases - 
in young country horses which are newly purchased and added to town 
studs, if no precautions are taken to gradually get them accustomed to 
the altered conditions of food and work. | 

The majority of “ colic” cases are furnished by cart-horses, and next 
to these come horses working in posting establishments. In the latter, 
long journeys, irregular hours of feeding, and quick driving, are important 
etiological factors. The digestive organs become weakened as the result 
of exhaustion, and but little time is allowed for the animal to rest and 
digest his feed before he is driven homewards. The result is that he 
either manifests symptoms of “colic”? on the journey or soon after he 
enters his stable. In our experience such cases are always serious, and 
frequently develop fatal lesions. 

In hunters, diseases of the digestive organs are not frequently met 
with. Although these animals are often subjected to a long fast during 
a hunting day, still, on arriving home, marked care is bestowed on them, 
and large feeds are not put before them after severe exertion. We find 
that, when hunters do suffer from digestive troubles, it is generally 
during a period of enforced idleness rather than on the working days. 
At the same time, we must remark that minor disorders of the digestive 
organs, such as dyspepsia, are by no means infrequent in this breed of horse. 

It is a well-known fact that some horses are what is termed subject 
to colic. Repeated attacks occur, varying in severity, but ultimately 
the animal succumbs. In the majority of such cases it will be found 
that a condition of chronic gastric catarrh is present which leads to in- 
testinal disorder, and this we have verified on post-mortem on several 
occasions. 


DISEASES OF THE MOUTH. 


GENERAL REMARKS. 


Although a large number of diseased conditions in connection with 
the oral cavity come properly within the province of surgery, there 
are, nevertheless, some important affections which merit attention 
in a work on veterinary medicine; and, in order to have a clear 


10 SYSTEM OF VETERINARY MEDICINE 


comprehension of the etiology of disorders and diseases of the digestive 
system, it is necessary to be familiar with certain surgical conditions of 
the mouth, throat, etc. 

The importance of the mouth, teeth, and tongue being in a normal 
condition cannot be over-estimated, as deviations in this respect not only 
interfere with the efficient mastication of food, but, if pronounced, may 
actually prevent the animal from feeding. A consideration of the 
physiology of digestion in the horse will readily explain the fact that, 
unless the food is properly prepared in the mouth by thorough mastica- 
tion and incorporation with saliva, the process of gastric and intestinal 
digestion becomes disturbed, and various disorders of the stomach and 
intestines are liable to follow. From an anatomical point of view it is 
quite clear that the primary preparation of the food for gastric digestion 
is amply provided for. The size and shape of the molar teeth and the 
well-developed masticatory muscles indicate that thorough crushing and 
trituration of the food was intended by Nature as an essential preliminary 
process for efficient digestion, while the extent of the salivary glands 
indicates that the salivary functions are of marked importance. Clinical 
experience bears out what anatomical and physiological considerations 
suggest, and we find that many affections of the digestive organs owe 
their origin to imperfect mastication of food, and this in most cases is 
due to dental irregularities and defects. 

The subject of dentistry cannot be considered in a work on veterinary 
medicine further than to point out the effects which are likely to result 
from abnormal conditions of the teeth. Full details will be found in 
Cadéac’s work, “‘ Pathologie Chirurgicale de Appareil Digestif ’’; also in 
Moller’s “ Veterinary Surgery,” to which the reader is referred. Here 
we may remark that, although it is quite possible to err in attributing 
too much importance to the condition of the teeth, and in employing the 
tooth-rasp as a panacea for every equine ailment, it is unfortunately true 
that errors are too frequently made in the opposite direction. Many 
cases showing loss of condition, capricious appetite, and evidences of 
indigestion, are dosed with various drugs and supplied with quantities 
of patent condiments intended to overcome digestive disturbances which 
in reality depend on dental irregularities. In such instances the effects 
are treated and the cause is ignored—a line of therapeutics which is 
irrational and cannot prove successful. 

The most common abnormal condition of the teeth is that associated 
with the presence of sharp edges on the molar teeth, which, coming into 
contact with the mucous membrane of the cheeks and tongue, cause 
abrasions, and give rise to pain during mastication. The result is that 


DISEASES OF THE MOUTH: HORSE 11 


mastication is not properly performed, the food is “ bolted,” it reaches 
the stomach in a state unfit for gastric digestion, and in this way dis- 
orders of the stomach and intestines are liable to be induced. 

Again, a large proportion of food, such as oats, may pass through the 
gastro-intestinal canal undigested, as is evidenced by the presence of 
whole grains in the feces. This causes loss of condition and debility. 

It is not uncommon to find that total loss of appetite results from 
such conditions of the teeth, and when they have received surgical atten- 
tion the appetite returns. When the loss of appetite or inability to feed 
is protracted, such as in cases due to gross irregularities of the teeth— 
e.g., an overgrown or diseased molar, etc.—the emaciation of the patient 
is often extreme, while the cause is unsuspected by the owner. 

We thus see the great importance of examining the mouth and teeth 
in all cases in which there is refusal of food associated with a normal 
temperature. Such examination should also include a diligent search 
for injuries of the tongue and the presence of foreign bodies. In carrying 
out this examination a mouth-gag is essential, and the most convenient 
pattern is that invented by Mr. Malloch, M.R.C.V.S., which is inserted 
between the molar teeth of one side, and enables an examination of the 
mouth and teeth to be made with facility. When one side of the region 
is explored, the instrument is then inserted between the molars of the 
opposite side, and the examination is completed. Clinical experience 
teaches us that if we neglect to make a proper examination of the 
mouth and teeth errors in diagnosis of an unpleasant character are likely 
to occur, which go to prove the veracity of the adage “that more mistakes 
are made by not looking than by not knowing.” 

There are certain symptoms occurring in connection with the mouth 
which are of importance with reference to the diagnosis not only of 
abnormal conditions of this region, but also in connection with affections 
of other organs, adjacent or remote. Amongst these symptoms the 
following merit consideration : 

Salivation or Ptyalism.—This is an excessive secretion of saliva, and. 
is a symptom met with in various disorders. The saliva may be in the 
form of foam around the lips and at the angles of the mouth, or it may 
be more tenacious in character, and hang from the commissures of the 
lips in ropy masses. Salivation may depend on increased secretion from 
the salivary glands or result from inability to swallow, such as occurs in 
acute pharyngitis, laryngitis, tetanus, etc. In paralysis of the lips, 
resulting from a lesion of the facial nerve, salivation is in evidence, and 
results, not from excessive secretion, but from inability to retain the 
saliva in the mouth (see Diseases of the Nervous System). 


12 SYSTEM OF VETERINARY MEDICINE 


In addition to the affections mentioned, ptyalism occurs in various 
forms of stomatitis, in specific affections of the mouth, in abnormal con- 
ditions of the teeth; also from foreign bodies in the mouth, glossitis, 
cesophageal obstruction, in certain gastric affections and diseases of the 
nervous system, in rabies, etc. 

Certain drugs also induce salivation—e.g., mercury, iodine, arecoline, 
pilocarpine, etc. Medicaments of an irritant nature, such as oil of tur- 
pentine, preparations of ammonia, etc., unless mixed with bland agents 
when administered in the form of drench, irritate the buccal mucosa, and 
cause salivation. Again, agents such as chloral hydrate and sweet 
spirit of nitre, when not properly diluted, have a similar effect. 

In cases such as tetanus, where the saliva is mixed with particles of 
food retained in the mouth, it becomes fcetid, and it has a similar character 
in septic conditions of the oral cavity. 

In ulcerative stomatitis and in wounds of the mouth and tongue 
the saliva may be streaked with blood. 

Arrest of the Salivary and Buccal Secretions (Dry Mouth, also known 
as Xerostomia).—Suppression of these secretions is a symptom met with 
in various acute febrile conditions, in inflammatory diseases of the gastro- 
intestinal canal, in superpurgation, in polyuria, and as the result of 
administering full doses of belladonna. 

Alterations in the Character of the Buccal Mucosa.—This membrane 
shows a sour, pasty condition in cases of indigestion depending on various 
causes. . 

A “coated ’”’ or “ furred’’? tongue, although common in the dog, is 
not so frequently met with in the horse as a symptom of digestive dis- 
turbances. 

Foetor Oris.—A foul or foetid condition of the mouth may depend on 
various causes—e.g., ulcerative stomatitis, the presence of a diseased 
molar tooth, pyorrhcea alveolaris, septic wounds of the tongue, tetanus 
with trismus, septic pharyngitis, diseased conditions of the maxillary 
hones, etc. The fcetid condition is immediately evident when the mouth 
is examined. It cannot be termed “ foul breath ” in the horse, as this 
animal breathes only through the nostrils. | 

When the breath is foul or foetid the condition usually depends on 
affections such as nasal gleet, disease of the turbinated bones, etc. ; also 
on septic pharyngitis, septic pneumonia, or pulmonary gangrene. 

Difficult or Painful Mastication depends on various conditions, such 
as stomatitis, dental irregularities, the presence of a foreign body in the 
oral cavity or fixed between the teeth, glossitis, etc. Mastication is 
slowly performed, and may be unilateral in the case of dental trouble. 


DISEASES OF THE MOUTH: HORSE 13 


The animal “ quids” the food while chewing, and particles of ingesta 
are retained in the mouth. In some cases only food of a soft nature can 
be masticated, hay and oats being refused. 

Difficulty in Prehension is observed in cases of paralysis of the facial 
nerve, popularly known as “dropped lip.” It is also seen in cases of 
tetanus with trismus and in acute glossitis, and in horses with that 
peculiar malformation known as “ parrot mouth,” when sent to pasture. 


STOMATITIS. 


This term signifies inflammation of the mucous membrane of the 
mouth. It includes a variety of forms, which are differentiated by the 
character and extent of the lesions and by the general effects produced 
on the system. Some constitute simple or benign affections, the patho- 
logical changes in which are superficial and limited to the buccal mucosa ; 
others show deep-seated lesions associated with constitutional disturb- 
ance and complications, and tend to assume an enzootic character in 
some species of animals. 

Stomatitis may be a manifestation of certain specific diseases, such as 
variola, contagious pustular stomatitis, etc. These symptomatic forms 
receive consideration under the respective headings of the affections 
named. The following varieties of stomatitis are met with in the horse : 

1. Simple, Catarrhal or Erythematous Stomatitis—Catarrhal stoma- 
titis is an affection frequently met with in the horse. It may involve the 
entire buccal mucous membrane, or may be limited to certain regions, 
such as the palate, the cheeks, the gums or tongue. Many authors state 
that it generally occurs in adult animals, and is rare in suckling foals. 
Robertson, however, met with it more commonly amongst the latter. 
In our experience the affection.may develop in animals of all ages. 

ErroLocy.—Various causes may give rise to this condition. It may be 
produced by direct irritation, resulting from acrid or irritant materials 
in food, or from the administration of drenches containing medicaments 
not sufficiently diluted, such as oil of turpentine, solutions of ammonia, 
chloral hydrate, etc. It is also occasioned by horses licking blisters 
or liniments of an irritating character applied to the limbs, etc. Lime- 
wash used for disinfecting purposes, and carelessly left in a bucket within 
reach of the animal, may be taken into the mouth and produce severe 
stomatitis. In France absinthe is often administered as a popular 
remedy for colic, and when not sufficiently diluted induces acute stoma- 
titis. The ingestion of fodder infected by certain fungi, such as blight- 
fungi, rusts, etc., is said to cause the disease, but their influence in this 
direction is doubted by many observers. Law states that ergotised hay 


14 SYSTEM OF VETERINARY MEDICINE 


may cause catarrhal stomatitis in some instances, but not in others. 
On the Continent it is found that the presence of certain caterpillars in 
fodder induces stomatitis in horses that partake of it. This is brought 
about by the mechanical irritation produced by the hairs which are 
present on these caterpillars, and also by the secretion of formic acid 
which occurs from glands situated in their skin. The species capable of 
exerting this action are the Bombyx or Cnethocampa processionea and the 
“hawthorn ” caterpillar (Porthesva chrysorrhea). 

Insects belonging to the genus known as Ayp/is, if ingested in large 
amount, have a similar effect ; also the insect known as Blaps mortesaga, 
the latter contaminating the fodder with a secretion having a vesicating 
effect. 

Stomatitis may occur as a secondary affection in cases of pharyngitis, 
etc. During digestive disturbances with loss of appetite, and also during 
the course of a long-continued illness, there 1s a tendency for degenerated 
epithelial masses, with particles of food, to accumulate and undergo 
decomposition in the mouth, and set up stomatitis. 

In young animals the congestion of the gums attendant on the process 
of teething predisposes to inflammation of the buccal membrane. 

Cadéac regards the majority of cases of stomatitis as depending on 
microbic infection. So long as the buccal mucosa is healthy, the 
micro-organisms which inhabit the mouth produce no effect, but when the 
mucous membrane is subjected to irritating influences, the epithelium 
is weakened or removed, the micro-organisms exert a pathogenic action, 
and stomatitis results. 

Symproms.—These vary according to the intensity of the inflammation. 
Congestion with redness and dryness of the buccal mucous membrane 
occur at first, but these phenomena may be overlooked. Usually the 
first symptom that attracts attention is an increased flow of saliva and a 
slight difficulty in mastication. On examining the mouth, we find the 
mucous membrane of the lips, cheeks, palate, gums, and of the inferior 
aspect of the tongue, swollen and of a light red colour. 

In severe cases swelling of the lips is present and profuse salivation ; 
the saliva may be frothy in appearance, or of a ropy, viscid character, 
hanging in stringy masses from the commissures of the lips. Prehension 
and mastication are interfered with, and the horse resents the process of 
examining his mouth. When stomatitis results from irritating medica- 
ments administered in the form of a drench, the tongue shows raw 
excoriated patches of a dark red colour, and may be swollen ; and when 
the irritant has been severe, the epithelial covering is denuded from a 
large area of the surface of the organ. Particles of food accumulate 


DISEASES OF THE MOUTH: HORSE 15 


between the molar teeth and the cheeks, undergo decomposition, and 
give rise to a foetid odour which is readily detected when the mouth 
is examined. Occasionally small superficial erosions occur in the mucous 
membrane, which tend to heal rapidly. 

Robertson described the symptoms as met with in very young foals 
as follows : “ Circumscribed red patches on the inner sides of the cheeks 
and roof of the mouth, shortly followed by removal of the epithelium and 
the formation of raw surfaces, which usually coalesce and extend over 
the greater part of the buccal mucosa.’ In advanced cases the buccal 
membrane is swollen and lightly covered in patches “with a grey, 
mealy-looking material and collections of denuded epithelium.” An 
accumulation of ropy saliva and a fcetid odour from the mouth may 
often be observed. When the lesions are extensive, difficulty in sucking 
is manifested. Evidences of digestive derangement are also observed in 
many cases, and occasionally the dam may show similar symptoms. 

In some cases of disturbance of the digestive organs and in febrile 
diseases a mild form of stomatitis is present, evidenced by a “ coated ” 
or “furred”’ tongue. This condition of the organ depends on an 
increased production of epithelium, due to the catarrhal process ; and, 
in consequence of the interference with appetite, this-epithelium is not 
removed by contact with the food, while, owing to the diminution of 
buccal secretions in febrile states, the epithelial layers become dry and 
tend to accumulate. | 

TREATMENT.—Catarrhal stomatitis is a benign affection, and yields to 
simple treatment. Attention to diet is necessary. The food should be 
restricted to oatmeal-gruel, barley-water, linseed-tea, hay-tea, etc., until 
the acute symptoms abate. 

A mouth-wash containing boric acid, or borax, or chlorate of potassium 
and honey should be prescribed. When the secretions of the mouth are 
foetid, antiseptic mouth-washes are indicated. or this purpose we 
prefer solutions of peroxide of hydrogen. Cadéac advises a 3 per cent. 
solution of naphthol or naphthalin. Dilute solutions of permanganate 
of potash are also useful. 

When salivation is profuse and the mouth very painful, we have 
found a mouth-wash containing extract of belladonna, chlorate of potas- 
sium, and honey, very useful. Electuaries containing borax or chlorate 
of potassium, with honey as a basis, are preferred by some practi- 
tioners. 

2. Vesicular Stomatitis (also known as Pseudo-aphthous Stomatitis 
or Sporadic Aphtha).—This affection is characterised by the presence of 
vesicles on the mucous membrane of the lips, cheeks, tongue, and gums, 


16 SYSTEM OF VETERINARY MEDICINE 


They may be disseminated on the mucosa or occur in groups. Rupture 
of the vesicles takes place and erosions are formed, which tend to heal 
rapidly. 

Dieckerhoff, Régis, and other authorities, have observed enzootics of 
vesicular stomatitis in horses, but were unable to ascertain the nature ot 
the infecting agent. In South Africa a contagious stomatitis of horses 
and mules was observed by Hutcheon in 1884, and by Theiler in 1897. 

Et1otogy.—Various causes are believed to be responsible for this con- 
dition; these include the ingestion of irritant plants with the fodder, 
and sharp vegetable barbs entering the mucous follicles. Vesicular 
stomatitis may also occur as the result of the animal licking a limb to 
which a blistering agent has been applied, and it has also been observed 
after the continued administration of iodine. 

Some authorities regard the affection as being microbic in character 
in many instances, and consider that the ingestion of irritating fodder, etc., 
acts only as a predisposing factor, by rendering the mucous membrane 
liable to invasion by micro-organisms. Frequently the definite cause 
cannot be determined. On the Continent the ingestion of Swedish clover 
infected by fungi is believed to be the cause of some of the enzodtics 
recorded. | 

Robertson has met with cases of vesicular stomatitis associated with 
certain febrile diseases. . 

Symproms.—Circumscribed red spots are first observed on the buccal 
mucosa. ‘These are succeeded by vesicles of a greyish-red colour and 
of various sizes. The contents are at first transparent, but soon become 
turbid. They are usually situated on the internal aspect of the lips and 
the cheeks, and along the lateral surfaces of the tongue. The vesicles 
rupture in about three or four days, or sooner, and small erosions result, 
with slightly elevated and irregular borders. Healing usually occurs more 
or less rapidly. Evidences of catarrhal stomatitis may also be present. 
In some cases, especially if the animal be fed on coarse food, the erosions 
may coalesce, and large excoriations are formed, which do not readily heal. 

Some authors state that the vesicles are associated with tumefaction 
of the mucous glands, following on obstruction of their excretory ducts 
- with a granular material, and term the condition “ follicular stomatitis ”’; 
but this designation should be applied to cases of catarrhal stomatitis 
in which small nodules are found in the internal aspect of the lips and 
cheeks, resulting from the alterations in the mucous glands mentioned 
above, and not associated with the formation of vesicles. In the enzootic 
forms of vesicular stomatitis described by Dieckerhoff, Regis, and other 
Continental authorities, erysipelatous lesions of the skin in the vicinity 


DISEASES OF THE MOUTH: HORSE 17 


of the lips, forehead, nostrils, and sometimes of the limbs, were observed, 
in addition to the mouth lesions, also profuse salivation, difficulty in the 
prehension of food, slight swelling and tenderness of the sublingual 
glands, and a mild degree of fever. Recovery generally occurred in 
from one to two weeks. 

DIFFERENTIAL D1aGNosis.—Vesicular stomatitis may require to be 
differentiated from equine variola. In the latter disease the eruption is 
not confined to the buccal mucosa, and it possesses special characteristics 
(see Equine Variola, Vol. I.). Some Continental authors advise that if 
any doubt exists, a calf should be inoculated with the contents of 
a vesicle, when, if the disease be variola, pustules of vaccinia will be 
produced ; while if it be vesicular stomatitis, the result will be negative.* 

TREATMENT.—Vesicular stomatitis being generally a benign affection, 
simple treatment suffices to bring about a favourable termination. Food 
of a soft nature should be allowed, and the use of astringent antiseptic 
mouth-washes hastens the healing of the erosions. In short, the treat- 
ment is similar to that advised for the catarrhal form of the disease. 

3. Ulcerative Stomatitis. — This form is characterised by the 
formation of ulcers.in various regions of the buccal mucous membrane, 
but especially on the gums in the vicinity of the molar teeth, or on the 
inside of the lips. In severe cases which assume a septic character the 
affection is termed gangrenous stomatitis, or noma. The ulcers may be 
rounded, linear, or irregular in their outlines. In some instances they are 
only found inside the lips, and on the lateral aspects of the tongue ; but 
in others they may invade the entire buccal mucosa, and even involve 
the pharynx. They may extend deeply and involve the entire thickness 
of the mucous membrane, their general appearance, extent, and character 
as regards healing, being influenced by the nature of the causal agent and 
the constitution of the patient. In some cases they tend to heal in a 
comparatively ready manner, in others they assume a gangrenous 
character. Occasionally they extend to the skin of the lips. 

ET1oLogy.—Ulcerative stomatitis may occur as a secondary condition 
in cases of equine variola, contagious pustular stomatitis, strangles, etc, 
It may also follow an attack of the catarrhal or vesicular form of stoma- 
titis. 

The etiological factors in the primary form of the affection are not 
definitely known, but in all probability the lesions depend on microbic 
infection. Irritation of the buccal mucosa, due to mechanical and 
chemical influences, is regarded as an exciting cause. Debility and 
cachexia predispose the animal to the condition. According to Fried- 


* Micellone et Rivolta, quoted by Cadéac, ‘‘ Pathologie Interne.” 
VOL. II. : 


18 SYSTEM OF VETERINARY MEDICINE 


berger and Froéhner, ulcerative stomatitis may sometimes result from the 
ingestion of food infected by fungi, also of hay containing much bristle- 
erass (Setaria viridis). In Batavia the mould-fungus (Hyphomycosis 
destruens equi) was found by De Haan to cause a severe form of the 
disease. 

Symproms.—In addition to the symptoms described as occurring in ~ 
catarrhal stomatitis, a foetid, blood-stained, ropy saliva drivels from the 
mouth, and mastication is extremely painful. On examination of the 
oral cavity in the early stages, raised spots of a grey or greyish-brown 
colour, and of various sizes, are observed, especially on the gums, palate, 
and sides of the tongue. These spots are covered by a crust, on removal 
of which an ulcerating surface is shown. | 

In some cases the ulcers are preceded by small vesicles, which, after 
rupturing, are covered by a soft, whitish exudate ; the latter becomes 
detached, revealing the presence of ulcers. In ordinary cases subjected 
to favourable conditions, the ulcers heal in about a week. In rare instances 
successive crops of vesicles and ulcers appear, and the course of the 
disease is prolonged. 

Cases of gangrenous stomatitis in the horse are described by Con- 
tinental authors, but seem to be of rare occurrence in Great Britain. 
The symptoms observed were : Intense fever, complete loss of appetite, 
a continuous drivelling of foetid sanguineous saliva from the mouth, 
loosening of the teeth, foetid odour from the mouth, inflammation of the 
salivary glands, tumefaction of the submaxillary lymphatic glands, and 
evidences of general septicemia. 

TREATMENT.—This includes attention to diet, the use of antiseptic 
mouth-washes, and astringent applications to the ulcers. The food 
allowed should be soft, and prepared so that little mastication is 
necessary, such as oatmeal gruel, linseed tea, bran water, hay tea, etc. 
Various antiseptic mouth-washes may be employed, such as solutions of 
boric acid, borax, permanganate of potash, chlorate of potash, peroxide 
of hydrogen, etc. Cadéac recommends that the affected parts be painted 
over with the following application: Powdered borax 1 part, mixed with 
vinegar and honey, of each 4 parts. 

In cases where the ulcers do not tend to heal, the careful application 
of nitrate of silver, or sulphate of copper, is necessary. 

4. Parasitic Stomatitis (also known as Thrush, Muguet, Mycotic 
Stomatitis) —In the equine species this affection occasionally occurs in 
foals. It is said to be a form of stomatitis due to the development on 
the mucous membrane of the mouth and cesophagus of the mycelium 
of Oidium albicans (Saccharomyces albicans), a fungus closely related to 


DISEASES OF THE MOUTH: HORSE 19 


the yeast fungi, and commonly met with in children. According to 
Cadéac, the identity of this fungus has not been definitely established 
in animals, and the affection is rarely met with in France or Germany. 
He also states that, even admitting the presence of the fungus, it is not 
the sole causal factor in the disease, but is associated with other micro- 
organisms. According to Friedberger and Froéhner, the disease can be 
transmitted from man to animals. 

Microscopical examination of a portion of the affected mucous 
membrane shows the presence of filaments, from the ends of which small 
ovoid bodies (torula cells) develop. According to Robin, the filaments 
represent the mycelium, and the ovoid bodies the spores; but Roux 
and Linossier regard the mycelium and ovoid bodies as two adult 
elements.* 

The parasite grows in the upper layers of the mucosa, and the filaments 
form a dense felt-work among the epithelial cells. 

Recent investigations by Plaut showed that the cause of the disease 
is a common mould-fungus—viz., Monilia candida—which grows in 
fresh cow-dung and rotten wood, and thrives in uncooked cow’s milk, 
and in nutritive media containing sugar. The disease occurs in calves, 
foals, and especially in birds. 

The affection is properly regarded as a secondary one; as it does not 
develop in a healthy mucosa. Amongst predisposing causes are: Bad 
hygienic conditions, debilitating affections, gastric disorders, the presence 
of catarrhal stomatitis, etc. The disease can be transmitted from one 
foal to another by infected feeding utensils, food, ete. 

Symptoms.—In the early stages inflammation of the buccal mucosa 
occurs, with the formation: of vesicles irregularly distributed. These 
rupture, leaving erosions, which are rapidly covered by a whitish or greyish- 
white, soft, thick, non-adherent membrane; and when detached, slightly 
ulcerated surfaces may be left. Salivation is seldom present. In severe 
cases the entire buccal mucosa may be covered by this membrane, and 
the process may extend to the pharynx and cesophagus, rendering deglu- 
tition difficult, in which instance debility soon supervenes. Generally, 
however, the affection is not a serious one, and recovery is the rule. 

TREATMENT.—Preventive measures are of importance, and should be 
directed to the disinfection of buildings and of feeding utensils, and the 
isolation of affected animals. Attention to general hygiene is also 
necessary. As regards medicinal treatment, the local application of 
borax generally gives the best results, as this agent has been found 


* Cadéac, ‘‘ Pathologie Interne.” 
+ Friedberger and Fréhner, “ Veterinary Pathology.” 


20 SYSTEM OF VETERINARY MEDICINE 


experimentally to inhibit the development of the parasite. It can be 
applied in the form of an electuary, with honey as the basis. 

Cadéac recommends the use of an electuary composed of powdered 
borax, 5 grammes; alcoholic solution of thymol, 50 centigrammes ; 
salol, 4 grammes ; and honey or treacle (q.s.). 

5. Mercurial Stomatitis, also known as mercurialism or hydrargyrism, 
occurs as one of the effects of the continuous administration of mercurial 
preparations, or of the local application of these agents over extensive 
surfaces, or their use as antiseptic injections in too strong solutions. 

As compared with cattle, sheep, and dogs, the condition is rarely 
‘met with in the equine species. Hence a full consideration of the subject 
is deferred until we come to deal with affections of the mouth in animals 
other than the horse (see p. 321), as the general symptoms are similar 
in all. 

The horse is less susceptible to the action of mercurials than the 
animals mentioned above. 


CONGESTION OF THE BUCCAL MEMBRANE—CONGESTION OF THE 
HARD PALATE. 


Under this heading is generally described a condition characterised 
by swelling and congestion of the membrane covering the hard palate, 
especially behind the incisor teeth. It is popularly known as “ lampas,” 
and much importance is attached to it by horse-owners and grooms. 
In reality the condition should be regarded as merely a symptom or 
accompaniment, and a minor one, of various abnormal states of the mouth 
and other organs of the digestive system. 

It is observed in ordinary stomatitis, in connection with the process 
of dentition in young horses; while in adult and aged animals it occurs 
in cases of dental irregularities and indigestion from various causes. 

When resulting in the young horse from dental changes, a varying 
degree of salivation may be observed, especially when feeding. On 
examining the mouth, the palatine surface is found swollen, especially 
behind the incisor teeth, so that it may project and be on a level with the 
cutting surface of the teeth ; it may also be heightened in colour and tender 
to the touch. There may be some difficulty in the mastication of dry 
food. When associated with other conditions, the tumefaction is not 
so well marked, and evidences of gastric disturbance will be present, 
or dental irregularities will be discovered on examination of the molar 
teeth. 

Treatment should be carried out according to the conditions on which 
the phenomena depend. When associated with the process of teething 


DISEASES OF THE TONGUE: HORSE 21 


in the young horse, and when mastication is interfered with, light scarifica- 
tion of the swollen membrane with the gum-lancet should be carried 
out, taking care to make the incisions in the middle line so as to avoid 
wounding the palatine arteries. Soft diet should be ordered for a few 
days, and simple salines may be given in the food. In adult animals 
the teeth should receive attention when necessary, and in cases due to 
digestive disturbances appropriate remedies should be prescribed. 

The inhuman practice of cauterising the palate with a hot iron adopted 
by farriers and empirics cannot be too strongly condemned ; and the 
perpetrators of such cruelty should be prosecuted under the Protection 
of Animals Act. It is surprising at times to find that owners of animals 

permit cruelty of this kind to be inflicted. 


DISEASES OF THE TONGUE. 


GLOSSITIS. 


This term signifies inflammation of the tongue, and is an affection of 
comparatively frequent occurrence in the horse. It varies in degree 
according to the nature of the causal agent, from a simple catarrhal 
inflammation of the lingual mucosa to extensive destruction of the 
epithelial covering, with marked tumefaction from infiltration of the 
structure of the organ. In some instances serious sequele occur, such 
as abscess formation, or even necrosis of the free extremity of the tongue. 

Et1oLogy.—The commonest causes of glossitis are direct injuries and 
the action of irritant substances. The various forms of stomatitis may 
also affect this organ, and induce inflammatory changes therein. 

Amongst direct injuries may be mentioned wounds resulting from 
various causes (see p. 23), the presence of foreign bodies (see p. 24), 
and dental irregularities. In such instances the influence of secondary 
infection from the mouth must be remembered. 

Glossitis arising from the action of irritants generally results from 
the administration of drenches containing medicaments of an irritating 
nature insufficiently diluted, or not combined with a suitable bland 
menstruum. Such substances include preparations of ammonia, sweet 
spirit of nitre, oil of turpentine, chloral hydrate, etc. Similar effects may 
occur as the result of the animal licking parts to which blistering ointments 
containing biniodide of mercury or cantharides have been applied, or 


22 SYSTEM OF VETERINARY MEDICINE 


from bringing the mouth and tongue into contact with fresh lime-wash, 
carelessly left within reach. All such agents irritate the mucous mem- 
brane, and destroy the epithelium to an extent varying according to the 
strength and nature of the causal factor. In severe cases it is likely that 
microbic infection occurs as a secondary condition. 

Mineral acids, carbolic acid, strong solution of ammonia, etc., adminis- 
tered by mistake, cause very serious injury to the tongue. 

Symptoms.—These vary according to the degree of inflammation of 
the organ. Salivation is a prominent symptom ; the saliva escapes from 
the commissures of the lips, and may be of a ropy character ; occasionally 
it is fetid. The tongue is swollen, painful to the touch, and in severe 
cases hangs from the mouth, and cannot be retracted. The dorsum, 
from exposure to the air, becomes dry and of a brown colour. When the 
glossitis arises from the action of strong alkalies, or of chloral hydrate, 
the organ has a saponaceous feel, the epithelial covering peels off as a 
semi-transparent bluish-white material, and the underlying surface is of 
a bright red colour. The mucous membrane of the cheeks also shows 
an inflammatory condition. 

Prehension of food, mastication, and swallowing, are difficult, and 
deglutition of solids or fluids may be impossible in severe cases. The 
mouth remains open, and if the swelling of the tongue be excessive, 
pressure is exerted on the soft palate, and difficulty in breathing results. 

ComPLicaTions.—An abscess may form on one of the lateral surfaces 
of the organ, generally in the vicinity of the frenum. Necrosis of the 
free portion of the tongue has been observed, while in rare instances 
general septicemia may result. 

TREATMENT.—The indications for treatment vary according to the 
severity of the case and the nature of the causal agent. In mild cases, 
all that is required is a simple antiseptic mouth-wash, such as a 3 per 
cent. solution of boric acid or borax. The diet should be restricted to 
boiled oatmeal gruel and milk. When the organ is much swollen, 
scarification of the tumefied portion and repeated irrigation with anti- 
septic solutions are advised by some authors. Should the tongue 
protrude from the mouth, support should be given by means of a linen 
bay fixed to the halter. 

In cases due to the action of mineral acids, mouth-washes containing 
dilute alkalies, such as lime-water, calcined magnesia, or bicarbonate of 
soda, are indicated. When due to-the action of alkalies, weak solutions 
of vinegar should be employed. We find that a mouth-wash containing 
boric acid, belladonna, honey, and camphor-water, acts well in all cases, 
relieving pain and promoting healing. 


DISEASES OF THE TONGUE: HORSE 23 


When the glossitis results from the presence of a foreign body, the 
latter should be located and removed (see p. 24). When arising 
from wounds, these will require careful surgical attention (see p. 24). 
When an abscess is present, a free exit to the pus must be given, 
and the cavity washed out with an antiseptic solution. In the case of 
necrotic foci, tincture of iodine should be carefully applied to the affected 
parts by means of a small brush. 


WOUNDS OF THE TONGUE. 


These arise from various causes, as follows: Foreign bodies, such 
as needles, pins, portions of glass, etc., in the food; nails projecting 
from the manger or hay-rack; sharp dental irregularities, which may 
wound the lateral surfaces of the organ during mastication ; careless 
handling of the tongue, as when, during the process of filing the teeth 
or administering a bolus, the horse suddenly pulls back or rears, and the 
attendant holds the organ roughly, the result being that the frenum 
becomes torn, or the tongue is wounded by the molar teeth. A common 
cause 1s the careless insertion of the “ cavil of the halter ” in the mouth, 
so that the tongue is included in the loop formed by the rope. In such 
instances the organ may be wounded very deeply, and cases occur in 
which complete section of the incarcerated portion has resulted. 

Begg has met with two cases in which the tongue was held by the 
attendant in order to control the animal during clipping, the horse reared, 
and a portion of the tongue was torn off. Severe bits manipulated by 
rough-riders or drivers may cause serious wounds of the tongue. In 
cases of glossitis, when the swollen organ projects between the incisor 
teeth, the animal may bite it while endeavouring to feed, and may inflict 
a deep wound. 

Continental authors record cases in which serious lesions of the 
tongue are produced by the horse falling while the tongue is projecting 
from the mouth. Also, when a horse is licking the ground, if he accident- 
ally treads on the tongue, the pain causes him to raise the head suddenly, 
and the extremity of the organ is torn or cut through. 

Symproms.—These will depend on the extent of the injury inflicted. 
All the symptoms of acute glossitis are present, but in a small wound of 
the frenum the tongue must be carefully examined in order to discover 
the lesion. 

In more extensive wounds the organ is much swollen, and may pro- 
trude between the incisor teeth, so that the circulation in the free 
extremity is impeded, and the part assumes a bluish colour. When the 
frenum is extensively torn, the tongue often deviates to one side, and 


24 SYSTEM. OF VETERINARY MEDICINE 


protrudes between the commissure of the lips. In cases where the organ 
is half cut though, it may sometimes be found retracted, and at other 
times the half-severed portion projects from the mouth. Mastication 
is very painful, or there may be total inability to perform this act. 
Particles of food accumulate in the mouth, and the oral cavity becomes 
septic and exhales a foetid odour. Cicatrisation of the wound occurs in 
an irregular manner, so that the cut surfaces do not come into regular 
apposition, and a permanent indentation remains at the seat of the 
lesion, which anteriorly may be bounded by an enlargement or ridge of 
cicatricial tissue. In such an instance the functions of the tongue may 
be interfered with, and the condition of the animal suffers in consequence. 

liven with the loss of 3 or 4 inches of the free portion of the tongue 
the animal after a time manages to carry on prehension and mastication. 

COMPLICATIONS may occur as the result of wounds of the tongue. 
These include hemorrhage, injury or section of a branch of the hypo- 
glossal nerve leading to paralysis and gangrene of portion of the organ, 
resulting either from interference with the blood-supply or from septic 
infection. Suppuration, abscess formation, and fistulae may also occur, 
especially when an extensive rupture of the freenum is present. 

The tongue may be permanently deformed as the result of the 
excessive production of cicatricial tissue on the dorsum of the organ. 

TREATMENT.—For slight. wounds, an antiseptic mouth-wash and soft 
diet constitute the treatment. In the case of deep wounds, sutures 
should be employed, preferably of strong silk, inserted deeply and close 
together. The food should be restricted to oatmeal gruel, milk, linseed _ 
tea, barley-water, etc., and the mouth should be irrigated with anti- 
septic solutions regularly after feeding. 

When the free portion of the tongue becomes gangrenous, it should 
be amputated. For the details of this operation, see works on veterinary 
surgery. Blanc advises that when healing has taken place, in order to 
permit the necessary freedom of the remaining portion of the tongue, the 
frenum should be incised. Other practitioners corroborate the beneficial 
results of this treatment. 


FOREIGN BODIES IN THE TONGUE. 


Needles, pins, portions of hair-pins, bits of wire, accidentally finding 
their way into fodder, may enter the substance of the tongue during the 
process of mastication. | | 

The symptoms presented are those occurring in glossitis. In addition 
there may be difficulty in swallowing, frequent attempts at deglutition, 
constant movements of the jaws, and in some cases the animal shakes 


DISEASES OF THE TONGUE: HORSE 25 


its head at intervals. Examination of the tongue generally enables us 
to detect a painful inflammatory area, an abscess, or a fistulous wound, 
in which the foreign body can be located. 

Treatment consists in the removal of the foreign body and the frequent 
irrigation of the mouth with antiseptic solutions. 


GLOSSOPLEGIA (PARALYSIS OF THE TONGUE). 


This may result from injury or section of the hypoglossal nerves, 
or may be due to cerebral affections involving the origin of these nerves. 
Moller has observed it as a complication of contagious pneumonia in the 
horse. It may occur as the result of violent traction on the tongue when 
administering a bolus, or when operating on the teeth. The paralysis 
is unilateral when the nerve of only one side is implicated, the organ 
is then found displaced towards the affected side ; when the nerves on 
both sides are involved, the tongue hangs from the mouth, and the power 
of retraction is lost. In protracted cases the lingual muscles become 
atrophied on either one or both sides, depending on whether the paralysis 
is unilateral or bilateral. In cases due to cerebral disease the paralysis 
is always bilateral. Mastication and deglutition are impossible in cases 
of complete paralysis of the organ. Paralysis of the tongue must be 
distinguished from the temporary inability to retract the organ, which 
occurs in acute glossitis, as the result of tumefaction. But glossitis due 
to wounds or injuries may be associated with lingual paralysis. Treat- 
ment is seldom satisfactory. When the paralysis is due to external 
injury, the latter should receive suitable attention (see p. 24). 


NEW GROWTHS IN THE TONGUE. 


Epitheliomata of the tongue are of very rare occurrence in the horse. 
Cadiot, Benjamin, and Rivolta each recorded a case of this description. 
The neoplasm may develop at the base of the organ, or it may originate 
close to the pharynx or in the soft palate, and involve the base of the 
tongue in a secondary manner. 

Papillomata.—These are of still rarer occurrence. Nicolas recorded a 
case in which a large papilloma, with an irregular vegetating surtace, 
was found on the base of the tongue. 

Sarcomata and Fibro-Sarcomata.—Cases are described by Siedam- 
grotzky and Johne in which the base of the tongue was secondarily 
affected by growths of this nature, resulting from extension of other 
neoplasms in the vicinity. 

Actinomycosis.—Cases of this disease affecting the tongue of the 
horse have been recorded (see Vol. I., Actinomycosis, p. 263). 


26 SYSTEM OF VETERINARY MEDICINE 


Cysts.—Nocard described cases of cysts affecting the base of the 
tongue ; these attained very large dimensions, and were filled with a 
thick, yellow, viscid fluid. In some instances they became displaced, 
invaded the pharynx, and by pressure on the soft palate induced dyspneea 
or asphyxia. 

Treatment consists in complete excision of the cyst by means of the © 
écraseur, and prior to casting the animal for operation Cadéac advises 
that tracheotomy should be performed, so as to avoid the occurrence of 
asphyxia. ay 

CONGENITAL DEFECTS OF THE TONGUE. 

Incomplete development of the tongue has been observed. Complete 
absence of the tongue is a congenital defect of extremely rare occurrence. 

Bifid Tongue has been met with by Barrier and Goubaux, associated 
with a mecaian fissure of the inferior maxillary bone and lower lip. Mégnin 
has recorded a case of hare-lip in a foal. 

Barrier has met with a case in which a well-marked separation of the 
two branches of the inferior maxillary bone was associated with bifid 
tongue ; such cases are hopeless, as the act of sucking is very difficult, 
and sufficient nourishment cannot be obtained. 


DISEASES OF THE SALIVARY GLANDS 


PAROTITIS. 


This term is applied to inflammation of the parotid gland, involving 
either the parenchyma or the surrounding cellular tissue. It is by most 
authors regarded as an uncommon affection in all animals. Robertson, 
however, states that parotitis often occurs during attacks of strangles in 
the horse, and is also associated with some febrile attack, or follows as 
a result of such. But it is probable that, as pointed out by Friedberger 
and Frohner, the condition has often been confounded with inflammation 
and suppuration in the subparotid lymph glands occurring during the 
course of strangles. 

Some authorities record instances in which the disease occurred in 
the form of,an enzootic, which they regard as a specific parotitis analogous 
to the affection known as “mumps” in man. Thus Aruch met with 
seventy cases in the horse during a period of eighteen months ; but Cadéac 
points out that the causal factor in this outbreak was the entrance of 


DISEASES OF THE SALIVARY GLANDS: HORSE 27 


spikelets of barley into Stenson’s duct in each instance. The foreign body 
was the means of introducing pyogenic and septic micro-organisms from 
the mouth, which extended up the duct and induced parotitis. Further 
investigation is necessary before the identity of specific parotitis in man 
and the enzodtic type of the disease in animals can be accepted. In the 
former affection suppuration of the gland is extremely rare, and in the 
latter also it seldom occurs, according to Friedberger and Fréhner. But 
in ordinary forms of parotitis abscess formation is very common in 
animals. 

KT1oLocy.—Infection from the mouth reaching the gland via Stenson’s 
duct is recognised as the most common etiological factor in parotitis. 
This occurs under the following conditions : 

Stomatitis may extend from the oral cavity to Stenson’s duct, and 
from thence the inflammatory process spreads to the gland. 

Foreign Bodies, such as spikelets of barley or of various grasses, grains 
of oats, etc., which enter Stenson’s duct from the mouth, and may reach 
the gland. Not only do they exert an irritating or traumatic action, but 
also act the part of carriers of pyogenic or septic micro-organisms from the 
mouth, which induce a suppurative parotitis. 

Salivary Calcul, either interfering with the flow of saliva, or causing 
complete obstruction of the duct; also funnel-shaped dilatations of the 
latter induce stagnation of the saliva, and favour the development of 
micro-organisms therein. The normal free flow of this secretion mechani- 
cally: flushes out the duct, and thus prevents the lodgment of germs 
entering the duct from the mouth. 

Metastatic Influences, such as infection occurring from strangles, con- 
tagious pneumonia, and pyemia. Some authors believe that the infec- 
tion can be carried by way of the blood-stream to the parotid gland, but 
it seems more probable—at least in the case of strangles—that it extends 
from the mouth by way of the duct, or by the lymphatics of the part. 

Traumatic Causes.—Occasionally the affection results from external 
wounds or mechanical injuries of the gland. 

Unknown Causes.—To these must be attributed those types of the 
disease termed “ primary ” or “idiopathic,” which occur in enzodtic 
form, and are recognised by Friedberger and Fréhner, Moller, and other 
observers. 

Lesions.—Hither one or both glands may be involved. In the seventy 
cases encountered by Aruch, the affection was unilateral in only one 
instance, and the submaxillary glands were also involved. In our ex- 
perience, which has been confined to sporadic cases, the disease was 
always unilateral. 


28 SYSTEM OF VETERINARY MEDICINE 


Cadéac recognises a parenchymatous, a suppurative, and a chronic 
type of lesion. 

In the parenchymatous form the affected gland is congested and 
swollen, and the interlobular connective tissue shows serous infiltration. 

In the suppurative form abscess formation occurs in the gland, and the | 
affected lobules become necrotic. Multiple purulent foci may also be 
observed ; the pus may contain necrotic shreds of glandular tissue ; salivary 
fistule may be formed, corresponding to the external openings of these 
abscesses. Stenson’s duct may undergo thickening and induration, and 
when a foreign body is present the lumen may be dilated or obstructed. 
Extensive abscesses of a septic nature, containing a brownish, foetid, 
sanious pus, may involve the greater part of the gland, and the muscles 
in the vicinity may be soft in texture and show a greenish tinge. 

In the chronic form the peri-glandular and interlobular connective 
tissues undergo thickening, the lobules diminish in size, and the gland 
becomes indurated. According to Friedberger and Frohner, in the 
enzootic form of the disease the swelling is of a more uniform character 
than in the other varieties, and suppuration seldom occurs. Per contra, 
in the sporadic form it is more circumscribed, and the affected lobules 
usually undergo suppuration. 

According to Robertson,* the inflammatory action is very erratic, 
in some instances being of an acute type, with a rapid course, terminating 
in the formation of a large abscess in the gland structure ; in others it is 
slow in progress and tedious in its course, and several distinct abscesses 
are formed. More often he observed that resolution occurred, and no 
suppuration resulted. This latter statement is not in accordance with 
the experience of other observers. 

SyMPToms.—The most prominent symptom is a diffuse swelling of 
the parotid region, the gland is enlarged, painful on pressure, and an 
cedematous infiltration is observed at its dependent part, which may 
extend to the intermaxillary space, and even to the lower lip. A swollen 
and painful condition of Stenson’s duct in its course around the lower 
border of the jaw and towards the cheek may also be present. A varying 
degree of fever accompanies the affection. On examination of the 
mouth the presence of stomatitis may be observed, and particles of food 
tend to accumulate between the molar teeth and the cheeks, and the 
secretions of the mouth are foetid. Mastication and deglutition are 
performed with difficulty. Several authors state that salivation is present, 
but Friedberger and Frohner have never observed it in connection with 
parotitis, and this has also been our experience. It seems probable that 


* “Textbook of the Practice of Equine Medicine.” 


DISEASES OF THE SALIVARY GLANDS: HORSE 29 


when salivation does occur it depends on the presence of dysphagia. 
The head is extended, and pain is evinced if attempts are made to turn 
it to either side. According to Moller, when the affection is unilateral, 
the animal may keep the head inclined towards the sound side. 

When the swelling is extensive, pressure on the pharynx, larynx, or 
laryngeal nerves may be induced, and dyspncea or roaring results, 

CoursE.—According to most authors, resolution but seldom occurs, 
but when it does set in, the swelling subsides after some days. In such 
instances it is not uncommon for the gland to remain permanently 
indurated. As already remarked, Robertson found that resolution was 
common in this affection, the inflammatory products being absorbed, 
and no suppuration being observed. 

When suppuration occurs, the febrile symptoms increase in intensity, 
the tension in the swollen gland is increased, and several prominent 
points appear on the surface, which ultimately rupture and discharge 
pus. The small abscesses may coalesce, producing larger cavities, or a 
single large abscess may be present. The abscesses may appear in from 
five to ten days, or sometimes later ; some may rupture into the duct, 
and the pus reaches the mouth, and on opening the jaws its presence 
can be discovered. Others open at the side of the mouth, and induce 
localised sloughing of the overlying skin and connective tissue at the 
point of exit. The pus may be whitish, creamy, or yellowish; but in 
cases depending on the presence of foreign bodies it is fluid, sanious, or 
greyish, and very foetid. 

CoMPLICATIONS AND SEQUEL&.—Salivary Fistule may be produced 
when one or more of the salivary canals are opened, as the result of abscess 
formation and sloughing of the gland tissue. 

Gangrene of the Parotid Gland and surrounding tissues occurs in rare 
cases, and may be followed by septiczemia. 

Paralysis of the Facial Nerve may result from pressure on the nerve 
exerted by the glandular abscess, and the condition known as “ facial 
paralysis ” or “ dropped lip ” is produced. 

Chronic Parotitis is sometimes observed. It may occur as the result 
of repeated attacks of inflammation of the gland, and also in suppurative 
cases where the pus becomes encysted. The gland remains swollen, 
hard, insensible, and prominent. 

Moller recorded a case where amaurosis resulted from parotitis; the 
inflammatory process extended to the orbit and produced paralysis of 
the optic nerve. 

DIFFERENTIAL DraGnosis.—The following conditions may require to 
be differentiated from parotitis : 


30 SYSTEM .OF VETERINARY MEDICINE 


Pharyngitis.—In this affection the presence of cough, nasal discharge, 
and the absence of swelling of the parotid gland are the distinguishing 
features. 

Abscess-Formation in the Subparotid Lymph Glands, a condition not 
uncommon in connection with strangles and phlegmonous pharyngitis, 
is distinguished from parotitis by the more diffused swelling and the ~ 
position of the abscess, which occurs close under the ear, just behind the 
temporo-maxillary articulation, or more frequently towards the lower 
posterior border of the parotid gland. The abscess is also more deep- 
seated than that occurring in parotitis. 

Empyema of the Guttural Pouch is distinguished by the diffuse swelling 
of the parotid region, and by the intermittent nasal discharge that accom- 
panies this condition. 

Tumours in the Parotid Gland are recognised by the absence of pain 
and inflammation, by the history of the cases, by the presence of induration, 
and by the irregular surface of the enlargement. 

TREATMENT.—In the early stages antiseptic mouth-washes are indi- 
cated, and the oral cavity should be thoroughly cleansed. The food should 
be restricted to bran and linseed mashes, oatmeal gruel, milk, etc. An 
ointment containing extract of belladonna and camphor may be applied 
to the inflamed gland. In the phlegmonous form the maturation of the 
abscess should be hastened by the application of a cataplasm, composed 
of kaolin and glycerine, applied hot and repeated twice daily. When 
evidences of pus-formation are present, early surgical interference is 
indicated. In consequence of the important bloodvessels and nerves 
related to this gland, great care is essential in order to avoid severing 
them, and also to avoid opening the salivary canals. A small opening 
is first made in the skin over the most prominent part of the swelling, 
then with the aid of a director or with the finger an attempt is made to 
locate the abscess cavity.* The necessary opening in the tissue can 
generally be safely obtained by means of the finger ; the use of the knife 
should be avoided. When the pus is evacuated, the cavity must be 
irrigated with an antiseptic solution and plugged with double cyanide 
gauze, this procedure being carried out once daily until healing has 
progressed. Any thickening of the gland that remains may be removed 
by the local application of iodine and the internal administration of 
potassium iodide. 

Other conditions of the parotid gland, which include traumatic in- 


* Moller draws attention to the dangers attending the employment of a trocar 
and cannula for this purpose, as serious hemorrhage may result from wounding 
one of the large bloodvessels. 


DISEASES OF THE SALIVARY GLANDS: HORSE 31 


juries, salivary calculi, foreign bodies in Stenson’s duct, fistule of the 
gland and of the duct, obliteration of the duct, tumours of the parotid, 
properly belong to the domain of surgery, and for full information thereon 
the reader is referred to the following work : “ Pathologie Chirurgicale 
de Appareil Digestif,” par C. Cadéac. 


MAXILLITIS (SUBMAXILLARY ADENITIS). 


Inflammation of the submaxillary salivary gland is sometimes termed 
“salivary abscess.” This occurs more frequently in the horse than in 
other animals, and is generally unilateral. In some instances it is asso- 
ciated with parotitis. Suppuration generally occurs either in Wharton’s 
duct or in the substance of the gland. 

ErroLocy.—The usual cause of the condition is the entrance of pyogenic 
micro-organisms by way of Wharton’s duct. These are generally carried 
by spikelets of barley or of certain grasses, grains of oats, the débris 
of food, etc. ‘The position of the opening of the duct by the side of the 
frenum lingue, and the fact that it is only imperfectly protected by a 
flattened, leaf-like papilla termed the “ barb,’ favours the entrance of 
the foreign bodies mentioned. 

It is stated that in the days when the ignorant custom of removing 
the “ barbs ’ was in vogue, cases of maxillitis were of frequent occurrence, 
as the opening of the duct was left completely unprotected. 

Symproms.—The primary symptoms observed are difficulty in mas- 
tication, “ quidding”’ of the food, avoidance of hard, dry fodder, and 
profuse salivation. The salivation is said to be due to reflex irritation 
of the buccal glands. Prehension may be interfered with in some cases. 

On external examination the submaxillary gland is found swollen 
and painful to palpation, while on examining the mouth and drawing the 
tongue towards the unaffected side the papilla protecting the duct is 
found inflamed, prominent, and painful. The tongue, on its lower and 
lateral aspect, is swollen and tender, and particles of food accumulate 
between it and the teeth, while a fcetid odour may be given off by the 
mouth. Wharton’s duct is swollen and painful to the touch, and can be 
recognised as a thickened cord. When subjected to pressure in a 
forward direction, a discharge of foetid pus, containing blood and débris 
of food, issues from the opening of the duct. The floor of the mouth 
may be oedematous, and the intermaxillary space swollen and painful. 
The suppurative process may be confined to the duct, in which instance, 
by applying pressure, the purulent material, débris of food, and the 
foreign body, can generally be removed, and recovery ensues. 

But when the foreign body or the pyogenic micro-organisms reach the 


32 SYSTEM OF VETERINARY MEDICINE 


acini of the gland, suppuration occurs, and the resulting abscess may 
rupture either externally or internally. When it points and ruptures 
externally, the intermaxillary space, the region of the throat, and the 
subparotidean tissue become swollen and cedematous, fluctuation occurs, 
and a discharge of foetid, sanious pus, containing shreds of necrosed gland 
tissue, or foreign bodies, is observed. In such instances a salivary fistula 
may result. i 

In cases where the abscess ruptures internally, an oedematous condition 
of the floor of the mouth is observed, the lower and lateral surface of the 
tongue on the affected side is swollen, and the organ deviates towards 
the opposite side; foetid pus mixed with saliva escapes from the mouth, 
and a cavity, varying in depth, can be discovered by inserting the finger 
in the affected region. Only in rare instances is the simultaneous opening 
of the abscess internally and externally observed. 

Cases have been recorded in which gangrene of the gland has occurred, 
Septiceemia as a complication is rarely encountered. 

DiFrFERENTIAL DiaGNnosis.—Strangles is the only condition likely to 
be confounded with maxillitis. An examination of the mouth and the 
presence of the phenomena just described will enable the differential 
diagnosis to be made. Moreover, in maxillitis there is an absence of 
cough, nasal discharge, and febrile symptoms. 

TREATMENT.—The indications for treatment are to remove foreign 
bodies and the purulent discharge from the duct. Careful pressure with 
the fingers from the origin to the opening of the duct may succeed in 
accomplishing this. Ifthe foreign body cannot be thus removed, a director 
or a catheter may be introduced into the duct as far as the obstruction, 
and gentle dilatation practised. If this fails, an incision must be made 
in the duct over the foreign body, and the latter is then removed. Anti- 
septic mouth-washes must be employed to cleanse and disinfect the oral 
cavity. 

When the gland structure is involved, the inflammation should be 
reduced by theapplication of cataplasms, composed of kaolin and glycerine 
or by the application of belladonna and glycerine. When evidences of 
approaching suppuration are present, a vesicant should be employed. 
When the abscess points externally, early incision is necessary. The after- 
treatment is similar to that advised in the case of abscess of the parotid 
sland. 

RANULA. 

This term is applied in the horse to an obstruction or a cystic trans- 
formation of Wharton’s duct, or of the excretory ducts of the sublingual 
glands (ducts of Rivinus). 


DISEASES OF THE TONSILS : HORSE 33 


It is occasionally met with, more especially in aged animals with 
worn teeth and fed on hard, rough food. The usual causes are said 
to be the presence of calculi or of foreign bodies in Wharton’s duct. An 
accumulation of saliva occurs below the obstruction, the duct gradually 
becomes distended, and also the salivary canals; finally the duct is 
obliterated, and atrophy with sclerosis of the gland results. According 
to Moller, the pathological cause has not yet been determined, as 
Wharton’s duct is generally found to be clear. On examining the mouth 
and drawing the tongue to one side, a movable, fluctuating tumour is 
observed, which may interfere with mastication and deglutition. The 
material it contains is variable in appearance and consistency ; it may 
be yellowish, thick, and mucoid, clear or turbid, or syrupy, and in some 
cases sanious. Its constituents include mucin, blood-corpuscles, fatty 
bodies, and glandular cells which have undergone mucous and hyaline 
degeneration. 

TREATMENT consists in either puncturing the cyst, removing the 
contents, and injecting tincture of iodine ; or, more preferably, the upper 
wall of the cyst should be removed by means of a sharp scissors ; tincture 
of iodine may then be applied to the remaining portion. 

For information on surgical conditions of the submaxillary gland, 
which include traumatic lesions, calculi, and fistulee, the reader is referred 
to “‘ Pathologie Chirurgicale de ’ Appareil Digestif,” par C. Cadéac. 


DISEASES OF THE TONSILS. 


These organs are very rudimentary in the horse, and we find little or 
no reference in veterinary literature to tonsillitis as occurring in this 
species. Law states that inflammation of the tonsils is found to a limited 
extent in the horse. Probably, if the affection occurs, it is associated with 
pharyngitis, and is not recognised. 

Calculi in the Tonsils.—Goubaux and Blanc have on several occasions 
met with calculi in the tonsils of old asses, while Law has found a similar 
condition in aged horses, 

They occur as the result of the entrance of foreign bodies, such as 
particles of food, into the crypts of the tonsil ; the foreign body acts as 
the nucleus of the calculus, and around it successive layers of a granular 
substance are formed, the latter being composed of the desquamated 
degenerated epithelium of the crypt, which is prevented from escaping 
by the presence of the foreign body. The crypt becomes dilated, and the 


VOL. II. 3 


34 SYSTEM OF VETERINARY MEDICINE 


entrance of micro-organisms is facilitated. The lymphoid tissue, the 
closed follicles, and finally the entire tonsil, undergo atrophy. 

The calculi are of a black or greyish-black colour, and contain a 
brownish substance arranged in layers and surrounded by a liquid re- 
sembling pus. In size they vary from a pin’s head to a pea, and they are 
located in the dilated orifices of the openings of the tonsillar crypts, 
forming small projections. 
 Asregards treatment, Law advises that the calculi be removed by the aid 
of a blunt metallic spud ; but Cadéac states that the region of th» tonsils in 
the horse cannot be sufficiently explored so as to apply rad ‘cal treatment. 


Injuries to the Soft Palate and Fauces, Congenital Defects of the 
Palate and Soft Palate, also Tumours in this region, are essentially surgical 
subjects, and for full information thereon the reader is referred to Cadéac’s 
work already alluded to. We may, however, draw attention to the 
occurrence of injuries to the region of the fauces which may result 
from the pernicious custom of administering boluses on the end of a 
pointed stick. We have met with serious cases of septic inflammation 
of the region resulting from this cause, which extended into the pharynx 
and produced pharyngitis, with extensive cedema of the surrounding 
parts (see p. 38). 


DISEASES OF THE PHARYNX. 


ACUTE PHARYNGITIS. 


Svynonyms.—Angina ; Pharynx-angina ; “Sore throat” ; Inflamma- 
tion of the pharynx. 

GENERAL REMARKS.—Inflammation of the pharynx may occur as a 
disease per se, but is more frequently encountered in association with 
laryngitis, the soft palate and surrounding structures being also involved. 
Hence the term pharyngo-laryngitis is sometimes employed to designate 
the condition when the lesions in the pharynx predominate, and laryngo- 
pharyngitis when laryngitis is the leading feature present. 

Pharyngitis frequently accompanies other affections, such as influenza, 
while it is one of the most common conditions associated with strangles— 
indeed, in its phlegmonous form it cannot be differentiated from strangles. 

Three forms of acute pharyngitis are generally recognised—viz., 
(1) Catarrhal ; (2) Phlegmonous ; (3) Pseudo-membranous or Croupous. 

In consequence of the impossibility of carrying out an examination 


DISEASES OF THE PHARYNX : HORSE 35 


of the pharyngeal region in the larger animals, the diagnosis of these 
conditions clinically is a difficult matter, and we have to depend on the 
presence of certain symptoms, which are not always reliable. Similar 
remarks apply to the differentiation of pharyngitis from laryngitis. 

Many authors describe the various forms of pharyngitis under one 
heading, but we are of opinion that the subject can be more readily and 
clearly discussed by considering each form separately, although admitting 
the difficulty in differentiating them clinically. 

There are a few points which are of importance in the study of 
diseases of the pharynx. In consequence of its situation this structure 
is specially liable to infection by micro-organisms entering by way of the 
mouth and the nasal passages. Again, there are many lymphatic glands 
in the vicinity of the pharynx, which are in direct communication with 
the lymph follicles of the pharyngeal mucosa by means of lymphatic 
vessels. Hence, in cases where the inflammation involves the submucous 
tissue, the infection extends to the adjacent lymphatic glands, and the 
phlegmonous type of the disease is produced. 

The normal pharyngeal mucosa, like that of the mouth and nasal 
passages, contains micro-organisms which are harmless so long as the 
structures are intact or in a healthy condition, but when from any cause 
the vital resistance becomes lowered, these micro-organisms are believed 
to exert a pathogenic action. It is now generally recognised that all 
forms of pharyngitis are microbic in origin, and that chills or exposure 
to cold act as predisposing causes by lowering the vital resistance, and 
thus permitting the micro-organisms to produce their effects. The various 
forms of pharyngitis are believed to depend on the virulence of the causal 
agent, and the enzootic character which the disease assumes at times is 
said to be due to an exalted virulency produced by the passage of the 
micro-organisms from animal to animal. We are inclined to believe, 
however, that the so-called enzodtics of pharyngitis are in reality out- 
breaks of strangles or of influenza, as in phlegmonous pharyngitis there 
are no distinguishing features between it and strangles, while it is well 
known that in some years influenza is characterised by the frequency 
of pharyngeal and laryngeal lesions. 

Pharyngitis is most frequently met with in the horse, less frequently 
in the mule, and only occasionally in the ass. 


I. Acute Catarrhal Pharyngitis. 
Synonyms.—Acute pharyngeal catarrh ; Inflammation of the fauces 


and pharynx. 
Under the above heading is described a superficial inflammation of 


36 SYSTEM OF VETERINARY MEDICINE 


the pharynx, which is not associated with involvement of the lymphatic 
glands in the vicinity, or with the presence of a fibrinous exudate. It is 
regarded as a mild type of the affection, although it may be the fore- 
runner of the more severe forms. The inflammatory action may be 
limited to the pharyngeal mucosa, or the soft palate and fauces may be 
simultaneously affected. Again, the condition may occur in connection 
with ordinary nasal catarrh, strangles, contagious pneumonia, and influ- 
enza, and in some epizootics of the last-mentioned disease it may be the 
most prominent phenomenon present. 3 

Etrotogy.—As already mentioned, al] forms of pharyngitis depend on 
microbic infection. The source of such infection is varied ; thus, micro- 
organisms may gain access to the pharyngeal mucosa from the mouth, 
nasal cavities, from infected food, water, and also from inspired air. 
In specific affections the pharynx is believed to be infected by way of 
the blood. In some cases of contagious pneumonia Schutz has isolated 
the diplococci and streptococci of pneumonia from the pharyngeal 
mucosa. Mechanical injuries of the mucous membrane permit entrance 
of the germs by inoculation, such as wounds from the presence of 
spikelets in the fodder, abrasions due to carelessness in the use of the 
tooth rasp, or the administration of a bolus by means of a pointed stick, 
etc. Medicaments of an irritating nature, when not properly diluted, 
induce pharyngitis, as well as stomatitis, by their irritant action on the 
mucous membrane, vitiating it, and so permittmg the entrance and 
development of micro-organisms. Irritating gases and smoke from 
burning buildings exert a similar effect. As an occasional etiological 
factor we may mention the presence of tumours or polypi projecting 
into the pharyngeal cavity. 

Hpizootics of pharyngitis are described by some authors, but, as 
already remarked, we are not aware of any means by which these can 
be differentiated from affections such as influenza, strangles, etc. 

As regards the bacteriology of pharyngitis, various micro-organisms 
have been isolated. Of these the streptococci are credited with playing 
the chief part as causal agents. Diplococci, micrococci, staphylococci, 
the ovoid bacterium, and the colon bacillus may also be found; while 
in the pharyngitis which may precede or accompany contagious pneu- 
monia, the diplococcus or streptococcus of pneumonia has been discovered 
in the pharyngeal lesions. 

Morsip ANatomy.—In the early stages the deere Bonk mucosa and 
that of the fauces are congested, swollen, and dry. This is succeeded by 
exudation, and the mucosa is covered by a thick, tenacious layer of 
mucus of a whitish, yellowish, or greenish tint, enclosing pus-cells, 


DISEASES OF THE PHARYNX : HORSE 37 


blood-corpuscles, micro-organisms, and débris of food. On removal of 
this layer, which is readily accomplished by washing the part, the 
mucous membrane shows redness, congestion of the capillary vessels, 
and cedema; it is thicker than normal and friable. In mild cases 
there may be no marked structural changes, but in severe instances 
erosions occur resulting from shedding of the epithelium. In very severe 
cases the submucous tissue is involved, and shows gelatinous infiltration. 
Hypertrophy of the lymphatic follicles occurs, especially at the under 
surface and sides of the posterior portion of the tongue. 

Symproms.—In mild cases, which are often associated with ordinary 
nasal catarrh, the only symptoms observed are a nasal discharge, a 
slight difficulty in swallowing, and an occasional soft cough. 

In severe cases the most striking symptoms are difficulty or pain in 
deglutition ; the head is kept extended on the neck, and the nose is raised 
and protruded. The difficulty in swallowing varies in extent, and may 
be so marked that all food is refused, and attempts to swallow fluid result 
in the latter being returned through the nostrils, together with masticated 
portions of food. If the animal is at pasture or is fed with grass, the nasal 
discharge may be stained a green colour. The peculiar stiff carriage of 
the head is due to the effort of the animal to avoid movements of the 
head and neck, as these induce pain; also this extension of the head 
facilitates the passage of food through the pharynx. 

The regurgitation of fluids and portions of food occurs through the 
nostrils in the horse, as the well-developed soft palate offers a barrier 
to their passage by way of the mouth. The cause of this regurgitation 
in pharyngitis is, according to Friedberger and Frohner, impairment of 
the muscles of the palate and pharynx, due to serous infiltration, or to 
an extension of the inflammatory process from the pharynx to these 
structures. The pillars of the fauces are similarly involved, and are 
unable to approach the middle line, so that passage of food and fluids 
into the nasal cavities can occur. 

According to Cadéac, regurgitation depends on an cedematous infil- 
tration of the submucous connective tissue of the soft palate and of the 
intermuscular connective tissue of the tongue, the result being a paralysed 
condition of these structures, so that they are unable to contract sufh- 
ciently to bring about deglutition. The upper opening of the cesophagus 
being normally very constricted, aids in the production of regurgitation. 

The pain in swallowing is mainly due to the passage of food or fluid along 
the inflamed pharyngeal mucosa. Attempts at swallowing may be made, 
but without success, and the animal, although anxious to drink, simply 
works both lips in the bucket of water or thin gruel when it is placed 


38 SYSTEM OF VETERINARY MEDICINE 


before him. Salivation is also present; this is due to the difficulty of 
mastication and swallowing, so that the saliva and mucus accumulate 
in the oral cavity, and on opening the mouth these issue therefrom in 
stringy masses, especially at the commissures of the lips. Mastication is 
performed slowly, and portions of the food covered with frothy saliva | 
and tenacious mucus may be ejected from the mouth during the process, 
while other particles are retained between the teeth and cheeks, and may 
become more or less foetid. Catarrhal stomatitis may be present in 
some cases. The external region of the pharynx is very sensitive to 
pressure, and may be swollen, and cough is readily induced by palpation 
of the pharyngeal region. 

Cough is not a prominent symptom except in cases associated with 
laryngitis. In some instances it may be absent, except during attempts 
at deglutition. The cough in pharyngitis is generally of a soft, “ gur- 
eling”’ character. It may occur in paroxysms, and is followed by profuse 
nasa] discharge. The nasal discharge occurs from both nostrils. It 
originates from the pharynx, but, of course, when nasal catarrh is 
associated with pharyngitis, the discharge is of a mixed character. As 
generally met with, it is muco-purulent, opaque, and varies in colour from 
grey to yellow, and may be green, due to the cause already mentioned. 
In pharyngitis of a septic type, such as orginates from injuries of the 
pharyngeal mucosa, the nasal discharge is offensive and the breath is 
foetid, while the external region of the pharynx is extensively swollen. 
The degree of fever varies according to the severity of the case; in 
mild, instances the rise in temperature is very slight. The amount of 
constitutional disturbance present also varies in proportion to the degree 
of pharyngitis. Associated with laryngitis, the symptoms are much in- 
tensified and accompanied by respiratory phenomena, such as severe par- 
oxysms of coughing, dyspneea, stertorous breathing, etc. (see Laryngitis). 

CompLications.—Portions of food or fluids may enter the trachea, 
and set up broncho-pneumonia, especially if drenches be administered. 
Acute laryngitis may occur by extension of the inflammatory process to 
the larynx. The gastro-intestinal and articular complications described 
by some authors appear to us to belong to influenza, and not to pharyn- 
gitis. In such cases the pharyngitis is doubtless one of the phases of 
influenza, and not a disease per se. 

CoursEe.—In uncomplicated catarrhal pharyngitis the course is gener- 
ally short, varying from seven to fifteen days, and terminating in re- 
covery. The nasal discharge is the last symptom to disappear, and during 
convalescence it alters to a serous liquid. 

Proenosis.—In ordinary cases this is favourable, provided rational 


DISEASES OF THE PHARYNX : HORSE 39 


treatment be adopted. If, however, drenches be administered, there is 
always the risk of a portion of the fluid entering the trachea and bronchi 
and setting up broncho-pneumonia. When pharyngitis is complicated by 
laryngitis, the prognosis should be guarded. 

DIFFERENTIAL DracNnosis.—In uncomplicated cases the diagnosis is 
based on the presence of dysphagia, the extension of the head and 
protrusion of the nose, and the regurgitation of fluids by the nostrils 
in severe cases. 

As, however, the affection is frequently complicated with laryngitis, 
a differential diagnosis between these two conditions presents much 
difficulty. When the laryngitis is well marked, respiratory symptoms 
are more in evidence, the cough is distressing, and dyspnoea, which may 
be accompanied by a roaring sound, is present (see Laryngitis). 

Catarrhal pharyngitis is distinguished from the phlegmonous form of 
the disease by the absence of glandular swellings and of marked tume- 
faction of the external pharyngeal region. 

One of the greatest difficulties in the diagnosis of pharyngitis as a 
disease per se is experienced when we attempt to differentiate it from 
similar conditions of the pharynx occurring in connection with influenza 
and strangles. | 

Clinical experience teaches us that it is a wise plan to isolate all cases 
of pharyngitis and regard them as infectious, unless we have direct 
evidence that the condition has resulted from the administration of irri- 
tating medicaments, or from mechanical injuries. It is not uncommon 
to find a horse suffering from symptoms attributable to ordinary pharyn- 
gitis developing, after a variable period, a typical strangles abscess. 
Again, pharyngitis may occur as one of the primary conditions in in- 
fluenza, and spread from horse to horse in this form. 

If, as some authors state, there exists an infectious type of pharyngitis 
distinct from influenza, we have yet to learn on what grounds the differ- 
ential diagnosis is based. So far as bacteriological evidence is concerned, 
a distinction cannot be made, and certainly the clinical phenomena 
presented do not enable us to state definitely whether a given case is of 
the sporadic type, an infectious form, or one of the phases of influenza. 

Foreign bodies lodged in the pharynx or cesophagus induce symptoms 
simulating those of pharyngitis, but the symptoms appear suddenly, 
there is marked distress, and other special phenomena are manifested 
(see p.. 73). 

TREATMENT.—Attention to hygienic and dietetic details is necessary. 
Pure air is essential, and the food should be limited to bran mashes, 
oat-meal gruel, linseed tea, hay tea, milk, ete. The mouth should be 


40 SYSTEM OF VETERINARY MEDICINE 


cleansed with antiseptic solutions, such as those containing borax, chlorate 
of potassium, etc. In order to relieve the painful condition of the 
pharynx, electuaries containing extract of belladonna, chlorate of potas- 
sium, and camphor, with honey as the basis, are indicated. If the 
fever be high, quinine may be added to the electuary. On no account 
should drenches be administered, as they induce paroxysms of coughing, 
during which portions of the fluid may be drawn into the trachea and 
cause broncho-pneumonia. Medicated inhalations of steam are useful 
in allaying irritation of the pharyngeal mucosa and promoting free 
discharge from the nostrils; the steam may be medicated with pure 
terebene, oil of eucalyptus, camphor, or compound tincture of benzoin. 
Too long and too frequent inhalations should be avoided, as they distress 
the patient; also care should be taken to prevent scalding the nostrils. 

As regards local applications to the external pharyngeal region, some 
practitioners advise heat and moisture, such as a cataplasm composed 
of kaolin and glycerine. In our experience the best treatment is the | 
application of a cantharides blister ; this rarely fails to give relief, and the 
effect in overcoming the dysphagia is readily seen. In severe cases we 
apply the cataplasm mentioned over the blister. 

Salines may be given in the drinking water ; a supply of the latter 
should always be left within reach of the animal. 

Should constipation be present, enemas of soap and warm water 
should be administered. We cannot agree with the recommendation 
found in some textbooks that in such instances pilocarpine or eserine is 
indicated. The former agent induces copious salivation, and, as swallow- 
ing may be impossible, saliva is likely to be drawn into the trachea. 
The latter agent is far too violent a remedy to apply in a debilitating 
affection, especially when simpler measures are likely to succeed. 

When hyperpyrexia is present, Friedberger and Frohner advise the 
administration of antipyrin subcutaneously as a febrifuge, in doses of 
from 23 to 5 drachms dissolved in equal parts of sterilised water. 


II. Phlegmonous Pharyngitis. 


In this form the submucous tissue of the pharynx is involved, being 
infiltrated with a serous fluid and with hemorrhages, which become 
purulent. Abscesses form in the submucous tissue, or the lymphatic 
glands in the vicinity of the pharynx and larynx become involved, and 
abscesses form therein. The pyogenic micro-organisms extend from the 
submucous tissue to the lymphatic glands by way of the lymphatic vessels. 

Phlegmonous pharyngitis may be a primary affection, or it may 
follow an attack of the catarrhal form. The abscess formation in the 


DISEASES OF THE PHARYNX : HORSE 41 


glands is believed to depend on a more virulent type of micro-organism 
than that causing catarrhal pharyngitis. Although sporadic cases of the 
phlegmonous form are observed, it is more commonly met with as an 
enzootic. According to Friedberger and Froéhner, “ enzootic pharyngitis 
among horses, accompanied by suppuration, must always be regarded 
as strangles,” and with this view we entirely agree. 

The lymphatic glands involved may be the submaxillary, the sub- 
parotid (behind the condyle of the inferior maxilla), the peripharyngeal, 
which include the anterior group of the pharyngeal (on the lateral aspect 
of the pharynx) and the posterior group of same (on the side of the 
cesophagus), and the retropharyngeal. 

Symptoms.—In addition to the symptoms of catarrhal pharyngitis 
already described, we observe a more marked degree of fever and con- 
stitutional disturbance, while the lymphatic glands in the vicinity of the 
pharynx become swollen, painful, and cedematous, and the seat of abscess 
formation. The position of these swellings will vary according to the 
glands affected. When the submaxillary glands are involved, the 
condition presents an exactly similar aspect to that of strangles accom- 
panied by abscess formation in these glands. The swelling may occupy 
the intermaxillary space, and extend to the lips, cheeks, and pharyngeal 
region. The abscess. “ points,” as in strangles, and ruptures, dis- 
charging a whitish-creamy pus, or the pus may be of a thin, septic 
character, extending into the surrounding cellular tissue. When the 
peripharyngeal and subparotid glands are involved, dyspnoea may occur, 
and respiration is accompanied by a roaring sound. In some cases the 
various glands are implicated at the same time, and the affection may be 
bilateral. On the occurrence of abscess formation, rupture of the 
abscess may take place externally, or the pus may burrow by the side 
of the pharynx, and gain an entrance to the pharyngeal cavity, being 
finally discharged by the nostrils. 

When the retropharyngeal glands are involved, external swelling is not 
marked, and the abscess does not rupture externally. In some cases 
abscess formation does not occur, the glands are enlarged to a marked 
extent, and encroach on the pharyngeal cavity. The abscess, when 
present, may have very thick walls. Dyspnoea may be extreme, and 
respiration is accompanied by a loud roaring sound. Cadéac and other 
writers have observed localised sweating on the face, head, neck, and 
forearm ; this phenomenon is attributed to compression of the vagus, 
the superior cervical ganglion, or the great sympathetic nerves. 

COMPLICATIONS AND SEQUELZ.—Salivary Fistule may result when 
the abscess ruptures externally. 


49 SYSTEM OF VETERINARY MEDICINE 


Pharyngeal Fistula may occur when the abscess perforates the pharynx 
and establishes a communication between the latter and the skin of the 
pharyngeal region. Cases have also resulted from the surgical procedure 
in opening the abscess. 

Fistula of the Hsophagus is comparatively rare. Saliva and particles - 
of food enter the periceso}:: geal connective tissue and set up a purulent 
infection. Cases are recorded in which purulent materia] and food 
débris descend between the mucous and muscular coats of the cesophagus 
and reach the vicinity of the stomach. 

The Guttural Pouches may be involved and become filled with pus. 

Paralysis of the Pharynx has occasionally been observed as a result 
of phlegmonous pharyngitis. 

Postpharyngeal Abscess is also a sequel of the affection (see 
below). 

Broncho-Pneumonia may result from extension of the inflammation 
from the pharynx to the bronchi, but more frequently it is due to the 
entrance of saliva, portions of alimentary material, etc., nto the trachea 
and bronchi, owing to the dysphagia which is present ; if medicaments 
be administered in the form of drenches, they contribute to this result. 
Pulmonary gangrene generally occurs in such cases. Pyawmia and general 
septic infection are observed in some instances. 

DIFFERENTIAL Diacnosis.—As already remarked, it is impossible 
to differentiate the enzodtic form of phlegmonous pharyngitis from 
strangles, and even in sporadic cases considerable difficulty is experi- 
enced in this direction. 

TREATMENT.—lIn addition to the line of treatment advised for catarrhal 
pharyngitis, attention must be directed to the abscess formation in the 
glands. The indications for treatment are similar to those mentioned 
for strangles (see Vol. I.). A cataplasm composed of kaolin and glycerine 
should be applied to the swollen glands, and when there are indications 
of the presence of pus, the latter should be evacuated, great care being 
exercised in the surgical procedure, so as to avoid injury to important 
structures in the vicinity of the abscess. 

Postpharyngeal Abscess, also known as Suprapharyngeal or Retro- 
pharyngeal Abscess—By some authors this is regarded as a special 
condition, in consequence of its chronic nature. It occurs as a sequel 
to phlegmonous pharyngitis, and also to strangles and influenza, but in 
some instances its etiology is obscure. Robertson regarded the condition 
as an abscess situated in the walls of the pharynx in connection with the 
muscular and connective tissue. Williams described it as “a collection 
of pus situated in the cartilaginous division of the guttural pouches 


DISEASES OF THE PHARYNX : HORSE 43 


associated with strangles or otherwise. The pus being confined in the 
tough cartilaginous structures of the guttural pouches, the abscess is 
prevented from rupturing spontaneously.” 

Friedberger and Frohner, as well as Cadéac, describe the condition 
in connection with phlegmonous pharyngitis as an abscess formation in 
the retropharyngeal glands, in which, after a time, the pus undergoes 
caseation and calcification, and the structure of the glands becomes 
indurated and hypertrophied, leading to a diminution of the circum- 
ference of the pharyngeal and laryngeal regions, and the occurrence of 
a roaring sound during respiration. The external swelling is moderate 
in extent, or may be absent, and the symptoms commonly present are a 
wheezing or roaring sound during respiration, dysphagia, and in some 
instances a discharge from the nostrils. Occasionally the pus may find 
its way to the pharynx, and less frequently it may open externally in 
the parotid or intermaxillary region. On examination of the pharynx 
by the mouth a fluctuating swelling is found, which in extreme cases 
may occlude the posterior nares, displace the soft palate, and induce oral 
breathing. 

Postpharyngeal abscess is differentiated from abscess of the guttural 
pouches as follows: In the latter affection there is an external swelling, 
which is generally unilateral, and a discharge from the nostril occurs 
when the head is depressed, or when the external swelling is pressed by 
the fingers. 

The treatment is essentially surgical. Williams advised that the 
abscess should be opened by way of the mouth. After inserting a mouth- 
gag, the fluctuating portion of the swelling should be sought for, and a 
straight bistoury, covered with tow, except at the point, should be care- 
fully introduced, and the abscess punctured in the middle line, so as to 
avoid injury to the bloodvessels in the vicinity. The pus readily escapes 
by the mouth. 

Law advises that, when fluctuation can be felt externally, the abscess 
should be opened through the skin, care being taken to avoid injury to 
important structures. The technique is similar to that described for the 
opening of abscesses of the parotid gland (see p. 30). 


III. Pseudo-Membranous Pharyngitis (also known as Croupous or Pseudo- 
Diphtheritic Pharyngitis, and as Croupous or Pseudo-Diphtheritic 
Angina). 

This affection is characterised by the presence of false membranes 
in the mouth, fauces, and pharynx, and in some instances the mucosa 
of various regions of the body may be involved. It may occur either in 


44 SYSTEM OF VETERINARY MEDICINE 


a primary or a secondary form. These false membranes are resistant, 
and composed of fibrinous exudates arranged in layers, which enclose 
epithelium, pus-cells, and micro-organisms. They vary in colour, and 
may be of a greyish, yellowish, greenish, or blackish tint. Although 
sometimes termed “diphtheritic,” they have no relation to human 
diphtheria. 

Robertson* described an outbreak of so-called “ diphtheria ” in horses 
n which the mortality was very high, and evidences of severe pharyngitis 
were present ; the larynx and trachea were extensively involved in one 
instance. Although false membranes were present, and the cases were 
regarded as contagious, no real connection with human diphtheria could 
be traced. Pseudo-membranous pharyngitis’is described by several 
Continental writers, including Delafond, Targue, Dieckerhoff, Sonin 
and Cadéac. 

As regards the bacteriology of the affection, the most important 
micro-organisms are streptococci, the bacillus of necrosis, and the microbe 
of gangrenous septicemia. 

Hit1oLogy.—The presence of sharp-pointed foreign bodies in the 
pharynx, by wounding the mucosa, permits the entrance and de velop- 
ment of the pathogenic micro-organisms. Irritating medicaments and 
caustic agents also facilitate infection. The smoke from burning buildings 
may produce a similar effect. A secondary form of the disease may occur 
in connection with purpura hemorrhagica, strangles, and influenza. It 
is believed that the micro-organisms capable of producing the disease 
exist in the mouth of healthy animals, and only exert their effects when 
the mucosa is wounded, irritated, injured, or has its vitality lowered 
from any cause. 

Lestons.—In the early stages the false membranes already mentioned 
are found in the mouth, fauces, and pharynx ; the nasal cavities, colon, 
and cecum. may be involved in some cases. The superficial layers are 
easily detached, but the deep layers are more adherent, and if forcibly 
removed, slight hemorrhage may result. These false membranes quickly 
disappear, and are succeeded by necrotic foci ; the latter are found chiefly 
in the fauces and pharynx, they vary in size, are of a greyish, greenish, 
or blackish tint, and show prominent, irregular edges. In some instances 
they are circumscribed, and after eschars are detached, ulceration occurs, 
which extends to the adjacent muscles, and healing by cicatrisation 
may be observed. The gangrenous process may extend to the larynx, 
and absorption of toxic products may occur, resulting in broncho- 
pneumonia and various septic complications. The nasal mucosa is 


* Veterinary Journai, August, 1375. 


DISEASES OF THE PHARYNX : HORSE 45 


markedly congested, and may be covered by false membranes, which in 
some instances are very adherent. 

Symproms.—In the primary form the symptoms presented are those 
of a very acute pharyngitis, with a high degree of fever, accelerated 
respirations, dyspnoea, marked dysphagia, anxious expression of counte- 
nance, general debility, weak pulse, painful cough, easily induced by manip- 
ulation of the pharyngeal region, which is generally swollen, and the 
swelling may be accompanied by tumefaction of the glands in the vicinity. 
The nasal discharge is greyish or greenish in colour and fcetid. During 
a paroxysm of coughing portions of false membranes may be expelled 
in this discharge. The visible mucous membranes are injected, and may 
be icteric. In some cases evidences of intestinal catarrh are present, such 
as very foetid dejecta covered with mucus, or peristalsis may be completely 
arrested. On auscultation of the pharynx a gurgling sound is detected ; 
in severe cases the mouth is open, the tongue dark in colour and pendant. 
The course of the disease is rapid, and death may result in less than six 
days. A fatal result may occur from asphyxia, or from septic broncho- 
pneumonia, the latter being due to extension of the septic process to the 
trachea and bronchi. 

ProGNosis is always grave, and the mortality very high. 

DIFFERENTIAL Dracnosis.—The presence of portions of false mem- 
branes in the nasal discharge is the only diagnostic symptom, otherwise 
the real nature of the case may be overlooked, more especially in the 
secondary type of the disease. As compared with the other forms, 
pseudo-membranous pharyngitis is seldom met with in the horse. 

TREATMENT.—In addition to the measures advised for catarrhal 
pharyngitis, attempts should be made to bring antiseptic agents into 
contact with the pharyngeal mucosa. For this purpose electuaries 
containing naphthol, salol, boric acid, calomel, etc., are recommended. 
Inhalations of steam medicated with antiseptic agents, such as carbolic 
acid, cyllin, lysol, menthol, etc., should also be prescribed. Some 
authorities advise antiseptic mouth-washes and gargles, but during the 
process of bringing these into contact with the interior of the pharynx, 
the danger of some of the fluid entering the trachea and bronchi must be 
remembered, as this is prone to occur owing to the dysphagia and 
convulsive fits of coughing which are present. 


CHRONIC PHARYNGITIS. 


This condition may result from an acute attack of catarrhal pharyn- 
gitis, or it may commence as a subacute affection. It may follow a 
subacute or prolonged attack of strangles or influenza, and it 1s some- 


46 SYSTEM OF VETERINARY MEDICINE 


times associated with affections of the heart, kidneys, and liver, and with 
chronic gastric catarrh. The presence of the larve of Gastrophilus equa 
on the pharyngeal mucosa is an occasional cause of chronic pharyngitis, 
as, owing to the constant irritation set up, and probably to the minute 
punctures of the mucous membrane, the entrance of micro-organisms 
is facilitated. 

Lestons.—The pharyngeal mucosa is covered with a layer of thick 
viscid mucus. On removing the latter, the mucous membrane is thick- 
ened and wrinkled in appearance ; the lymph follicles and the mucous 
elands are hypertrophied and prominent. LHrosions and ulcers may be 
found in some cases. Minute abscesses, with their contents undergoing 
calcification, are sometimes observed. | 

Blane describes lesions of the tonsils, consisting of hypertrophy of 
the mucous crypts, which contain caseous or calcified pus. Ulcers under- 
going cicatrisation may be present. Trasbot has observed a granular 
fatty degeneration of the pharyngeal muscles with interstitial sclerosis. 
The mucous membrane showed on its surface a raised surface or he 
which interfered with respiration and deglutition. 

Symptoms.—The most prominent symptom is a cough, chronic in its 
nature, but subject to intermissions. It generally occurs in paroxysms, 
is often of a dry character, and is readily induced when the horse is 
feeding on dry fodder, or drinking cold water, or when the animal first 
leaves the stable and is put to exertion. Slight pressure on the pharyn- 
geal region may cause a paroxysm of coughing, but in some instances, 
although the animal resists the manipulation, pressure of the pharynx 
fails to induce coughing. This is said to be due to calcification of the 
laryngeal cartilages. 

Difficulty in swallowing may be observed at the commencement of 
feeding or drinking, but this usually disappears after the first few mouth- 
fuls have been swallowed. In some instances both solids and fluids are 
returned by the nostrils. Swelling of the pharyngeal region is present 
occasionally. A muco-purulent nasal discharge, slight in extent, may 
sometimes be observed, and the animal is generally in poor condition. 

TREATMENT.—Chronic pharyngitis very often proves most resistant to 
treatment. Attention to hygienic details is of importance, as hot, ill- 
ventilated stables are likely to exert an unfavourable influence on the 
course of the disease. A cantharides blister should be applied to the 
external pharyngeal region. An electuary containing belladonna, 
potassium chlorate, and camphor, should be administered three times 
daily. Inhalations of steam medicated with terebene prove beneficial. 
Some authors advise the inhalation of the fumes of heated tar. 


DISEASES OF THE PHARYNX : HORSE 47 


In obstinate cases the internal administration of arsenic and potassium 
iodide sometimes gives good results. Tar water in lieu of ordinary water 
is also useful. 

PARALYSIS OF THE PHARYNX. 


Judging by the small number of cases recorded, this affection appears 
to be rarely met with in Great Britain, but in Germany instances have 
been reported by several observers. Pharyngeal paralysis was first 
described by Ringheim in 1818, and in 1904 Markert observed it in an 
endemic form, three horses, five cattle, and a calf in one building being 
successively affected. Partial paralysis of the pharynx is more frequently 
met with than the complete form of the affection. This is explained by 
the extensive nerve-supply of the organ’; and when complete paralysis 
occurs, it is always of central origin. 

The nerve-supply of the pharynx is as follows : 

1. Pharyngeal Plexus, situated on the lateral walls of the pharynx, 
supplies all the pharyngeal muscles except the stylo-pharyngeus, and is 
formed by (a) filaments from the superior cervical ganglion of the sym- 
pathetic ; (b) the pharyngeal branch of the glosso-pharyngeal ; (c) the 
pharyngeal branch of the vagus. 

2. External Laryngeal, a branch of the superior laryngeal, supplies 
the crico-pharyngeus muscle. 

3. A branch from the glosso-pharyngeal supplies the stylo-pharyngeus 
muscle. 

Cadéac points out that, in consequence of this powerful and varied 
nerve-supply, paralysis of the pharynx is very rare; while that affection 
of the larynx known as “ roaring,” and generally depending on a lesion 
of the recurrent nerve, is very common. 

All authors agree that paralysis of the pharynx is nearly always 
associated with paralysis of the cesophagus. 

Etrotocy.—In many instances no definite etiological factors can be 
determined. The affection may depend on central or peripheral lesions. 

The Central lesions may arise from injuries to the cranial region, 
affecting the centres of origin of the ninth, tenth, and sympathetic 
nerves. The disease may also be associated with various nervous 
maladies, such as cerebro-spinal meningitis, progressive bulbar paralysis, 
rabies, etc, Some authors believe that the presence of rust and mould 
fungi, etc., in fodder may induce the affection, but there is no definite 
evidence to support this view. 

The Peripheral lesions may be due to various causes. Compression of 
the nerves along their course may result from the presence of tumours, or 
of abscesses in the case of phlegmonous pharyngitis and of strangles. 


48 SYSTEM OF VETERINARY MEDICINE 


Bassi recorded a case depending on ulceration of the guttural pouches 
which implicated the glosso-pharyngeal nerves. The affection has also 
been observed in connection with contagious pneumonia and influenza, 
probably depending on the action of toxins on the pharyngeal nerve- 
supply. Cases are also recorded which occurred subsequently to an 
animal falling in the stall and hanging from the halter-chain. Extensive 
pressure was thus exerted by the halter on the parotid region and sides 
of the maxilla, and lesions of the pharyngeal and superior laryngeal nerves 
were induced, resulting in paralysis of the pharynx. 
Symproms.—The leading symptom is dysphagia. This varies in 
degree according as the pharyngeal paralysis is partial or complete. In 
the case of the latter, swallowing, either of solids or fluids, is impossible, 
and regurgitation by the nostrils occurs. The affection may commence 
in a sudden manner, or the symptoms may gradually appear. Some 
observers record transient cases in which recovery is rapid. 

In cases of complete paralysis attempts at deglutition are followed by 
a paroxysm of coughing, and both solids and fluids are returned by the 
nostrils ; while a roaring sound during respiration and a nasal discharge 
are also observed. External swelling of the pharyngeal region and of 
the glands is absent. The soft palate may be paralysed. This may 
occur as a morbid condition per se, and is evidenced by dysphagia, or it 
may be associated with paralysis of the pharynx, in which case deglu- 
tition is impossible. 

In pharyngeal paralysis the animal is unable to drink, and efforts to 
do so.are followed by extension of the head, accompanied by a gurgling, 
snoring sound ; and when a bucket of water is placed before him, he 
plunges his nose into the fluid, but is unable to drink it. But Fried- 
berger and Frohner point out that inability te drink may occur inde- 
pendently of pharyngeal paralysis in both adults and foals, and record 
cases in which horses were able to masticate and swallow dry food in a 
normal manner, but could not drink water. The cause suggested was some 
defect in performing movements of suction, probably of congenital origin. 

The larynx may be involved through implication of its nerve-supply. 
Roaring is produced, and septic broncho-pneumonia may result from the 
entrance of débris of food, saliva, and fluids into the trachea and bronchi. 

The animal loses condition rapidly, and succumbs from inanition in 
a variable period, or from pulmonary complications. 

Other complications recorded are—Paralysis of the facial nerve, with 
its train of symptoms ; atrophy and gangrene of regions supplied by the 
implicated nerves; oral and snuffling respiration, due to paralysis and 
closure of the alee of the nostrils. 


DISEASES OF THE PHARYNX : HORSE 49 


Prognosis.—This is unfavourable, especially in complete pharyngeal 
paralysis. 

DIFFERENTIAL D1AGNosis.—This is carried out by a manual examina- 
tion of the mouth, fauces, and pharynx. If one finds an absence of 
local lesions, and if the symptoms mentioned above are present, a 
diagnosis of pharyngeal paralysis may be made. In doubtful cases, 
‘some authors suggest that an exploratory laryngotomy should be per- 
formed in order to determine whether the larynx is in a normal condi- 
tion or otherwise. This is carried out by incising the crico-thyroid 
ligament. It is not possible in many instances to differentiate paralysis 
of the pharynx from paralysis of the cesophagus (see p. 59). 

TREATMENT.—This often proves unsatisfactory. Nutrient enemata 
are required when the pharyngeal paralysis is complete. Hypodermic 
injections of strychnine are advised in order to overcome the inertia of 
the pharyngeal muscles. When constipation is present, a hypodermic 
injection of eserine is indicated. LElectricity applied to the affected 
pharyngeal area should prove beneficial, but, in consequence of the 
resistance of the horse to the procedure, it is seldom practicable. A 
cantharides blister may be applied to the external pharyngeal region. 


PARASITES OF THE PHARYNX. 


_ Céstridee.—The larvee of the Gastrophilus equa and of the G. hemor- 
rhoidalis may occasionally be found attached to the pharynx, the soft 
palate, the epiglottis, the Eustachian tube, and the nasal cavities. The 
larvee of the G. hemorrhoidalis are the variety generally found in these 
regions, as the fly, unlike the common species, lodges its ova principally 
on the lips and nostrils of the horse. In Austro-Hungary, Andalusia, 
and Africa, a variety termed the G. purpureus occurs, and the larvee are 
not infrequently found on the pharyngeal mucosa. 
_ Symproms.—The presence of the larve induces a condition of chronic 
pharyngitis. Difficulty in mastication and deglutition is observed. In 
some cases ptyalism, dyspneea, a paroxysmal dry cough, and a roaring 
sound during respiration, may be present. Acute pharyngitis and 
evidences of asphyxia have also been observed. 

Lestons.—Chronic pharyngitis may be found, but in some cases the 
l arvee may be present in the absence of thislesion. Buffington recorded a 
case in which the mucosa of the nasal cavities, pharynx, larynx, and upper 
region of the cesophagus, showed evidences of necrotic changes. Viltry 
found the larve attached to the borders of the epiglottis, causing death 
by asphyxia. Limann found fourteen of the larve attached to the 

VOL. I. 4 


50 SYSTEM OF VETERINARY MEDICINE 


pharyngeal mucosa, and pharyngitis complicated with broncho-pneu- 
monia was induced, resulting in death. 

TREATMENT.—The larvee must be detached by the hand after the 
insertion of a mouth-gag ; or this procedure can be carried out by means 
of a sound or stick, having the end enveloped in lint soaked in olive oil. | 
Inhalaticns of the fumes of heated tar are also advised. 

Heemopis.—The Hemopts sanguisuga of the horse (the horse leech) is 
found in all parts of Kurope, but is especially prevalent in the north of 
Africa, Tunis, Algeria, and Syria, being more common during the summer 
months. The young specimens of this parasite enter the body with 
the drinking water, and become attached to the inside of the cheeks, 
the frenum of the tongue, behind the soft palate, or the fauces, and may 
reach the nasal mucosa or even the trachea. The adults may enter the 
anus and vulva, after becoming temporarily attached to the limbs, 
when the animals are standing in ponds infested with the parasites. 

Symproms.—These vary according to the number of parasites present. 
The most important is hemorrhage, which results not only from the 
amount of blood withdrawn by the parasites, but also from the punc- 
tures which occur in the mucous membranes when the leeches are 
detached. From the constant loss of blood a condition of anemia is 
produced, Hpistaxis and dyspnoea are often observed. If the parasites 
become attached to the entrance of the larynx, asphyxia may result. 
When the parasites are present in very large numbers, the animal 
may die from anemia or from hemorrhage. 

The DIAGNOSIS is based on the discovery of the parasites in accessible 
regions, but the examination must be carefully carried out. 

In fatal cases the lesions found are those of anemia. An cedematous 
condition of the mucous membranes is observed, and there are numerous 
ecchymoses, which are red at the periphery and black in the centre, 
resulting from the bites of the parasites. 

TREATMENT.—When the parasites are accessible, they must be de- 
tached with the hand, or each may be divided into two parts. They are 
firmly fixed and not easy to detach. When occurring in deep-seated 
localities, in the region of the head and throat, inhalations of the fumes 
of heated tar are advised, also injections of vinegar, decoction of tobacco, 
or weak solutions of sulphate of zinc. 

Blaise advises inhalations of fumes obtained by slowly heating a mix- 
ture of oil of turpentine, sulphuric ether, and tar. When attached to the 
larynx, and evidences of asphyxia arise, tracheotomy must be performed. 
If anemia be present, the patient will require suitable dietetic and 
medicinal treatment. In districts where these parasites are common 


DISEASES OF THE PHARYNX: HORSE 51 


attention must be directed to the water-supply, which should be suitably 
filtered so as to remove the parasites, or the animals should be allowed 
to drink through a fine wire gauze net. According to Lemichel, if eels 
are placed in the water, they devour the parasites, and he has carried 
out this preventive measure at Mustapha. 


WOUNDS AND LACERATIONS OF THE PHARYNX. 


These may result from the presence of sharp-pointed foreign bodies, 
such as needles, pins, portions of wire, etc., which tend to perforate the 
walls of the pharynx and find their way to the surface of the skin. 
The careless employment of instruments during dental operations may 
produce wounds or lacerations of‘ the pharynx, and the organ may be 
injured by rough manipulation of the probang in cases of choking, or of 
articles improvised for a similar purpose. In such instances rupture of 
the pharyngeal wall may be produced, and the resulting wound becomes 
septic from the entrance of portions of ingesta and saliva. The pernicious 
custom of administering a bolus by means of a pointed stick has on many 
occasions caused a wound of the pharynx with very serious results. 
Cases are recorded of fracture of the hyoid bone due to injuries and 
falls in which one of the portions of the bone caused a wound of the 
pharynx. The pharynx may be wounded when deep-seated abscesses 
in this region are being surgically treated. A fistula may result, and 
this may also supervene when a peripharyngeal abscess, in the case of 
strangles or of phlegmonous pharyngitis, opens simultaneously into the 
pharynx and externally on the skin. Such fistule are generally situated 
beneath the pharyngeal region, but in some instances they open in the 
intermaxillary space. 

Symproms.—These vary according to the extent of the lesion. 
Hemorrhage from the nostrils is observed, and in an extensive wound 
the blood may enter the trachea and bronchi, giving rise either to 
asphyxia or to broncho-pneumonia. In superficial wounds a pharyngitis 
is set up, which, however, tends to recovery. But when the entire thick 
ness of the pharyngeal wall is penetrated, saliva and portions of food 
enter the wound, septic inflammation is induced, which may be followed 
by abscess formation, ulceration, or even gangrene and general septi- 
_ cxemia. 

Septic pharyngitis as the result of a wound is characterised by high 
fever and extensive swelling of the pharyngeal regicn. Deglutition is 
impossible, either of solids or fluids ; salivation is profuse. The secretions 
of the mouth, the nasal discharge, and the expired air, are foetid. Marked 
dyspncea may be present, sometimes accompanied by a roaring sound, 


hows 


_. : 
Sew ae Hot 3, 


52 SYSTEM OF VETERINARY MEDICINE 


Retching, followed by a discharge of saliva mixed with alimentary 
matters from the nostrils, is sometimes observed. In some cases the 
pus may extend between the muscles, follow the course of the esophagus 
and trachea, and reach the thoracic cavity, setting up purulent pleuritis. 
A similar result has been met with in cases of fistula of the pharynx. 

TREATMENT.—In slight wounds and lacerations the treatment is similar 
to that advised for pharyngitis. Only sloppy food should be allowed. In 
more severe cases antiseptic mouth-washes are indicated. When the 
laceration is extensive, the case often proves fatal. Law suggests 
that, as a last resort, the septic pouch should be opened externally, 
the contents removed, and the wound in the pharynx thoroughly 
cleansed and sutured, and repeated irrigations with antiseptic solu- 
tions should be carried out. Fistula of the pharynx is to be treated 
according to the ordinary surgical principles for such conditions. Cadéac 
draws attention to the danger of injecting fluids into the pharynx, as 
they may enter the trachea and set up broncho-pneumonia. 


FOREIGN BODIES IN THE PHARYNX. 


This condition is not of frequent occurrence in the horse, as such 
bodies generally pass on to the cesophagus. Portions of timber, sharp 
ends of sticks, needles, pins, hairpins, etc., are among the articles that 
may become implanted in the pharyngeal mucosa. Cases are recorded 
in which a ball administered for medicinal purposes has become lodged in 
the pharynx (see p. 70). 

Symptoms.— The following are those most commonly observed : 
Dysphagia, varying in intensity, salivation, and violent fits of coughing. 
Some authors record the presence of spasm of the pharynx, intense 
dyspneea, and roaring. For further description of symptoms, see 
Choking, p. 70. 

TREATMENT.—On examination of the mouth by means of a mouth- 
gag, the foreign body, if within reach of the hand, can be extracted. 

When this is impossible, some authorities advise that laryngotomy be 
performed, and the pharyngeal cavity explored by this route. 


TUMOURS OF THE PHARYNX. 


These are not common in the horse, as compared with other animals. 
Hpitheliomata, carcinomata, sarcomata, lipomata, and, rarely, papillo- 
mata, have been met with ; also retention cysts. Fibro-myxomata occur 
in the form of polypi, and when displaced they enter the glottis and 
cause dyspnoea and roaring. 

Symptoms.—Evidences of chronic pharyngitis are present. Deglu- 


DISEASES OF THE CG&SOPHAGUS : HORSE 53 


tition is difficult, and in some cases may be impossible. Amongst other 
symptoms, salivation, cough, attacks of dyspnoea accompanied by 
epistaxis, and roaring, may be observed. Attempts at vomition and 
regurgitation of ingesta sometimes occur. 

In the case of a pedunculated tumour (polypus), the symptoms are 
intermittent, and due to displacement of the tumour between the arytenoid 
cartilages, or even into the glottis. During repose nothing abnormal 
may be detected, but when the animal is exercised or is feeding, an attack 
of intense dyspnoea with roaring occurs. 

DIFFERENTIAL D1acnosis.—The history of the case, the absence of 
swelling in the external pharyngeal region and of evidences of phlegmonous 
pharyngitis, and a careful examination of the pharynx by way of the 
mouth, will prove of marked assistance in diagnosis. At the same time 
the presence of the tumour may be overlooked. Some authors advise 
that in doubtful cases an exploration of the pharynx should be made by 
opening the larynx (laryngotomy) in a similar manner to that adopted 
for the operation of stripping the ventricles in the treatment of roaring. 

TREATMENT.—This is essentially surgical. The malignant tumours are 
generally inoperable, as they have an extensive base. In the case of 
pedunculated tumours, which can be manipulated from the mouth, they 
can be removed by means of the écraseur. But when they are voluminous 
and sessile, and situated far back in the pharynx, removal by way of the 
mouth is impossible, and we must resort to laryngotomy or pharyngotomy. 
For full details of these operations the reader is referred to “ Pathologie 
Chirurgicale de l’Appareil Digestif,” par Cadéac. 


DISEASES OF THE G@SOPHAGUS. 


GENZRAL REMARKS. 


Diseased conditions of this organ are of comparatively rare occur- 
rence in the horse, and a differential diagnosis is attended with great 
difficulty. Theoretically, a description of the various lesions can be 
given with facility, but it is generally admitted that in many instances 
the exact pathological condition present is only revealed at the autopsy- 
Moreover, it is not uncommon to find more than one lesion of the ceso- 
phagus associated in a given case. When the organ is affected in its 


54 SYSTEM OF VETERINARY MEDICINE 


thoracic or abdominal portions, a differential diagnosis is still more 
difficult. The symptoms presented in the various conditions are by no 
means diagnostic, and in many instances it is even impossible to differ- 
entiate morbid alterations occurring in this organ from “ choking ” due 
to the presence of a foreign body in its inferior divisions. 


CGESOPHAGITIS (INFLAMMATION OF THE GESOPHAGUS). 


GENERAL RemMARrKS.—As pointed out by Friedberger and Froéhner, 
sufficient attention is not directed to morbid conditions of the cesophagus 
during autopsies, hence our knowledge of the alterations produced by 
inflammatory action is neither extensive nor definite. Clinically speak- 
ing, inflammation of this organ is not a common condition, and this is 
accounted for as follows: (1) On anatomical grounds; the epithelial 
lining is thicker and less sensitive than that of the mouth, fauces, and 
pharynx. (2) Irritants are generally rejected by the animal after they 
have reached the mouth ; but even when swallowed their passage through 
the cesophagus has been rapid, hence the injury inflicted on the mucosa 
is likely to be far Jess than in the case of the buccal and pharyngeal 
regions. Although the lesions produced by irritants are not so severe 
in the cesophageal mucosa as in other regions, it is of importance to 
remember that they may prove more serious in their after-effects, as, 
in consequence of the tendency to cicatricial contraction, organic altera- 
tions may be produced, leading to stenosis of the organ. 

As in the case of pharyngitis, the various structures composing the 
cesophagus may be involved in the inflammatory process—+.e., the 
mucous membrane, the submucosa, the muscular coat, and the peri- 
cesophageal connective tissue—hence the following varieties of the 
affection are recognised—viz., catarrhal, phleqmonous, parenchymatous, 
and eri-esophageal. Clinically, however, it is by no means easy, nor 
is 16 possible in many instances to differentiate these various forms. 

Etrotogy.—The catarrhal form may occasionally be due to an ex- 
tension of the inflammatory process from an existing pharyngitis. 

Medicaments of an irritant or caustic nature, administered in error 
or insufficiently diluted, set up cesophagitis, which varies in severity 
according to the nature of the causal agent. In such instances the lesion 
extends along the entire length of the mucosa, and a pseudo-mem- 
branous inflammation may sometimes be produced. According to 
some authors, ulcerous changes have been observed in the cesophagus 
of horses after the administration of undissolved tartar emetic. Food 
of a hard nature, insufficiently masticated, such as occurs in the case 
of an aged animal, or in one suffering from an affection of the mouth, 


DISEASES OF THE CESOPHAGUS : HORSE 55 


may injure the cesophageal mucosa and produce a septic inflammatory 
condition. 

The presence of sharp foreign bodies, such as needles, pins, thorns, 
etc., has a similar effect. The careless introduction and manipulation 
of the probang in cases of “choking” may produce lesions varying in 
extent from bruises and slight abrasions or wounds of the mucous mem- 
brane to perforation of all the coats of the organ. Infection of such 
lesions readily occurs, and areas of necrosis may result, the severity of 
the inflammatory process depending on the extent of the original injury. 
A parasitic cesophagitis is recognised, due to the presence of the larves 
of the G. equa in the terminal portion of the cesophagus. A localised 
inflammation is produced, and some observers record a septic infection 
of the minute wounds inflicted by ‘the parasites. _ 

A secondary form of cesophagitis may be met with during the course 
of affections such as strangles and purpura hemorrhagica. Cadéac has 
observed the occurrence of ulcers in the cesophageal mucosa following 
various general infections. 

Morsip ANAtomy.—The lesions vary according to the intensity of 
the affection. In the catarrhal form, which is superficial in character, the 
alterations observed are congestion of the mucosa and desquamation 
of the epithelium. In more severe cases erosions and circumscribed 
hemorrhages occur, and the submucous connective tissue is involved, 
being infiltrated and showing ecchymoses. 

Chronic catarrh is observed in some instances. According to Fried- 
berger and Frohner, this is characterised by a tendency to papillary 
proliferations, explained by the fact, demonstrated by Schiitz, that the 
cesophageal mucous membrane, especially in cattle, resembles the skin 
in structure, hence chronic catarrh in both presents pathological changes 
resembling each other. Vegetations on the mucosa and stenosis of the 
organ have also been observed as the result of chronic catarrh. 

Amongst other lesions met with are—Superficial ulcerations in the 
lower two-thirds of the organ ; the presence of a simple ulcer terminating 
in stenosis due to cicatricial contraction, the usual location of which is 
in the upper third of the cesophagus or close to its termination. Necrotic 
areas may also be observed, which may involve the muscular as well 
as the mucous coat. Occasionally cesophagitis terminates in abscess 
formation in the submucous and pericesophageal tissues, and an abscess 
_is observed, especially in the cervical region. As sequela to the above 
lesions, strictures or dilatation of the cesophagus may result. 

Symptoms.—In mild cases of catarrhal cesophagitis symptoms are 
not well marked, and the condition is likely to be overlooked, In severe 


56 SYSTEM. OF VETERINARY MEDICINE 


cases dysphagia is a prominent symptom, the head is extended on the 
neck, and the animal makes frequent attempts to swallow ; but the food 
is recurgitated and rejected by the nostrils, previous to which act a 
wave is observed extending along the jugular furrow from below upwards. 
Coughing in paroxysms, salivation, pain on palpation over the region of 
the cesophagus, localised when the affection is of traumatic origin, and 
spreading when due to other causes, are amongst other symptoms 
observed. The cesophagus may feel rigid or cedematous, and spasms 
of the organ with regurgitations may be present in some instances. 
When abscess formation occurs, fever, increase of local pain and of 
dysphagia, and the presence of a localised tender swelling in the left 
jugular furrow, are observed. 

As complications, perforation of the gullet, putrid infection of the 
surrounding tissues, septic pleurisy, septic peritonitis, and general 
septicemia, may be mentioned. Sclerosis of the mucosa and sub- 
mucous connective tissue, with stricture of the gullet, may occur as a 
sequel to acute cesophagitis. 

. Proanosis.—In simple catarrhal cesophagitis this is favourable ; 
recovery generally ensues in from one to two weeks. In the severe forms 
the prognosis must be guarded, as complications may set in, and also 
serious sequele may result. 

DIFFERENTIAL Dracnosis.— The affection is differentiated from 
pharyngitis by the absence of swelling and of tenderness on palpation of 
the external pharyngeal region. It must be remembered, however, that 
both affections may coexist in the same animal. From “choking” 
cesophagitis is distinguished by the symptoms being less urgent and 
distressing in the latter condition, and usually only manifested when 
the animal attempts to swallow either liquids or solids. 

TREATMENT.—In cases arising as the result of irritating or caustic 
medicaments, demulcents should be given, such as linseed tea, barley 
water, etc., and the food restricted to milk, oatmeal-gruel, etc. An 
electuary containing potassium chlorate and belladonna, with honey as 
a basis, will relieve the dysphagia. Some authors advise the applica- 
tion of a vesicant to the region of the jugular furrow, but Friedberger 
and Frohner consider that counter-irritation is useless. Cadéac points 
out that vesicants may produce a dangerous swelling, and he restricts 
their employment to cases of parenchymatous cesophagitis, or to those 
in which the pericesophageal tissue is inflamed. 


DISEASES OF THE CESOPHAGUS: HORSE 57 


C2SOPHAGISMUS (SPASM OF THE G&SOPHAGUS). 


GENERAL REMARKS.—Spasm of the cesophagus may occur as a purely 
nervous condition, depending on unknown causes, and independent of 
any organic lesion of the organ. This form is rather rare. In the majority 
of instances a lesion of the cesophagus is present, such as constriction, 
dilatation, or ulceration, etc., but it is generally admitted that a neuro- 
pathic element exists as well in such cases. However, spasm of the 
cesophagus does occur as a Symptom in cases of constrictions and dilata- 
tions of this organ. The condition is characterised by an abnormal 
contraction of the cesophagus, accompanied by dysphagia and regurgita- 
tion of solids and fluids, associated with marked distress, and occurring 
in a spasmodic manner. The affection tends to recur. Cadéac records 
an instance in which the attacks occurred at intervals during a year and 
a half, and Roy has observed five attacks in the same animal during a 
period of five years. Robertson* regarded the affection as a functional 
derangement of the cesophagus “ of irregular and uncertain occurrence, 
showing itself on particular occasions without apparent cause, and 
disappearing in the same erratic manner.” 

Htrotogy.—As already remarked, the cause of the affection in some 
instances cannot be determined. According to some authors, a nervous 
element is present in every case, but is generally accompanied by a lesion 
of the cesophagus. The ingestion of very cold water, or of too hot food 
or liquid, or of a bran-mash improperly prepared by being too thick, 
are said to act as exciting causes. Occasionally the condition occurs 
after anzesthesia induced by chloral hydrate or chloroform, and it has been 
known to follow hypodermic injections of morphine. 

The following conditions of the cesophagus have been found in cases 

presenting symptoms of cesophagismus—viz., wounds of the gullet, the 
presence of foreign bodies, tumours in the vicinity of the cesophagus, 
constrictions, dilatations, and ulcerations. 
- (CKsophagismus is also a symptom met with in cases of epilepsy and 
rabies. Law has observed a casein which the autopsy revealed the 
presence of the larvee of G. equi, attached to the inferior extremity of the 
esophagus close to the cardia, and regarded these as the cause of the 
condition. 

Symproms.—The symptoms appear suddenly, and as a rule when the 
horse is feeding on foods such as bran. The animal abruptly ceases to 
feed, extends the head on the neck, inclines the nose towards the ground, 
or points it towards the sternum, shows marked distress, champs the 


* “The Practice of Equine Medicine.” 


58 SYSTEM OF VETERINARY MEDICINE 


jaws ; a thick saliva issues from the commissures of the lips ; uneasiness, 
even amounting to slight colicky pains, may be observed ; there are fre- 
quent attempts at deglutition, during which distinct wavy movements 
may be seen along the course of the esophagus, followed by regurgita- 
tion of saliva and other fluids. In some cases so severe is the spasm 
that at its first appearance, while the animal is feeding or drinking, the © 
material, either solid or fluid, is instantly regurgitated by the nostrils 
when swallowing is attempted. In other instances the material is able 
to pass along the cervical portion of the gullet, but is arrested below 
this, and regurgitated after a brief interval. 

Attempts at vomition may be observed, the act being occasionally 
accompanied by a sharp cry, and sometimes by a hissing sound produced 
in the laryngeal region; at the same time a thick, ropy liquid, mixed 
with saliva and mucus, issues from the mouth and nostrils. Asa rule the 
material regurgitated is composed of saliva and mucus, as no food is taken 
from the commencement of the symptoms. On palpation the cesophagus is 
felt as a firm cord, very painful to pressure, and manipulation of it may 
increase the evidences of spasm. On auscultation of the organ, a gurgling 
sound of a jerky character is revealed. Cough occurring in paroxysms 
results from the entrance of saliva into the larynx, and respiratory dis- 
tress with sweating may be observed in some instances. 

In mild cases there may be simply an arrest of a portion of food in 
the cesophagus, the spasm not being sufficient to cause ejection, and 
after a short period it passes on to the stomach. In rare instances an 
accumulation of food occurs, evidenced by an external swelling, gradually 
increasing in an upward direction, and regurgitation may take place 
with but a slight degree of spasm. Cadéac records a case in which 
during the attack the bolus of food could be seen moving energetically 
up and down the cesophagus ; the upper lip was retracted at intervals, 
and showed frequent vermicular movements. 

CoursE.—The duration of the attack varies. In some instances the 
acute symptoms last for a few minutes, and recur at irregular intervals ; 
during the latter the animal appears fatigued and dull, and may rest his 
head on the manger. In other cases the attack may last for one, two, 
or even five hours. As already mentioned, relapses are liable to occur 
in a variable period. Recovery may set in rapidly in some cases ; in 
others it is delayed. Attention to diet may prevent a recurrence in 
some instances, but in those depending on incurable lesions of the 
cesophagus the prognosis is unfavourable. 

DIFFERENTIAL Dracnosis.—The sudden appearance of the symptoms, 
and their rapid disappearance in some cases, 1s an important diagnostic 


DISEASES OF THE G&SOPHAGUS : HORSE 59 


feature. The employment of the probang will give valuable assistance, as 
by this means the spasm is generally overcome. Moreover, the presence of 
a constriction may also be discovered. 

TREATMENT.—Some practitioners advise that the probang be passed, 
as this overcomes the local spasm, but the process may require to be 
repeated. In cases where the gullet is obstructed by soft ingesta, the 
probang should not be used, but the employment of the stomach-tube 
to remove the material by irrigation is indicated (see Choking, p. 80). 
Antispasmodics are advised, such as bromide of potassium in large 
doses; but it must be remembered that, except between the spasms, 
such agents cannot be administered, as swallowing is impossible. Hence 
hypodermic injections are preferable, and morphine has been found to 
give good results. Cadéac advises valerianate of atropine, 2 centigramme 
to be given three times a day at intervals of three or four hours. Chloral 
hydrate may be administered per rectum. Hot fomentations and the 
application of spirits of camphor to the region of the gullet are said to 
assist in relieving the spasm. With reference to preventive measures, 
attention to diet is necessary, and those foods which tend to induce the 
condition in a given case should be avoided. 


PARALYSIS OF THE GESOPHAGUS. 


This condition is so frequently associated with paralysis of the 
pharynx that some authors describe both affections together. Accord- 
ing to Moller, “no strict division or sufficient points of distinction can 
be made between paralysis of the pharynx and cesophagus.” The same 
author also states that some of the recorded cases of paralysis of the 
cesophagus really depend on structural changes in the organ, or on the 
presence of foreign bodies. 

Other authors state that in exceptional instances cesophageal paralysis 
may occur as an independent affection, the distinguishing feature being 
that, when pharyngeal paralysis is absent, food is able to enter the 
cesophagus until the organ becomes distended. 

It must be remembered, however, that in dilatation, stricture, and 
impaction of the cesophagus, a condition of paralysis of the organ may 
occur, with its attendant phenomena. The contraction of the cesophagus, 
by means of which alimentary matters pass on to the stomach, is a 
reflex action, the centre for which exists in the medulla. When 
food enters the fauces, afferent impulses are sent to the centre for 
deglutition by branches from the fifth and superior laryngeal nerves, 
the efferent impulses are conveyed to the constrictor muscles of the 
pharynx by the vagus and glosso-pharyngeal nerves, to the tongue by 


60 SYSTEM OF VETERINARY MEDICINE 


the hypoglossal, and to the muscles closing the glottis by the recurrent 
laryngea] nerves. ‘The peristaltic wave passing down the cesophagus 
is produced by impulses sent out from the centre through the vagus, 
and is not due to the nerve handing on a contraction by direct conduc- 
tion from one layer of the muscular wall of the cesophagus to the next.* 
Hence disorders of innervation may be of central origin, or depend on — 
peripheral causes. 

EtioLogy.—The etiological factors concerned in paralysis of the 
cesophagus are as follow: Paralysis of the centre of deglutition occurring 
in connection with cerebral concussion, cerebral hemorrhage, tumours of 
the brain, and subacute encephalitis. The condition is also met with in 
cases of rabies. According to some authors, poisoning by pathogenic 
fungi (mould-fungi) may induce paralysis of the centre of deglutition. 

Local causes believed to act in a peripheral manner are—Inflamma- 
tion of the cesophagus extending to the muscular coat, and a secondary 
cesophagitis occurring during the course of strangles and purpura hemor- 
rhagica. 

Moller has observed cases occurring during convalescence from in- 
fectious diseases, also as the result of injuries to the vagus, and as a 
sequel to the operation of arytenoidectomy. Law observed a case 
depending on the attachment of larvee of G. equa at the lower end of the 
gullet. Other authorities have met with cases in which no apparent 
cause could be discovered. 

At post-mortem examinations an accumulation of food may some- 
times be found in the cesophagus, without any lesion of the organ being 
apparent. This is believed to depend on cerebral paralysis occurring at 
the moment of death. 

Symptroms.—When the pharynx is involved as well as the cesophagus, 
the symptoms already mentioned as occurring in the former condition 
(see p. 48) predominate. In complete paralysis of the pharynx it is 
clear that but little, if any, food can reach the cesophagus; but in the 
incomplete form a limited amount enters and is quickly regurgitated by 
the nostrils. 

According to Cadéac, when the pharynx is not involved, the con- 
traction of its walls forces the bolus of food into the cesophagus, through 
which it passes by the force of gravity, as the organ becomes in reality 
an inert tube, the power of peristaltic contraction being absent. The 
food tends to accumulate in the gullet, and may fill up the entire tube, 
so that on examination of the left jugular furrow the organ is found as 
a hard rope-like body, and the condition is in reality one of paralysis 


* F. Smith, ‘‘ Veterinary Physiology.” 


DISEASES OF THE GSOPHAGUS : HORSE 61 


with impaction. In the less severe cases, however, the contents are 
regurgitated, this symptom being associated with inability to swallow, 
salivation, etc. 

It is said that paralysis of the cesophagus does not interfere with the 
swallowing of liquids. It is clear, however, that when impaction of 
the organ is present, the deglutition of fluids is impossible. When the 
condition depends on nervous diseases, symptoms of the latter will be 
associated with those of cesophageal paralysis. 

CouRSE AND Duration.—In rare instances a spontaneous recovery 
may take place. Cases are recorded in which the animals lived for three 
months, and then succumbed in a cachectic condition. A fatal termina- 
tion may occur from impaction of the cesophagus. Gangrenous pneu- 
monia may result from the entrance of portions of alimentary matter 
into the trachea. 

TREATMENT.—When impaction of the organ occurs, the employment 
of the probang is advised by many authors, but there is grave danger of 
serious injury resulting from its use, as the cesophageal walls are very 
easily ruptured in their paralysed and distended condition, and the 
effect of the probang is to convert the ingesta into a hard mass. A 
more rational method of treatment is to employ the double tube designed 
for irrigation of the stomach. For directions as to its use see Obstruc- 
tion of the Gsophagus (p. 80). 

In cases not characterised by impaction, also in those where this 
condition has been relieved, nerve stimulants are indicated, such as the 
hypodermic injection of strychnine, with a view to overcoming the para- 
lysis of the gullet. Mdller, however, states that such agents are of little 
use. Counter-irritation to the region of the cesophagus and galvanism 
are advised. The food should be restricted to gruels and milk. When 
the affection depends on central nervous lesions, treatment cannot be 
expected to prove of any service. If associated with organic aflections 
of the gullet, these must receive attention (see p. 65). 


DILATATION OF THE CGESOPHAGUS. 


This condition is of comparatively rare occurrence. It is usually 
described under the headings of—(1) Ectasis ; (2) Diverteculum. 

1. Ectasis is generally applied to a diffuse dilatation of the oesophagus, 
which may be spmdle-shaped, or may involve the entire organ. The 
mucous and muscular coats become dilated, and the condition is generally 
associated with constriction of the organ (stenosis). As the result otf 
the stenosis, progressive dilatation occurs above the constriction, due 
to pressure of food, which is prevented from passing downwards by the 


62 SYSTEM OF VETERINARY MEDICINE 


narrowing of the tube. In exceptional cases ectasis may be present 
without stenosis, and in such is ascribed to local inflammatory GbE 
in the cesophageal walls, or to injuries. 

The muscular coat is at first hypertrophied, but subsequently may 
become degenerated. There is, however, no rupture of this coat, such - 
as occurs in a diverticulum of the organ. 

2. Diverticulum.—This is the term applied to a circumscribed dilata- 
tion of the cesophagus, in which there is a rupture of the muscular coat 
and protrusion of the intact mucosa through the opening. The condi- 
tion is also known as an w@sophagocele, and is termed by French authors 
jabot, by reason of the resemblance of the dilated portion to the crop of 
a bird. 

EtroLtogy.—As regards the etiology of the affection, it is generally 
admitted that certain morbid alterations occur in the muscular coat, 
such as relaxation, weakness, and atrophy, depending on loss of nerve 
power or inflammation set up in the adjoining tissues. When such 
alterations are in existence, there are two factors which are instrumental 
in producing a diverticulum. 

(a) Pressure from with, such as that exerted by a hard bolus of 
food, especially of a rough and prickly nature, in the case of old horses 
with dental irregularities. The lesion often occurs at the lower portion 
of the cervical division of the cesophagus, but more frequently is found 
close to the entrance of the organ into the abdominal cavity. The 
anatomical peculiarity of the cesophagus of the horse—viz., being 
normally thick and narrow in the thoracic portion and at the cardia— 
explains why the diverticulum more commonly occurs at the point 
mentioned, and also why the lesion in this locality is only met with in 
the horse, as in other animals the cesophagus does not show the above 
peculiarity, being dilated at the entrance to the stomach. 

In twenty-six cases of diverticula in the horse observed by Rubelli, 
eleven were situated behind the diaphragm, seven in the thoracic por- 
tion, and eight in the cervical portion towards its entrance to the chest. 
Occasionally a diverticulum is so developed that it extends into the 
cervical as well as the thoracic division of the cesophagus. 

(b) Traction. —This is a rare factor in the production of a diverticulum. 
The cesophagus becomes adherent to structures in the vicinity by 
cicatricial tissue. Thus it may become firmly attached to neighbouring 
lymphatic glands, or to the pericesophageal connective tissue; the latter, 
undergoing cicatricial contraction, exerts traction on the gullet. 

Storch states that a congenital form of diverticulum may occur, 
or a predisposition to the formation of the lesion. A diverticulum may 


DISEASES OF THE GSOPHAGUS : HORSE 63 


attain very large dimensions, and the rupture in the muscular coat is 
variable as regards extent. 

According to Cadéac, “ the edges of the rupture are smooth when the 
lesion is of long standing; the portion of mucosa that protrudes is 
attenuated, and shows an absence of folds. When the mucosa is rein- 
forced by a layer of inflammatory fibrous tissue, which joins it to struc- 
tures in the vicinity, it has a corrugated appearance resembling the 
cesophageal canal in ruminants. It may show inflammatory changes 
and ulcerations, and in some instances becomes gangrenous and ruptures. 
When perforation occurs, we observe sometimes the formation of a 
large pouch situated inferiorly, and‘containing decomposed alimentary 
matter.” 

Symptoms.—In the earlier stages of the affection the symptoms are 
not well marked, and may even be overlooked, as the development of 
the lesion is slow. A capricious appetite is observed, and the animal is 
often a slow feeder and loses condition. The first marked symptom is 
that the horse, while apparently hungry and anxious to feed, shows 
evidences of dysphagia and of spasm of the cesophagus. In other cases 
attempts at vomition occur after feeding, with regurgitation of alimentary 
matters through the nostrils. The appearance and chemical reaction of 
the regurgitated material will indicate that it does not proceed from the 
stomach, as, although altered in appearance and covered with frothy 
mucus, it shows no digestive changes. But, asin a case recorded by Colin, 
the diverticulum may communicate directly with the cardia of the stomach, 
in which instance gastric contents may be intermingled with the regur- 
gitated material—in fact, actual vomition may then occur. 

When the dilated portion becomes filled with ingesta, all the symptoms 
of “choking” appear (see p. 70). Friedberger and Frohner have 
observed cases in which movements of mastication and deglutition, with 
profuse salivation and frequent colicky pains, were present, but not 
subsequent to feeding, and these occurred periodically. In some in- 
stances the animal can swallow oats and chop, but not hay. 

When the lesion is situated in the cervical portion of the cesophagus, 
an elongated swelling occurs in the left jugular furrow. Lxcept in cases 
where the accumulation of food is extensive, compression or massage of 
the swelling succeeds in causing the contents to pass on to the stomach ; 
or they may partially or totally disappear in a spontaneous manner during 
the intervals between feeding. 

On passing a probang, the accumulated mass of food forms an obstruc- 
tion in the diverticulum, and in the event of this mass being passed on, the 

stenosis which is so frequently associated with the condition is detected. 


64 SYSTEM OF VETERINARY MEDICINE 


ComMPLICATIONS.— When a diverticulum is extensive, and becomes filled 
with ingesta, it may exert pressure on the trachea and vagus nerves, and 
produce cough, dyspnoea, or even asphyxia. The carotid arteries may 
also be compressed, giving rise to cerebral anemia. ‘“ Choking” results 
when the dilatation becomes distended with food, and the symptoms of 
that condition are produced (see p. 70). Rupture of a diverticulum in 
the cervical region causes the formation of a putrid abscess, which may 
terminate in general septicemia. When the rupture occurs in the 
thoracic portion, septic pleurisy or gangrenous pneumonia is produced. 
Septic broncho-pneumonia may be induced by portions of food entering 
the trachea during BELG DRS at deglutition. 

CoursE.—So long as “ choking ”’ does not occur, the animal may live 
for a comparatively long period without developing serious symptoms, 
as the accumulation of food may disappear partially or totally during the 
intervals between feeding, or the attendant may assist the case by com- 
pressing the swelling in the cesophagus after each feed, that is when the 
lesion occurs in the cervical region. 

When a marked stenosis is associated with the condition, the Beity 
of the case is much increased. As the disease tends to progress, the 
diverticulum increases in extent, symptoms appear either during or after 
each feed, the appetite is interfered with, emaciation occurs, and death 
results from inanition, or from one of the complications already men- 
tioned. ; 

In a case recorded by Cheetham * a dilatation occurred in the cervical 
portion of the cesophagus of a mare, the external swelling extending 
from about 6 inches below the pharynx to a point opposite the sixth 
cervical vertebra. A partial obstruction had existed for many months, 
but this increased of late, so that after feeding it was necessary to wash 
down the contents of the sac by means of drenching with water, and on 
some occasions the use of the probang was necessary. While at grass it 
was observed that food lodged in the sac, and was frequently returned to 
the mouth and then reswallowed. Stenosis of the thoracic portion of the 
cesophagus was present in addition. The animal recovered under surgical 
treatment (see p. 65). 

Proenosis.—This is always unfavourable, : in consequence of the pro- 
gressive nature of the affection and the difficulty of treatment. When 
the lesion occurs in the thoracic portion of the cesophagus, the gravity of 
the case is greatly increased. 

DirFERENTIAL Diagnosis.— [tf the lesion is situated in the cervical 
portion of the cesophagus, a cefinite diagnosis can be arrived at by 


* Veterinarian, 1830. 


DISEASES OF THE GESOPHAGUS: HORSE 65 


observing the phenomena described above. The presence of a stenosis 
associated with the condition is ascertained by the employment of the 
probang. When the thoracic portion of the cesophagus is the seat of the 
ectasis or diverticulum, there is considerable difficulty in diagnosis, as 
other conditions give rise to similar symptoms. The history of the case 
will assist, as in the affection we are discussing the course is generally 
slow. 

TREATMENT.—In cases of ectasis sities are extensive, tenet 
measures seldom prove of service, and it is only in exceptional instances 
that the expense of continued treatment will be justified. Palliative 
measures consist of attention to diet. Food of a hard, dry nature should 
be withheld, and the animal should be fed on oatmeal and linseed gruels, 
crushed oats, etc. The teeth should be examined, and any irregularities 
surgically treated. Long fasts must be avoided, so as to prevent any 
tendency to “ bolt ”’ the food. 

In the case of a diverticulum in the cervical region, ie palliative 
measures consist of manual compression, which may temporarily succeed 
in overcoming the distension of the sac. Some practitioners, by applying 
a pad fixed on a leather shield, so as to exert continuous compression on 
the region of the diverticulum, claim to have brought about a cure when 
the case was recent, the indication being to prevent the protrusion of the 
mucosa, and to obtain cicatrisation of the rupture in the muscular coat. 
But it is generally admitted that such a fortunate result is very rarely 
obtained. 

When evidences of “choking” are manifested, some authorities 
advise the administration of agents which induce salivation, and contrac- 
tion of the cesophagus, such as hypodermic injections of pilocarpine, 
eserine, arecoline, and apomorphine. It is said that such treatment, 
assisted by manual compression of the swelling, often proves successful. 
The employment of the probang is contra-indicated, as it not only 
compresses the ingesta into a firm obstruction, but there is also extreme 
danger of causing rupture of the diverticulum. An attempt may be 
made to wash out the ingesta by means of the double tube already 
referred to. For remarks as to its employment, see p. 80. In the 
treatment of these cases it must be remembered that we may have to 
deal not only with a dilatation, but also a stricture of the cesophagus, 
as both are often associated. 

Surgical measures have been attempted by practitioners, with a vari- 
able degree of success, even from an early period. In the case recorded , 
by Cheetham, referred to on p. 64, an incision 4 inches long was made 
in the diverticulum opposite the sixth cervical vertebra. The muscular 

VOL, II. 5 


66 SYSTEM OF VETERINARY MEDICINE 


coat was absent, and the wall of the sac consisted of the mucosa only. 
The sac was 3 or 4 inches in diameter, and the lumen of the cesophagus 
below it—+.e., where the organ entered the thorax—was so narrow that 
it only admitted a probang } inch in diameter. {Probangs of progressively 
larger sizes were passed through the wound into the stomach, the pro- 
cedure being repeated two or three times daily for ten days. Some 
sloughing of the wound occurred, but ultimately it became healthy. The 
stricture was gradually overcome. A broad breastplate fitted with a pad 
was applied to the sac, so as to exert pressure thereon, and the diverti- 
culum gradually grew less, the animal at length making a complete 
recovery. 

Various operators on the Continent, including Reinemann, Moisant, 
Colin, Aubry, and Schindelka, have adopted surgical measures for the 
relief of diverticula with success. In recent cases, after exposure of the 
sac, an attempt is made to close the rupture in the muscular wall by 
means of sutures after the mucosa has been returned. In cases of longer 
standing, the above measures may not be possible, and the technique 
adopted is to open the diverticulum, remove the contents, excise an 
elliptical portion of the protruding mucosa on each side, suture the 
wound in the cesophagus, and then the skin. Fluid food only should be 
allowed for a few days. When the lesion occurs in the thoracic division 
‘of the cesophagus, surgical treatment is not practicable. 


CONSTRICTION OF THE CGSOPHAGUS 
(Also known as Stricture or Stenosis of the CEsophagus). 


As already remarked, this condition is generally followed by dilata- 
tion or a diverticulum of the organ above the constriction. The lesion 
may occur in the cervical, thoracic, or abdominal divisions of the organ, | 
Cases of congenital stenosis are recorded by Continental observers. 

Two groups of etiological factors are recognised : 

1. Compression Stenosis, in which pressure is exerted on the cesophagus 
from without. The causes include tumours, pericesophageal abscesses, 
abscess formation and enlargement of the bronchial or mediastinal 
glands due to strangles, aneurisms of the aorta, etc. Hobday recorded 
a case of cesophageal stenosis with secondary dilatation, caused by an 
exostosis of the first rib, the size of a goose’s egg. 

2. Obturation Stenosis.—In this the lumen of the cesophagus is nar- 
rowed from within. This condition is brought about by various causes, 
such as impacted foreign bodies ; the presence of sharp-pointed bodies, 
such as a pin, etc.; injuries to the mucosa resulting from the careless 


DISEASES OF THE G&SOPHAGUS: HORSE 67 


use of the probang in cases of “ choking,” which produce cicatricial con- 
traction ; inflammation of the cesophagus, especially when due to the 
action of caustic agents; tumours of the cesophageal walls; and the 
presence of the larvee of G'. equa at the inferior end of the organ. 

Cicatricial contraction of the mucosa may be in the form of a ring, or 
of a projection of the thickened tissue into the lumen of the tube. In 
cases observed by Percivall the muscular fibres surrounding the stricture 
were increased in volume, and the submucous tissue was thickened, while 
the mucosa was thrown into large ruge and increased in substance. 
Labat met with cases in which the cesophagus was displaced in part of 
its course, or was found traversing the right side of the neck. Serres 
recorded an instance where the mucosa was folded in a longitudinal 
manner. The organ may be pale and anemic, and may show ulcers in 
the mucosa. Sclerosis of the muscular coat may be observed at the seat 
of the stenosis. In some cases complete occlusion of the cesophageal 
tube is caused by the presence of cicatricial tissue. 

A temporary stenosis occurs in spasm of the cesophagus, or the 
stenosis may be in itself the cause of cesophageal spasm. 

Symptoms. — Stenosis being generally followed by dilatation, the 
symptoms are similar to those described as occurring in the latter condi- 
tion. Dysphagia and attacks of cesophagismus are the leading phenomena 
present. In some instances the cesophagus may be dilated and distended 
with food from the region of the stenosis up to the pharynx, and may 
exert compression on organs and structures in the vicinity. The aftfec- 
tion is progressive in character, and in the earlier stages the symptoms 
may not be well marked. According to Percivall, in some cases the 
animal masticates his food with avidity, but does not attempt to swallow 
it, and most of it is returned to the manger. 

In congenital cases, symptoms appear as soon as the foal attempts to 
suck its dam. Fluids, however, cause less disturbance in swallowing ; 
hence marked evidences of the condition may not appear until the 
animal takes solid food for the first time. 

TREATMENT.—This is directed with a view to restore the cesophageal 
canal to its normal calibre, but is seldom successful. Progressive dilata- 
tion with probangs of various sizes is advised by some authorities, but 
great care is essential in order to avoid rupturing the oesophagus. The 
frequency with which dilatation or a diverticulum accompanies the con- 
dition must be borne in mind, as such are very readily perforated by the 
probang. 

A flexible hollow gum-elastic probang was advised by Lesage for the 
purpose of exploring the cesophagus, and also for carrying out irrigation 


68 SYSTEM OF VETERINARY MEDICINE 


with a view to removing retained ingesta and overcoming the stenosis, 
Sendrail invented a flexible tube composed of bands of copper arranged 
in a spiral manner, which proved more durable than the above. A gag 
is inserted in the mouth, and the tube is carefully directed towards the 
pharynx. The tongue is left free, and the act of swallowing is readily 
- induced, so that the instrument passes easily into the cesophagus. No - 
force is to be employed, and only gentle pressure must be exercised. It 
is advised that the procedure be carried out several times daily, and 
that the instrument be left an situ for five to eight minutes. 

The double tube devised by Knisley may be tried in cases where a 
_ diverticulum accompanies the stenosis. This will not only remove the 
contents of the sac by the employment of irrigation, but may also assist 
in overcoming the constriction. 

If the above means fail, and if the patient is a valuable animal, the 
operative measures carried out by Cheetham (see p. 65) are worthy of 
a trial. In cases depending on the presence of cicatricial tissue or of 
neoplasms, treatment of any kind is usually hopeless. Operative measures 
have been attempted when the lesions occurred in the cervical portion 
of the organ, such as opening the cesophagus and removing the cicatricial 
tissue or neoplasm, but the relief obtained was only temporary. 


FOREIGN BODIES IN THE GESOPHAGUS (« CHOKING ’’). 


The presence of a foreign body in the cesophagus gives rise to a series 
of symptoms which constitute a condition popularly known as “ choking.” 
This term is also applied when the seat of obstruction is in the pharynx, 
and in this case similar symptoms are manifested, but they are generally 
more urgent and distressing in character. 

As compared with the ox, obstruction from foreign bodies in the 
cesophagus is far less common in the horse. This is accounted for by the 
tendency to swallow food with but little mastication, and by the nature 
of the feeding in the former animal, in which roots play a prominent 
part ; also because the cesophagus in the ox is comparatively narrow in 
its cervical division, especially at the lower end of the upper third, and 
it is in this region that obstruction is most likely to occur. In the horse, 
on the other hand, there are anatomical peculiarities which render a 
foreign body more likely to become arrested in the thoracic or abdominal] 
division of the gullet. The cesophagus of the horse is composed of red 
striated muscle for the greater part of its length, but in its thoracic 
portion posterior to the region of the heart it alters to the pale non- 
striated variety of muscle, the muscular coat becomes very thick and 


DISEASES OF THE GSOPHAGUS: HORSE 69 


rigid, and the lumen of the tube very narrow. The terminal portion 
of the organ is very thick, and always closely contracted. The length 
of the cesophagus in the horse is from 49 to 52 inches, but in larger 
animals it has been found to measure up to 60 inches (Rubelli). These 
peculiarities render choking a very serious condition in the horse. Another 
region of the gullet where obstruction is likely to occur is at the com- 
mencement of the organ just behind the pharynx. 

Choking may be associated with diseased conditions of the cesophagus, 
such as dilatations, diverticula, constrictions, and paralysis. Per 
contra, the morbid alterations induced by the long-continued presence 
of a foreign body, or the injury inflicted on the mucosa may induce | 
ectasis, diverticulum, or constriction. __ 

Choking may occur even when the cesophagus is in a perfectly healthy 
condition, and this is exemplified by the case where a horse, unaccustomed 
to feeding on roots, such as mangels, carrots, etc., especially if the animal 
be hungry or greedy, bolts a large and irregular portion, which is unable 
to pass through the gullet, and becomes arrested either close behind the 
pharynx or in the thoracic division of the organ. Dental irregularities, 
ereedy feeding, and senility, being usually associated with imperfect 
mastication, are predisposing causes of choking in the horse. 

The agents which are capable of producing choking are many and 
variable in character, and may be classified as follows : 

1. Certain Kinds of Food.—A portion of carrot, turnip, mangel, or 
potato, swallowed quickly, as already mentioned, is one of the commonest 
causes of choking in the horse. Dry food, such as corn, cut hay, chop, 
oat chaff, etc., when swallowed rapidly by a greedy feeder, may accumu- 
late in the cesophagus to a greater or less extent, and when the entire organ 
becomes distended a very dangerous condition is produced. 

Locust beans, especially when in a green condition, constitute, accord- 
ing to several Continental authors, a common cause of choking. The 
beans become much swollen by the absorption of fluid, and if a portion 
becomes lodged in the gullet a serious obstruction is likely to ensue. 

2. Foreign Bodies.—These include a variety of articles. Several cases 
are recorded of choking due to the administration of a ball, especially 
when of large size, hard consistence, and wrapped in thick paper. 

Cooper* reported a case in which a large-sized hen’s egg was adminis- 
tered unbroken to a horse by the attendant, with a view to improving the 
animal’s condition, and a fatal termination ensued (see p. 71). Cases 
due to a similar cause were met with by King and by the late Protessor 
Williams. 

* Veterinarian, 1835. 


70 SYSTEM OF VETERINARY MEDICINE 


King also recorded a case in which a ball composed of the ashes of 
tobacco enveloped in double paper was administered to a horse by the 
owner as a “cure” for worms. The cause of the symptoms presented 
was not suspected, and the animal died. At the autopsy the ball was 
found lodged within the thoracic portion of the cesophagus. 

Sharp-pointed articles, such as thorns, needles, etc., may induce 
choking. Walther recorded a case in which a safety-pin perforated the 
cesophagus transversely, and caused occlusion of the organ. Amongst 
other articles which have been found to cause choking in the horse we 
may mention a whip-handle about 3 feet long (Moller), fishing-hooks, 
portions of wood or of stone, a molar tooth or a milk tooth accidentally 
swallowed (Cadéac). ‘The larve of the G. equi or of the G. hwmor- 
rhordalis were also found to produce cesophageal obstruction. As already 
remarked, organic affections and paralysis of the esophagus may be 
followed by choking. The presence of tumours in the organ or external 
compression due to enlarged bronchial glands are occasional causes of 
the condition. 

Symptoms.—The prominent symptoms are dysphagia or complete 
inability to swallow, profuse salivation, and evidence of spasm of the 
cesophagus. 

The clinical picture varies in some cases according to the position of 
the obstruction. As pointed out by Percivall, when the foreign body is 
lodged in the pharynx, the symptoms are generally of a more urgent 
character than when it is located farther down. The animal suddenly 
ceases to feed, and makes several attempts to swallow or to get rid of 
the obstruction. There are repeated efforts at vomition, and marked 
evidences of distress. 

We observed one case in a weight-carrying hunter, due to lodgment 
of a physic-ball in the pharynx. The animal resisted the administration 
of the medicine, and we had to insert a gag before we were able to give 
him the ball. He refused to swallow, and was given a handful of oats, 
which he took readily. In a few minutes he showed marked distress, 
and had violent fits of coughing. He made frequent attempts at vomition. 
The neck was arched, and the head depressed towards the sternum at 
intervals, The muscles of the neck and throat were violently contracted, 
and with each effort at vomition the animal emitted a shriek and bent 
himself till the knees almost touched the ground. Salivation was pro- 
fuse, and saliva mixed with grains of oats issued from both nostrils. 
The gag was inserted, and a manual examination failed to discover the 
location of the ball. The above symptoms continued for about fifteen 
minutes, then we carefully administered some water. After applying a 


DISEASES OF THE GESOPHAGUS: HORSE 71 


twitch to the nose, the fluid was swallowed, and in a short time the ball 
was seen to pass down the gullet, and all symptoms disappeared. 

When the obstruction is situated in the cervical portion of the 
cesophagus, its presence can be detected by an examination of the course 
of the organ in the left jugular furrow. If due to an accumulation of dry 
food, the distended organ can be readily felt, and in some instances palpa- 
tion of it is followed by violent contractions, succeeded by the passage of 
saliva and mucus from the nostrils. The head may be extended, but in 
some instances is depressed ; and when the ingesta is discharged, portions 
may in occasional instances issue from the mouth as well as from the 
nostrils, and may be expelled with force. In cases depending on the 
presence of dry food the horse may continue to feed until the entire 
cesophagus becomes distended. Othersymptoms observed are convulsive 
trembling of the muscles, partial sweats over the body, anxious expres- 
sion of countenance, paroxysmal fits of coughing, cardiac palpitation, 
accelerated respirations, etc. When the obstruction is in the thoracic 
or abdominal portion of the cesophagus, the symptoms are not so well 
marked—indeed, they may be so obscure that an erroneous diagnosis 
may be made. The animal may drink water until the cesophagus 
becomes filled from the point of obstruction upwards. This is followed 
by attempts at vomition, and the fluid is discharged by the nostrils, 
If fluids be forcibly administered, they are rejected by the nostrils. 

In Cooper’s case, already referred to, in which an egg had been ad- 
ministered by the attendant, and the fact was not disclosed at the time, 
the early symptoms were violent coughing, stamping with the fore-feet, 
and a flow of saliva from the mouth, which the animal occasionally 
attempted to swallow, but the greater part returned through the nostrils. 
The horse had been eating Swedish turnips. A probang was passed 
down the cesophagus, and a rounded substance was distinctly seen to be 
driven before it. Relief was obtained, and the animal ate some hay and 
drank some water. On the following day marked heaving was observed 
at the flank, all food was refused, saliva with mucus issued from the 
nostrils, but a large amount of this was also swallowed. A physic-ball 
was administered, and on the third day gruel was given from a bottle. 
The animal died on the following morning, and at the autopsy a large 
hen’s egg unbroken was found firmly impacted in the cesophagus within 
a few inches of its cardiac termination, “ the parietes of the tube around 
the egg being much dilated and ulcerated nearly through.”* 

This case is instructive, as it seems that the ball administered must 
have passed the egg in a liquid state probably along with the gruel. It 


: * Veterinarian, 1835. 


72 SYSTEM OF VETERINARY MEDICINE 


also shows that fluid foods like gruel can be swallowed in some cases of 
obstruction of the gullet—a circumstance which would easily lead one to 
overlook the real nature of the case. 

Williams points out that in some rare cases of choking in the horse 
an error in diagnosis may easily be made, more especially when the 
foreign body is situated in the thoracic portion of the cesophagus, and he 
has met with cases where “ Joss of appetite, bloodshot eyes, constipation, 
and a discharge of saliva from the mouth, were the only apparent symp- 
toms until a more minute examination proved the existence of a swelling 
along the course of the cesophagus on the left side of the neck.”* 

In occasional cases tympanites may accompany choking in the horse ; 
and, when the accumulation of ingesta in the thoracic portion of the 
gullet is extensive, it may press on the trachea and induce dyspnea or 
even asphyxia. A roaring sound accompanies respiration in some in- 
stances. . 

Course.—In some cases the obstructing body spontaneously finds its 
way into the stomach after a variable period, or in the case of choking 
from dry food the material may be discharged through the nostrils and 
mouth during attempts at vomition. If, however, the efforts of the 
animal fail to dislodge the obstruction, and unless the treatment adopted 
by the surgeon is successful, a fatal termination will result either from 
asphyxia, inanition, or the various complications that may ensue. 
Provided the cesophagus was previously in a normal condition, and that 
careful treatment has succeeded in removing the obstruction without 
injury to the gullet, a perfect recovery is likely to follow. 

_ COMPLICATIONS AND SEQUEL&.—The lining membrane may be injured 
by the foreign body or by the probang during the efforts made by the surgeon 
to dislodge the obstruction. (Esophagitis may result, followed by sup- 
purative inflammation, ulceration, necrosis, and perforation. Complete 
rupture of the organ may occur from the careless use of the probang, and 
if a diverticulum be present prior to the employment of this instrument 
but little force is required to produce rupture. For the symptoms of 
this condition, see p. 82. 3 

Kctasis and diverticulum may be a sequel to choking, and render the 
animal liable to a recurrence of the condition. Septic broncho-pneumonia 
may result from the entrance of fluids and portions of food into the 
trachea during attempts at vomition, or when the animal tries to swallow 
fluid, or if fluid medicines are forcibly administered. 

Procnosis.—In every case of choking the prognosis should be guarded. 
It is generally admitted that obstruction due to dry food and involving 


* “Principles and Practice of Veterinary Surgery.” 


DISEASES OF THE GSOPHAGUS: HORSE 73 


a large extent of the gullet is especially dangerous, as is also obstruction 
in the thoracic portion of the organ. 

 Drrrerentian DragNosis.—The history of the case is of importance. 
The fact of a horse showing the symptoms mentioned after feeding on roots 
is very suggestive of choking. But too much reliance cannot be placed 
on the history given by the attendant, as in some of the cases recorded, 
where whole eggs had been administered or a ball, the groom either kept 
back the information or denied having given the animal anything. 

When the obstruction is in the cervical portion of the gullet, and can 
be felt, the diagnosis is clear. 

A very acute case of pharyngitis or laryngitis might be mistaken for 
one of choking at first sight, but attention must be paid to the history of 
the case, and to the presence of external swelling in the region of the 
throat in the former aflection. In choking, the symptoms appear sud- 
denly, and the condition of the animal is one of acute distress, while the 
constant attempts at swallowing and the attempts at vomition are absent 
in pharyngitis and laryngitis. We have already drawn attention to the 
obscure nature of the symptoms in some cases of choking (see p. 72). 
When the obstruction is in the thoracic division of the cesophagus, the 
difficulties in diagnosis are much increased. Unless we are given a 
correct history of the case, it is difficult to decide whether an organic | 
affection of the gullet has been in existence or otherwise—that is, 
when the obstruction occurs in the thoracic division of the organ. 
The recurrence of attacks points to the presence of organic changes 
in the cesophagus, but the actual condition of affairs existing in obstruc- 
tion of the thoracic division of the organ is often impossible to discover 
clinically. A constriction, a diverticulum, or the presence of a foreign 
body firmly lodged in this region, may all give rise to similar symptoms, 
and prevent the passage of the probang into the stomach. 

TREATMENT.—In the treatment of cases of choking great discrimina- 
tion is necessary. The injudicious and hasty employment of the probang 
has on many occasions been productive of fatal results, and too often it 
has converted a curable case into a hopeless condition. As we shall point 
out later on, simple measures should always be tried before resorting 
to the employment of instruments. 

Dealing first with the case of a foreign body lodged in the pharynz, 
an attempt should be made to remove the obstacle with the hand aiter 
a gag has been fixed in the animal’s mouth and the tongue drawn forward. 
An assistant helps in the process by manipulating the external region of 
the pharynx, so as to push the object upwards and within reach of the 
operator. When the obstructing body is small, such as a bolus, it may 


T4 SYSTEM OF VETERINARY MEDICINE 


be impossible to locate it either by internal or external examination. 
Moreover, the narrowness of the space between the molar teeth and the 
soft palate in the horse renders manipulation in the pharynx very difficult ; 
and if the foreign body be situated at the posterior aspect of this region, 
there is considerable danger to the operator. Moller advises that the 
horse should be cast before attempting to introduce the hand into the ~ 
pharynx. Holmes* recorded a case in which a ball administered by an 
attendant had become lodged in the pharynx, and produced marked 
dyspnoea, heaving at the flanks, foaming at the mouth, coldness of the 
extremities, and threatened asphyxia, probably due to pressure on the 
larynx. He performed tracheotomy, and after this passed the probang 
with successful results. 

In some instances after the occurrence of alarming symptoms the ball 
may be swallowed without artificial aid, as in the case we have men- 
tioned (see p. 70). Should the symptoms persist, and manual explora- 
tion combined with external manipulation fail to remove the foreign 
body, a hypodermic injection of pilocarpine may be tried (see p. 75). 

If this fails, the probang might be resorted to ; but in consequence of 
the violent character of the symptoms, it is necessary to cast the horse 
before introducing the instrument ; also, it is possible that in the case of 
a small obstacle, such as a ball, the probang might fail to direct it into 
the cesophagus. 

Cadeéac, as already mentioned, advises that when a foreign body in 
the pharynx cannot be removed by manipulation, laryngotomy should be 
performed, and the obstacle removed by this route. 

When the foreign body is of a solid nature, and is lodged in the cervical 
region of the cesophagus, external manipulation should first be tried ; if 
the obstruction is situated close to the pharynx, an attempt should be 
made to direct it upwards, and to adopt manual extraction according to 
the procedure described above. In other instances an attempt should be 
made by external manipulation to gently push the foreign body upwards 
and downwards. If this can be accomplished, the obstruction will 
generally pass downwards to the stomach spontaneously. 

When this method fails, Williams advised that the animal be made to 
swallow an emulsion composed of oil, water, and a small proportion of 
carbonate of potash. As this process generally produces a violent fit of 
coughing, there is danger of a portion of the fluid entering the trachea, 
and inducing septic broncho-pneumonia ; hence it is condemned by other 
authors. 

When simple measures fail, the following courses are open to the 


* Veterinarian, 1839. 


DISEASES OF THE GESOPHAGUS: HORSE 75 


practitioner: (1) The use of medicinal agents ; (2) instrumental ards ; 
(3) @sophagotomy. This latter is only adopted when all other means 
have failed. 

1. Medicinal Agents.—These include pilocarpine, eserine, arecoline, 
and apomorphine. They are employed hypodermically in small repeated 
doses, and the selection is largely a matter of choice; but in case one fails 
it is advisable to try another. The beneficial result is attributed to the 
profuse salivation, to the contraction of the cesophagus, and to the move- 
ments of deglutition which these drugs produce. It is believed that the 
foreign body, if it be a portion of a root, such as a carrot, mangel, or turnip, 
is so acted on by the saliva that it becomes partly macerated and dimin- 
ished in volume, and its passage into the stomach is facilitated. 

American practitioners speak very highly of apomorphine, given 
hypodermically in 2 to 3 grain doses. Relief is said to occur in about 
one hour, and the animal should have access to water during the 
treatment.* : 

Penrod} administers 2 drachms of fluid extract of belladonna in an 
ounce capsule, filling the remainder of the capsule with water. ‘This is 
followed by $ grain of arecoline hypodermically, and ten minutes later 
by an ounce capsule of linseed oil. If necessary, another 4 grain of 
arecoline is given later on. The belladonna causes local relaxation of 
the constricted cesophageal wall, the arecoline induces salivation and 
movements of deglutition, and the oil lubricates the obstruction and 
facilitates its movement. Relief is said to be obtained in less than forty- 
five minutes. 

Cadiott records a case in which a stallion ate some sliced carrots 
greedily, and showed acute symptoms of choking. A well-defined swelling 
was found in the jugular furrow a short distance below the larynx. No 
foreign body could be detected by examination per os. External manipu- 
lation and the probang were employed without success. A hypodermic 
injection of pilocarpine and eserine was administered. In half to three- 
quarters of an hour there was abundant salivation and frequent attempts 
at deglutition ; then the symptoms suddenly disappeared, and the foreign 
body passed down to the stomach. There was no subsequent difficulty 
in swallowing. 

Cadéac considers that the above treatment by drugs is preferable to 
the employment of the probang, but admits that the agents mentioned 
do not always prove successful. Mattern found that a period of nine- 
teen to twenty-four hours elapsed before medicinal treatment succeeded. 


* American Journal of Veterinary Medicine, April, 1912. t Ibid. 
t “‘ Studies in Clinical Medicine and Surgery,” Cadiot and Dollar. 


76 SYSTEM OF VETERINARY MEDICINE 


Moller is of opinion that such remedies require to be used with caution, 
as inhalation pneumonia may be induced by the saliva entering the 
trachea. 

2. Instrumental Aids—A variety of instruments have been devised 
for the removal of foreign bodies from the oesophagus by way of the 
mouth, but none of them have proved of practical utility. As pointed — 
out by Cadéac, they are not only useless, but positively dangerous, as 
they injure the cesophagus and tend to produce rupture of the organ. 
In the same category may be placed the probang containing a stilet 
with a screw at the end, and we envy the manual dexterity of one author, 
as much as we pity his patient, when he advises that an attempt should 
be made to transfix the obstacle with the corkscrew termination of the 
stilet, and to withdraw it through the mouth, and compares the opera- 
tion to “ that of drawing a cork out of a bottle.” Similar remarks apply 
to the advice given as to piercing the obstacle in several places by the 
screw, and thus by breaking down its integrity, to facilitate its gradual 
softening and displacement. 

Another author suggests placing a piece of wood against one side of 
the neck, and breaking down the foreign body from the other side with 
a hammer, and naively adds that “ care must be taken not to injure the 
cesophagus or produce solutions of continuity in the trachea.” Surely 
such a procedure would be a typical example of the cure being more 
harmful than the disease. 

In the case of obstructions of a solid nature, the only safe and effectual 
mode of treatment, when the simpler measures already mentioned fail, is 
the employment of the probang, with a view to propel the foreign body 
along the cesophagus into the stomach. When this procedure fails, and 
the obstruction is in the cervical region, the last resource is the operation 
of cesophagotomy (see p. 77). 

In employing the probang, there are certain important points to be 
considered, the neglect of which may turn a curable case into a hopeless 
one. 

1. In choking with dry food (see p. 79) the probang should not be 
used, as it simply converts the ingesta in the gullet into a hard mass, 
further pressure on which by the operator would probably cause rupture 
of the organ. 

2. Care is required in the technique of introducing the instrument. 
Some authors advise that the horse should be cast for the operation, 
others state that the procedure can be carried out with the animal in the 
standing position. Moller is convinced that the latter method can be 
adopted with safety. In the case of nervous, excitable horses, and in 


DISEASES OF THE G&SOPHAGUS: HORSE 77 


those that resist manipulation of the mouth, casting is necessary. A 
mouth-gag is inserted, and the probang, well smeared with oil, is care- 
fully passed over the base of the tongue and epiglottis into the pharynx 
and cesophagus. During the procedure the head should be kept in such 
a position that the mouth and throat may be in as straight a direction as 
possible, also, the neck should be kept straight. When the instrument 
reaches the foreign body, a very gentle intermittent pressure should be 
applied, and, should this fail to cause the obstruction to pass downwards, 
on no account should any force be employed, as rupture of the gullet, 
either partial or complete, is likely to be produced. 

In our experience, the safest form of probang is one composed of 
sum-elastic. This is made hollow, and contains a mount for fixing to a 
Winton’s pump, so that a small amount of oil can be introduced into the 
eullet, and may, by its lubricating effect, assist in dislodging the foreign 
body. Only a small quantity of oil should be thus administered. If a 
large amount be given, the fits of coughing induced may result in a portion 
of the oil entering the trachea, and broncho-pneumonia may result. 

In the act of passing the probang the tongue should be left 
free. Some practitioners advise that one hand should be placed over 
the back of the tongue, so as to direct the probang, which should be 
pushed very slowly, and as the horse makes a movement of deglutition 
the tube passes readily into the cesophagus. Itis of importance to make 
sure that the instrument does not enter the trachea instead of the 
cesophagus—an accident which may easily happen. This can be ascer- 
tained by applying the ear to the proximal end of the instrument. 
If the tube has entered the trachea, the presence of air passing in and 
out during respiration can be detected, while coughing and dyspncea are 
observed ; also, when the instrument is in the cesophagus, it can be felt 
externally in the jugular furrow on the left side of the neck. 

In cases where the above measures fail, and when the obstruction is 
in the cervical portion of the cesophagus, the operation of ewsophagotomy 
is the only resource. Local anesthesia is induced in the region of the 
foreign body by injecting a solution of adrenalin and cocaine, or adrenalin 
and eucaine. The skin is shaved, and then disinfected by painting with 
tincture of iodine. An assistant elevates the animal’s head, extends 
the neck, and presses with his fingers on the jugular furrow of the right 
side, so as to cause the foreign body to become prominent on the left side. 
Williams advised that a bold longitudinal incision should be made on to 
the foreign body, so that the skin, muscles, and cesophagus are incised at 
one stroke of the knife. This course was adopted to prevent the untoward 
effects which might result from a more careful technique in consequence 


78 SYSTEM OF VETERINARY MEDICINE 


of the animal becoming restive. But with the use of local anesthesia any 
risks in this direction can be avoided. Moller advises that an incision 
about 4 inches in length should be made in the skin at the under border 
of the jugular vein, and parallel with it. This position is selected so as 
to provide for efficient drainage of the wound. The muscles and con-_ 
nective tissue are next incised, the position of the carotid artery is located, 

the finger is passed forward in the direction of the posterior aspect of the 
trachea, and the cesophagus is readily found by reason of the prominence 
produced by the foreign body. The organ is then drawn forward, care 
being taken to separate it as little as possible from its surroundings, and 
its walls are incised to a sufficient extent to permit removal of the obstruc- 
tion. 

Cadéac advises that, after division of the muscles and connective 
tissue, the jugular vein, the carotid artery, and the nerves in the vicinity 
should be drawn to one side by means of the operator’s thumb, and the 
pericesophageal connective tissue divided ; then the cesophagus is drawn 
outwards by introducing a curved blunt-pointed pair of scissors behind 
it. A small opening is made in the organ a little beneath the obstructing 
body, and a blunt-pointed tenotomy knife is introduced, with which the 
foreign body is divided, so that it is reduced in volume, and the divided 
portions may be carried to the stomach by the peristaltic movements of 
the gullet. This procedure is advised because the resulting wound in 
the cesophagus is small in extent, and heals without difficulty. 

But in cases where division or reduction in size of the obstruction is 
impossible, a director is introduced, and by means of a bistoury the 
opening is enlarged, so as to permit extraction of the foreign body. 

Moller states that under certain circumstances the foreign body may 
be divided within the cesophagus, and the pieces removed through a 
small opening in the organ. This procedure, as well as the similar one 
mentioned above, can only be carried out with difficulty, and the risks of 
injuring the mucosa of the organ are so great that the ordinary operation 
would appear to be more advisable. 

After cleansing and disinfecting the wound in the cesophagus, suturing 
of the part is best carried out as follows : The mucous coat is first brought 
together with interrupted sutures of catgut. In order to facilitate the 
operation, Cadéac advises that the cesophagus be drawn slightly out- 
wards, and secured by placing a forceps above and below the wound in 
the organ. One border of the mucous membrane is then held with a 
dressing forceps, and a needle passed through it from outside to inside. 
The needle is then passed through the other border from inside to outside. 
The needle is threaded with catgut, and drawn through the edges of the 


DISEASES OF THE CGESOPHAGUS: HORSE uo 


mucosa, and the suture is tied. Sufficient interrupted sutures are inserted 
in the same manner. The muscular coat is sutured with silk in a similar 
way. The cesophagus is replaced in position, and after disinfection 
of the parts sutures are inserted in the skin at the superior aspect of the 
wound, and a drainage-tube fixed in the inferior aspect. Moller advises 
that no sutures be inserted in the skin, as healing by primary intention 
cannot be expected. On the other hand, Williams advised that strong 
metallic sutures be inserted in the skin, and every endeavour made 
to secure healing by first intention. He applied collodion or styptic 
colloid to the parts, so as to assist in the approximation of the external 
lips of the wound. Moreover, in dealing with the cesophageal wound he 
sutured the mucous and muscular coats simultaneously.* 

After-treatment is of importance. Moller advises that for the first 
twenty-four hours neither food nor drink should be permitted, but if 
thought necessary pure water may be allowed. After this, soft diet can 
be given. Cadéac does not allow food or water for two or three days, 
and suggests that in lieu of these, simple and nutritive enemata should be 
given, After this, milk, hay tea, and water may be allowed, followed 
Jater by cooked food. Williams says that milk ad lib. may be allowed 
three times a day until the wound has healed. In order to prevent the 
horse from injuring the wound, it is advisable to keep him tied up for a 
suitable interval. | 

In cases of choking from impaction of dry food, as already pointed out, 
the probang should not be employed. Various forms of treatment are 
advised for this condition. Massage, carried out as directed for the 
treatment of choking by solid bodies, occasionally proves successful. 
The medicinal measures already mentioned may also be tried. Williams 
advised that water be administered until the cesophagus becomes quite 
full above the seat of obstruction. A violent fit of coughing is induced, 
and the fluid, with portions of the impacted mass, is forcibly ejected by the 
nostrils. The process is repeated after short intervals until all the solid 
material is got rid of. Williams stated that, if carefully performed, this 
method is quite safe ; and that if the animal fights against the fluid being 
administered by the mouth, it should be given through the nostrils. 
We cannot agree as to the safety of this method, as there is a grave 
risk that the fluid may enter the trachea and set up broncho-pneumonia. 
Moreover, if the impaction extends along the length of the cesophagus, 
the above procedure would be impossible. 

American practitioners have had considerable success in these cases 
by the use of a double tube, by means of which irrigation of the cesophagus 


* “Principles and Practice of Veterinary Surgery.” 


80 SYSTEM OF VETERINARY MEDICINE 


is carried out. This instrument is also employed for washing out the 
stomach, and for a description of it the reader is referred to p. 118. The 
idea of washing out the cesophagus is not a new one, as it was mentioned 
by Percivall in his “ Hippopathology,” ag an idea put forward by King, 
who advised the employment of a “ stomach syringe ” for the purpose. 

Mr. Knisley, D.V.S. of Topeka, Kansas, U.S.A., the originator of the © 

‘double current stomach tube,” has kindly furnished us with the fol- 
lowing details as to the use of this instrument in cases of choking by dry 
food : The tube (which is made of rubber) is passed down to the obstruc- 
tion in a similar manner to the probang. Water is then pumped into the 
large opening by means of a Winton’s enema syringe. When the tube 
is full, the mount of the syringe is quickly changed to the small opening 
of the tube, and water is pumped into the latter. A continuous stream 
of water is thus produced, which issues from the large opening, bringing 
with it a large amount of the ingesta contained in the cesophagus, the 
remainder passing down to the stomach. If the animal has been choked 
for two or three days, the above method will not succeed, and Mr. Knisley 
advises that the cesophagus be opened just above the seat of the obstruc- 
tion, and the tube inserted into the opening, and the water pumped in as 
before. 

When the foreign body is situated in the thoracic portion of the 
cesophagus or close to the stomach, the case is always a serious one. In 
this region the organ is very narrow, and not capable of much dilatation. 
Contraction takes place immediately behind the seat of obstruction, and 
tumefaction occurs in the part occupied by the foreign body due to 
irritation produced by the latter. Hence, if the probang is employed, 
the cesophagus contracts when the instrument reaches the seat of obstruc- 
tion, and forcible attempts to move the foreign body are followed by 
rupture of the organ. The obstruction cannot be reached by the opera- 
tion of cesophagotomy. 

Simple measures are rarely successful, and irrigation, as described 
above, should be carried out. Should this fail, American practitioners 
advise that the tube should be passed down to the seat of obstruction. 
The cesophagus is then exposed in the neck, but the organ is not incised. 
A soft tape is passed round the organ, and carefully tied, so that the 
cesophageal wall is in firm apposition to the tube passing through the 
gullet. A full stream of water is next pumped through the large opening 
of the tube. This gradually distends the cesophagus below where the 
ligature is placed, and may have the effect of enabling the obstruction to 
reach the stomach. Or the tube may be inserted into an opening made 
in the cesophagus just above the seat of obstruction, and water pumped 


DISEASES OF THE ESOPHAGUS: HORSE 81 


in, a8 already described. When the cause of the condition is impaction 
with dry food, it is possible that the material may be washed out. 

If there is evidence that the obstruction is due to an egg impacted in 
the cervical portion of the cesophagus, Gamgee advised that the egg 
should first be pierced by an exploring needle, and afterwards crushed 
by a blow. Great care is necessary, however, in order to avoid injuring 
the cesophagus. ) 

Here we may repeat that in the treatment of choking, when the 
obstruction is in the thoracic portion of the cesophagus, unless the 
history of the case points to the presence of a constriction or of a diverti- 
culum, it is impossible to be aware of the existence or otherwise of these 
lesions in addition to the condition of obstruction of the gullet. Hence 
the importance of great care in the manipulation of the probang, so as 
to avoid the occurrence of perforation or rupture of the cesophagus. 


TRAUMATIC LESIONS OF THE CESOPHAGUS (PERFORATIONS AND 
RUPTURES). 


These may result from—(1) External causes ; (2) Injuries or patho- 
logical conditions affecting the interior of the cesophagus. 

1. Hxternal.—The usual seat of the lesion in this case is at the lower 
portion of the cervical division of the cesophagus towards the inferior 
aspect of the neck, as the organ is here more superficially situated. 

The causes recorded are kicks and bites from other horses, and injuries 
from the horns of cattle. Such cases are not of frequent occurrence. 
When resulting from kicks, the injury is generally subcutaneous, the skin 
being intact. When due to bites and injuries from horns, the vessels 
and nerves in the vicinity may be injured at the same time, and also the 
trachea. 

2. Internal Injuries may result from the careless use of the probang 
in cases of choking, or for the treatment of constriction or diverticula, 
and are most likely to occur when the latter conditions are present. The 
injury may take place either in the cervical region or in the thoracic 
portion of the organ. The rupture may be complete, having irregular 
and jagged edges, or it may be incomplete. When incomplete, the 
mucous coat only is ruptured, and food issues therefrom, which distends 
the muscular coat. In complete rupture, food and saliva enter the sur- 
rounding tissues, and set up septic inflammation and suppuration in the 
pericesophageal connective tissue. The structures along the neck may 
become involved, and the septic inflammation may extend to the pleural 
cavity, | 

VOL. II. 6 


82 SYSTEM OF VETERINARY MEDICINE 


Rupture of the cesophagus in the thoracic region is. always followed 
by gangrenous pleurisy. The structures related to the organ in its pas- 
sage through the thorax become involved, including the lymphatic 
glands and the posterior mediastinum, and a large abscess may form 
between these glands, the pericesophageal connective tissue, and the 
layers of the mediastinum. The cesophagus at this region becomes — 
dilated and thickened, and causes pressure on the lungs. 

Perforation of the cesophagus may also result from pathological 
conditions, such as ulceration (see p. 83), abscess formation in 
the retro-pharyngeal glands, pericesophageal abscess occurring in 
strangles. 

Foreign bodies retained in the cesophagus may give rise to ulceration, 
followed by perforation, especially when the obstruction is hard in con- 
sistence and possesses sharp edges. 

Symproms.—The symptoms observed in cases of perforation nd 
rupture of the cesophagus are as follow: When occurring as the result of 
injury during the passage of a probang, the end of the instrument, when 
withdrawn from the cesophagus, is covered with blood. When the injury 
occurs in the cervical region, we observe an cedematous swelling, emphyse- 
matous in character, extending along the neck and breast, and it may even 
reach the head, thoracic region, and shoulder. Swallowing is mpossible, 
salivation is profuse, and a foetid nasal discharge occurs later on, which 
is purulent, contains portions of alimentary matter, and may be blood- 
stained. Dyspnoea and evidences of septicemia or purulent pleurisy 
develop rapidly, unless early treatment is capable of repairing the injury. 
When the lesion occurs in the thoracic region, respiratory symptoms are 
early observed. Hvidences of pleurisy develop rapidly if the rupture in 
the cesophagus is extensive, due to the entrance of alimentary material, 
saliva, etc., into the pleural cavity. The respiratory movements are short 
and rapid, the thoracic walls tremble, and the breathing is of the “ ab- 
dominal” type. According to Cadéac, when a large amount of alimentary 
material enters the thoracic cavity, inhibition of the nerves presiding over 
the movements of the chest walls occurs, so that they remain almost 
motionless. He has observed in such cases that compression of the trachea 
may occur from the presence of the escaped ingesta, intense dyspneea and 
even roaring being induced. The presence of alimentary matters in the 
mediastinum or of a pericesophageal abscess causes interference with the 
expansion of the lung or atelectasis of the organ. Pleural effusion occurs 
as in ordinary pleurisy. As already mentioned, the pleurisy is of a gan- 
grenous type. ‘The course varies. Death may occur within twenty-four 
hours, or the case may continue for several days, presenting colicky 


DISEASES OF THE GSOPHAGUS: HORSE 83 


symptoms, attacks of vertigo, muscular tremblings, contractions of the 
muscles of the neck, and protrusion of the head.* When perforation 
occurs close to the stomach, septic peritonitis results. A case of double 
rupture of the cesophagus is recorded by Laser, in which one lesion 
occurred in the cervical portion, and the second in the thoracic region. 


FISTULA OF THE GESOPHAGUS. - 


This may occur from injury to the mucous membrane, resulting from 
the presence of foreign bodies. Septic inflammation is produced and 
abscess formation, the pus finding its way through the wall of the organ, 
and a fistula is formed. According to Méller, a common seat of fistula 
is the upper end of the cesophagus close behind the pharynx. Perforation 
first occurs, and an abscess is formed, which discharges offensive pus, often 
mixed with food. During deglutition, saliva, food, and water escape. 
The wound closes gradually, but a small fistulous canal remains, which 
is very difficult to heal. 

Cases are recorded in which fistulee followed abscess formation in the 
retropharyngeal glands; pericesophageal abscesses occurring in connec- 
tion with strangles; also from the surgical opening of a pharyngeal abscess. 


ULCERATION OF THE G&SOPHAGUS. 


This occurs most frequently at the upper extremity of the organ, but 
it may also be met with lower down. The usually accepted cause for 
this condition is the presence of an obstruction, such as a large amount 
of hard, dry food, which exerts compression on the mucosa. This is 
most likely to occur at those points where the cesophageal canal is narrow, 
such as just behind the pharynx, at the commencement of the thoracic 
portion, and at its termination close to the cardia. The character of the 
ulceration varies. Thus, when the obstruction is smooth on the surface, 
the ulcer is superficial. In other instances the ulcer is deep, and extends 
to the muscular coat. Perforation may result, as already mentioned, 
especially in the upper part of the organ. Drouin records a case in which 
a deep ulcer was found close to the termination of the cesophagus, and 
a diverticulum was formed, into which food penetrated. Leblanc has 
observed an annular form of ulcer at the commencement of the thoracic 
portion of the organ. Ulcers in the upper extremity of the cesophagus 
are generally situated at its anterior aspect, which is related to the trachea. 

The symptoms observed in ulceration of the cesophagus are those 


* Cadéac, ‘‘ Pathologie Chirurgicale de P Appareil Digestif.” 


84 SYSTEM OF VETERINARY MEDICINE 


usually associated with inflammation of this organ. Colson has met with 
a case associated with spasm of the cesophagus. The animal showed 
marked difficulty in drinking, and sometimes raised his head after each 
draught of water, resembling the manner in which fowls drink. Manipu- 
lation of the gullet over the affected region causes pain. 


EXPOSED WOUNDS OF THE CGiSOPHAGUS. 


These may occur without loss of substance. At each movement of 
deglutition saliva and portions of food issue from the wound. Such wounds 
tend to heal without constriction or dilatation resulting, provided early 
surgical measures are adopted and septic infection is prevented. When, 
however, loss of substance occurs, organic alterations are likely to result, 
such as constriction, or a troublesome fistula which may persist for a 
long period. 


Treatment of Traumatic Lesions and Fistulee of the Gsophagus. 


In lesions affecting the thoracic and abdominal portions of the organ 
treatment of any kind is impossible. In the cervical portion, however, 
surgical measures may prove successful. 

Hynes* records a case of strangles in which rupture of the cesophagus 
followed abscess formation in the parotid gland. A longitudinal rent, 
13 inches long, was found 2 inches below the pharynx. The wound was 
dressed with antiseptics, and the horse was fed with eggs and milk by 
means of a stomach-tube twice daily for twenty-two days. The opening 
in the gullet became gradually smaller, and the animal was sent to work 
on the twenty-fourth day cured. 

In subcutaneous ruptures the lesion should be exposed as soon as 
possible, thorough disinfection of the parts carried out, suitable drainage 
provided, and after trimming the edges of the cesophageal wound with 
sharp scissors, sutures should be inserted according to the technique 
described at p. 78. In order to insure thorough disinfection of the 
pericesophageal tissue, which is, of course, infected by portions of food 
and by saliva, it is advised that all tissues infiltrated by liquids should 
be removed by means of sharp scissors, and careful irrigation with anti- 
septic solutions carried out. After-treatment is similar to that advised 
for cesophagotomy (see p. 79). 

In fistula of the cesophagus occurring as the result of abscess forma- 
tion, Cadéac advises the injection of tincture of iodine, care beg taken 
that it does not pass along the cesophagus towards thestomach. Nitrate 


* American Journal of Veterinary Medicine, April, 1911. 


DISEASES OF THE ESOPHAGUS: HORSE 85 


of silver may be used with similar precautions. These agents promote 
cicatrisation, and, according to this author, healing will take place in 
a few weeks. He condemns operative measures. Moller states that 
fistule resulting from perforation prove very obstinate to treatment. 
He has found that by exposing the fistula and suturing the opening in 
the cesophagus healing is generally produced, but admits that the 
operation is by no means an easy one, and does not in every case 
produce the desired result. 

Wounds of the cesophagus without loss of substance should be sutured 
in a similar manner to that advised for cesophagotomy (see p. 78). When 
considerable loss of substance occurs, treatment is useless, as cicatricial 
contraction results, producing an incurable constriction of the organ. 


TUMOURS OF THE CESOPHAGUS. 


These include melanomata, fibromata, carcinomata, epitheliomata, 
sarcomata, myomata, and mucous cysts. Some are situated external 
to the cesophagus, and produce effects by compression of the organ or by 
gradual invasion of its walls ; others are found associated with the mucous 
or muscular coats. 

Melanomata invade the cesophagus from without inwards, and are 
regarded as the most common type of tumours occurring in this manner. 
In addition to their effects on the cesophagus, they exert pressure on the 
vagus and induce respiratory symptoms. 

Fibromata are usually found in the pericesophageal tissue, and by 
pressure on the cesophagus they may produce stenosis of the canal. 

Carcinomata.—These generally occur at the termination of the 
cesophagus, close to the cardia. Epitheliomata are the types usually 
found in this region. In some instances the neoplasm is located at 
the origin of the organ. The epitheliomata may occur singly, or 
there may be several tumours on the mucous coat, extending more or 
less rapidly to the submucosa and muscular coat, invading the organ 
in a circular manner and to a variable height, producing well-marked 
constriction and ulceration (Cadéac). 

Sarcomata are sometimes found in the region of the cardia. They 
may attain a large size, but are said to be less liable to cause stenosis 
of the canal than the epitheliomata. 

Myomata occur in the thoracic or abdominal region of the esophagus. 
especially in old animals, and the lesion consists of a hypertrophy of the 
muscular fibres. 

Mucous Cysts are of rare occurrence in the horse. 


86 SYSTEM OF VETERINARY MEDICINE 


Symptoms.—These vary according to the degree of stenosis produced, 
and the pressure exerted on the vessels and nerves in the vicinity. Ac- 
cording to Cadéac, dysphagia, attempts at vomition, spasm of the gullet, 
emaciation, intense hunger, and ineffectual attempts to swallow food, 
may be observed. Lorenz observed grinding of the teeth and biting of - 
the manger, and Chouard noted frequent movements of the jaws and 
yawning during the intervals of feeding. Stertorous breathing, dyspnea, 
and foetid exhalations from the mouth, may be present. When the 
tumour occurs in the cervical division of the organ, it may be felt by 
palpation of the left jugular furrow. Death may result from inanition, 
rupture of the cesophagus, septicemia, purulent pleurisy, or from perfora- 
tion of the cardia and septic peritonitis. 

TREATMENT.— When the neoplasm occurs in the thoracic or abdomina | 
divisions of the ceesophagus, treatment of any kind cannot be attempted. 

In the case of a tumour situated in the pericesophageal connective 
tissue, an operation may be attempted ; but obviously it is one requiring 
ereat care and surgical skill in order to avoid injury to the important 
vessels and nerves in the vicinity, and also not to divide the wall of the 
cesophagus. 

When the neoplasm occurs in the mucous coat of the organ, operative 
measures cannot be carried out with any deeree of safety or success, as 
stenosis is certain to result. Moreover, in the case of a malignant tumour 
the question of recurrence has to be considered. 


DISEASES OF THE STOMACH. 


GENERAL RemarKs.—The majority of observers hold the opinion that 
gastric affections in the horse are of far less frequent occurrence than 
intestinal disorders. To such an extent is this view carried by some 
authors that a very limited space is allotted to the diseases of the 
stomach. Others, while admitting that this organ is more frequently 
the seat of disease than is imagined, consider that, in consequence of the 
difficulties attached to a differential diagnosis between gastric and in- 
testinal affections, and from the frequency with which such disorders 
are associated together, they should be considered under the same 
heading. And thus, not only do we find a number of affections of the 
stomach and intestines discussed in one chapter, but also the various 


DISEASES OF THE STOMACH: HORSE 87 


gastric disorders are grouped under a few headings. This plan is followed 
by Friedberger and Froéhner, and, as stated by them, it was the routine 
adopted by the old authorities. 

While admitting the difficulties in diagnosis that exist in connection 
with the above affections, we are of opinion that, by careful attention to 
the phenomena presented and to post-morten examinations, much 
valuable information can be added to existing knowledge by the clinician, 
and that it is desirable to make an attempt to differentiate these dis- 
orders—at least, as far as is possible. 

As the result of a fairly wide experience of such cases, we have arrived 
at the conclusion that by careful observation it is sometimes possible, 
when certain symptoms are present, to differentiate not only gastric 
from intestinal cases, but also to distinguish certain disorders of the 
stomach from one another. 

But, on the other hand, we freely admit that in a large number of 
instances the revelations presented by post-mortem examinations were 
matters of surprise, and demonstrated how erroneous were the diagnoses 
given, and how deceptive symptoms may be in diseases of this kind. 
From this statement the reader will gather that we do not claim to 
possess the diagnostic skill which is assumed by some writers on the 
subject, nor can we agree with the definite symptoms ascribed to each 
disorder. No doubt such read well in a textbook, and engender faith in 
the belief that our knowledge of such diseases has advanced in the present 
day ; but when tested by the clinician whose mind is open to conviction, 
they are found not infrequently to be false guides, leading to the expres- 
sion of erroneous opinions, which neither enhance the reputation of the 
practitioner nor assist him in prescribing rational treatment for his 
patient. 

Dogmatism in connection with such matters is dangerous, for not 
only will it lead us to give a definite diagnosis as to the existence of 
a certain condition which after-events prove to be erroneous, but also 
it is likely to render us liable to express an opinion with reference to the 
presence or absence of a fatal lesion, and to offer an incorrect prognosis. 

In the following pages we shall endeavour to discuss the various 
affections of the stomach, pointing out the limitations of diagnosis, the 
value of certain symptoms, and the facility with which erroneous opinions 
may be given. 

In judging of the frequency of gastric affections in the horse, certain 
difficulties are encountered. The positive evidence we possess as to the 
incidence of such maladies is largely based on the results observed at 
post-mortem examinations, as in the cases that recover the symptoms 


88 SYSTEM OF VETERINARY MEDICINE 


presented are not always diagnostic of the region of the gastro-intestinal 
canat that is involved. It is very probable that a number of cases of 
gastric disorder recover, and are diagnosed as simple colic—a term which, 
as we shall see later on, is applied to a variety of conditions. Again, it 
must be remembered that systematic post-mortem examinations are not 
carried out on all cases that succumb—at least, in private practice—as 
the number of clinicians who are sufficiently enthusiastic in this respect 
is limited. So far as the evidence obtained from autopsies is concerned, 
we are led to the conclusion that, with the exception of rupture of the 
stomach, other fatal lesions of this organ are rare as compared with those 
occurring in the intestines. But we must remember that rupture of the 
stomach is the result of certain gastric disorders, such as impaction and 
tympany of the organ. 

F¥. Smith* points out that simple muscular spasm may affect the 
stomach as well as the intestines, but there are no definite symptoms by 
which a positive diagnosis of location can be established. He also states 
that the possibility of spasm of the muscular walls of the stomach oc- 
curring is generally overlooked, and the symptoms are almost universally 
ascribed to an affection of the intestines ; while the liability of the stomach 
to suffer from disorder is suggested by the frequency of rupture of this 
organ, the spasm being caused by the gastric disorder, and the rupture 
following as a sequel. 

It is not possible on physiological grounds to assert that gastric 
affections must of necessity be of comparatively rare occurrence in the 
horse. Although admitting that, as compared with the ox, the stomach 
of the horse does not play as important a part in digestion, we are well 
aware that any marked disturbance of normal gastric digestion is likely 
to exert serious effects, and, besides, interferes materially with the 
functions of the intestines, and may give rise to very grave conditions 
in these organs. Moreover, it cannot be said that all the problems in 
connection with gastric digestion in the horse are as yet fully solved. 
Again, wé are well aware that many minor disorders of the stomach occur, 
whose presence is overlooked, and the symptoms are attributed to other 
organs. : 

There are certain points in connection with the anatomy and physio- 
logy of the stomach in the horse to which it is necessary to direct atten- 
tion, as a knowledge of these proves of marked assistance in the con- 
sideration of the various diseases of this organ. As previously remarked, 
we do not believe that such peculiarities actually predispose to disease 
but there is sufficient evidence to enable us to assert that when the 


* “ Veterinary Physiology.” 


DISEASES OF THE STOMACH: HORSE 89 


animal is subjected to irrational treatment and to erroneous methods of 
feeding, serious if not fatal results are likely to ensue, which thera- 
peutical skill is often powerless to obviate. 

These points may be classified as follows : 

(A) The Comparatively Small Size of the Stomach.—Attention was 
directed to this by the earlier writers, even before physiological details 
in connection with the organ were known. Coleman pointed out that 
the horse is the only animal that can exert himself after a full meal, and 
that the small stomach is so designed by Nature to avoid the incon- 
venience which a large amount of ingesta in this organ would bring about 
—1.e., by pressing on the diaphragm, and thus rendering the animal 
either short-winded or physically incapacitated for exertion after feeding. 
The practical deduction is that the horse requires to be fed often, and 
that long fasts tend to induce gastric disorder. 

The small size of the stomach has an important bearing on the physi- 
ology of the organ and on gastric digestion. It is quite apparent that this 
organ could not contain the ordinary amount of ingesta taken at one 
meal. According to F. Smith,* experiments have demonstrated that— 
(1) the stomach is rarely empty. (2) When the horse is feeding, a certain 
amount of ingesta passes into the intestines, but at first this amount is 
far less than the quantity entering the stomach. The stomach gradually 
becomes distended, and when about two-thirds full is in the most favour- 
able condition for gastric digestion to take place. (3) If more food be 
taken, the ingesta passing into the intestines will equal the amount which 
is being swallowed. At the finish of the meal, the passage of partly 
peptonised chyme either ceases or proceeds very slowly and gradually, 
and a Jong period elapses before the entire gastric contents reach the 
intestines. 

According to the same author, the condition of gastric digestion may 
be modified according to the nature of the food, its quantity, form, and 
the order in which different foods are given ; also, it is influenced by the 
period at which water is allowed—.e., before or after feeding. 

It will thus be seen that, although a certain proportion of ingesta 
remains but a short time in the stomach, a considerable amount is re-. 
tained for a long period. These points demonstrate that gastric digestion 
is an important and complex function, although, in consequence of the 
small size of the stomach, one might imagine that the opposite was the 
case. They also explain to a certain extent the manner in which gastric 
disorders are brought about, as interference with the normal process of 
digestion may result in impaction of the organ, or distension due to the 


* “ Veterinary Physiology.” 


90 SYSTEM OF VETERINARY MEDICINE 


excessive formation of gases, or a combination of both these conditions. 
Moreover, if the food be imperfectly masticated and insalivated, and 
hurriedly swallowed, it is not in a fit condition for gastric digestion, and 
may enter the intestine improperly prepared, and thus set up intestinal 
disorder. Gastric affections afford an excellent example of the pernicious 
results following the violation of natural laws in connection with dietetics. 
As we shall point out later on, the majority of these disorders can be 
traced to erroneous methods of feeding, and to ignorance or carelessness 
with reference to rational horse management. 

(B) The other points in connection with the anatomy and aie 
of the stomach which are of interest to the clinician refer to the question 
of vomition in the horse, and to the serious consequences which result 
when this organ suffers from impaction or from tympany. 

(1) The cardiac extremity of the cesophagus is very thick, the opening 
into the stomach is narrow, and the cuticular coat is thrown into folds 
at this region ; also, the cesophagus enters the gastric walls in an oblique 
manner. 

(2) The peculiar arrangement of the muscular fibres at the cardia, 
forming the so-called cardiac sphincter. Careful dissections of this struc- 
ture by F. Smith and Caulton Reeks show that the sphincter is a very 
powerful one, owing to the special arrangement of the muscular fibres. 
It contributes materially to the prevention of vomition in the horse, as, 
when contraction of the muscular walls of the stomach occurs, the lower 
end of the cesophagus where it enters the stomach becomes firmly com- 
pressed.. It has also an important bearing on the subject of gastric 
impaction and gastric tympany, as, being in constant operation, it does 
not permit the egress of ingesta or accumulated gases by way of the 
cesophagus, except under unusual conditions. 

(3) The stomach rests on the colon, and is not in contact with the 
abdominal walls. This may have some influence in connection with the 
absence of vomition in the horse. It is of importance with reference to 
the therapeutics of gastric tympany, as, owing to the position of the 
organ, the use of the trocar and cannula is impracticable. 

Another anatomical feature is that the cardiac and pyloric orifices are 
rather close together, the latter being below the former. This point may 
also have some influence in connection with vomition. 

(4) The arrangement of the pyloric opening and of the duodenum has 
an important bearing on the subject of gastric affections. The pyloric 
outlet, under normal conditions, is usually open to a certain extent, and 
a distinct pyloric ring exists. The duodenum, where it commences at 
the pylorus, is dilated, and passes downwards and upwards, resembling 


DISEASES OF THE STOMACH: HORSE 91 


in shape the letter U, and also bearing a resemblance to a well-known 
trap used in drainage. F. Smith first drew attention to this peculiarity, 
and termed.it the “siphon trap of the duodenum.” He also pointed 
out that this arrangement appears to regulate the passage of ingesta 
from the stomach to the intestine, and that after the formation of this 
“trap ”’ the duodenum ascends towards the spine, lying all the while on 
the colon. The same observer showed how this anatomical peculiarity 
exerts an adverse influence when tympany of the stomach or intestines 
occurs. The distended organs press on this trap, and occlude it, the 
result being that the stomach becomes practically a closed cavity, as, in 
consequence of the arrangement of the cardia already mentioned, neither 
ingesta nor gases can escape by way of the cesophagus ; hence, a serious 
state of affairs results, which is often followed by rupture of the stomach. 

There are two conditions to which it is now necessary to direct atten- 
tion, as they have an important bearing on certain serious affections of 
the stomach. These are—(1) Vomition ; (2) Regurgitation of Fluids and 
Ingesta, and Eructations of Gases. In reality they are symptoms, and 
very important ones, of certain gastric lesions, but we must point out 
that these phenomena may be observed in other affections as well (see 
p. 118). | 

1. Vomiting.—In carnivora this is a symptom common to many aflec- 
tions. It is readily induced by gastric irritation arising from various 
causes, and by emetics. In the horse, however, it is a very important 
symptom, and one of great gravity, and hence demands special con- 
sideration. If vomiting could be induced with facility in the horse, there 
seems little doubt but that rupture of the stomach would be rarely met 
with, while diseases such as gastric impaction and tympany would be 
deprived of their grave and often fatal character. But as vomiting is of 
comparatively rare occurrence under ordinary circumstances, and is 
observed as a rather common symptom in connection with rupture of the 
stomach, it is seldom indeed that it proves of any relief to the patient, nor 
can it be induced as a therapeutical measure in connection with gastric 
disorders in the horse. 

Various reasons have been adduced to account for the fact that 
vomition so seldom occurs in the horse. Amongst these may be men- 
tioned—(1) the thickened and contracted condition of the cardiac ex- 
tremity of the cesophagus, and the oblique manner in which it enters the 
gastric walls ; (2) the peculiar arrangement of the cardia, by means of 
which it is in a state of firm contraction, and the presence of the folds of 
mucous membrane in the cardiac extremity of the cesophagus ; (3) the 
comparatively dilated condition of the pyloric outlet, also its position— 


92 SYSTEM OF VETERINARY MEDICINE 


z.e., lying close to the contracted cardia, and below the latter: hence, 
when the gastric contents become compressed, they tend to pass into the 
duodenum ; (4) the stomach not being in contact with the abdominal 
walls. F. Smith, however, points out that some further explanation 
is necessary, and suggests that the vomiting centre in the medulla is _ 
rudimentary or very insensible to ordinary impressions in the horse. 
This view is supported by the fact that central emetics fail to induce 
emesis in this animal. According to the same authority, dilatation of 
the cardia must occur before vomiting can take place in the horse, and 
that in cases where this act was observed during life, post-mortem ex- 
aminations showed dilatation so marked that two or three fingers could 
be introduced into the cardia with facility. He also states that, as a rule, 
vomiting in the horse is not accompanied by distressing symptoms. The 
ingesta dribbles away from one or both nostrils, and occasionally an 
effort is made by depressing the head to facilitate expulsion. He, how- 
ever, observed in a case of volvulus of the small intestine that the horse 
lay on the sternum, with the nose extended, while the ingesta rushed in 
a stream from both nostrils, and a distinct sound accompanied the 
effort. 

But other observers state that in many instances the expression of 
the animal is indicative of extreme nausea while emesis is in progress, 
and that the following phenomena may be present: The amount of 
ingesta expelled varies, and is usually mixed with a large proportion of 
fluid. In some instances the amount discharged is very considerable, 
while in others, after repeated attempts at vomition, only a small 
quantity of fluid is emitted. Occasionally, when the amount is large, it 
is discharged by the mouth as well as by the nostrils. During the process 
the muscles of the abdomen and neck may be spasmodically contracted, 
and the head drawn towards the sternum. Sweating and a staring con- 
dition of the eyes may also be observed, and during the intervals exhaus- 
tion, trembling, and coughing, may be present. In some instances 
attempts at vomition only are observed (straining and retching); no 
actual vomition occurs, but profuse salivation is present. In others 
vomition is preceded by frequent eructations of gases and repeated 
attacks of retching. 

Although vomiting is a symptom met with in many cases of rupture 
of the stomach, it may also occur in connection with other conditions 
which are not necessarily fatal. 

Considerable difference of opinion exists as to whether vomiting 
occurs prior or subsequent to rupture of the stomach. Percivall very 
much doubted whether vomiting could take place after rupture of the 


DISEASES OF THE STOMACH: HORSE 93 


stomach, and was of opinion that the act of vomiting should be taken 
as, proof of the stomach being intact. 

Robertson believed that the nature and extent of the rupture, and 
the relations of the viscus to other influences, nervous and muscular, 
should be taken into consideration in discussing the question, as the 
lesion may be of such a character that its interference with forcible 
contraction of the muscular tissue and lessening of the capacity would 
not be absolute and complete. As the result of observations made 
in many cases just previous to death and immediately afterwards, he 
formed the opinion that rupture of the stomach and escape of ingesta into 
the peritoneal cavity may exist some time antecedent to the exhibition 
of attempts at vomition. 

Friedberger and Fréhner point out that when this lesion takes place 
to such an extent that the gastric contents are emptied into the peritoneal 
cavity, it is impossible for any portion of such contents to be discharged 
by vomition. When vomiting and rupture of the stomach occur together, 
these authors regard the latter condition as being a consequence of the 
former ; but in the case of only a partial rupture of the gastric walls, 
such as a rent of the muscular coat or of a portion of it, the rupture may 
induce vomiting if the lesion coincides with a paralysed condition of the 
cardia. F. Smith believes that vomiting may occur either before or 
after rupture of the stomach, and that it is not possible to explain why 
vomition should take place more frequently with a ruptured stomach 
than with a sound one. But this lesion is not always accompanied by 
vomition (see Rupture of the Stomach, p. 120). 

According to Cadéac,* rupture of the stomach does not prevent the 
occurrence of nausea, but the ingesta, having three means of exit—viz., 
the cardia, the pylorus, and the seat of rupture—generally pass out by 
the latter of these, as it offers the least resistance. He also states that 
true vomiting can take place after rupture has occurred, provided the 
ingesta can escape by way of the cardia, and that such may happen when 
the mucosa remains intact, although the other coats of the organ have 
been ruptured. According to his experience, the majority of cases olf 
rupture of the stomach are not accompanied by vomiting. 

We observed a. case of laceration of the stomach due to penetration 
of a car-shaft into the abdominal cavity. The horse lived for about eight 
hours, and vomited repeatedly prior to death, thus showing that this 
symptom may occur subsequent to rupture of the organ. 

Amongst other conditions in which vomiting may occur as a symp- 

» tom, we may mention the following : 


* “ Pathologie Interne.” 


94 SYSTEM OF VETERINARY MEDICINE 


Impaction of the Stomach.—In this condition vomiting may in reality 
be a natural attempt at cure by getting rid of the ingesta. Unfortunately, 
however, in many cases of extreme distension of the organ, although the 
gastric walls are paralysed, the cardia remains firmly contracted, and 
vomiting does not occur. Mignon has observed instances in which the 
stomach was extremely distended, but the cardia was dilated, the mucous | 
folds in the lower portion of the cesophagus paralysed, and by energetic 
action of the abdominal expiratory muscles vomiting occurred. But 
there are a large number of cases of gastric impaction in which vomiting 
is not observed (see p. 102). 

Robertson* recorded cases in young horses in which gastric distension 
resulted from the animals feeding on haws from the hedgerows during 
the late autumn. In those which recovered, marked distress with 
vomition of considerable quantities of the berries occurred. 

Certain Conditions of the Hisophagus.—Dilatation of the lower portion 
of this organ, or a diverticulum close to the cardia may be accompanied 
by vomiting. It must be remembered, however, that there are morbid 
conditions of the cesophagus in which all the phenomena of vomiting 
occur, but the material expelled does not proceed from the stomach, 
being simply ingesta which has become lodged in the gullet. 

Certain Intestinal Lesions, such as volvulus or rupture of the intestine, 
may be preceded or accompanied by vomiting. 

Axe has observed vomiting in connection with rupture of the dia- 
phragm. 

Certain Drugs.—Occasionally vomiting has followed the administra- 
tion of eserine, arecoline, pilocarpine, and barium chloride. It also 
occurs as one of the symptoms in poisoning by aconite or veratrine. 
Robertson and others have observed it to follow prolonged chloroform 
anesthesia. With reference to the latter, we may remark that during a 
fairly long experience in the administration of chloroform we have never 
met with vomiting as a complication or sequel, and we are inclined to 
believe that, when such a condition occurs, it depends on a paralysed 
condition of the cesophagus, resulting in the occurrence of choking when 
the animal is fed too soon after recovering from the anesthetic. In a 
case of this kind the material expelled would proceed from the cesophagus, 
aad not from the stomach. 

2. Regurgitation and Eructations. = Thelde are important symptoms, 
and their presence generally, but not always, points to the existence of 
a gastric disorder. Unfortunately, however, there are certain serious 
affections of the stomach in which these symptoms cannot occur ; 


* “The Practice of Equine Medicine.” 


DISEASES OF THE STOMACH: HORSE 95 


and, so far as eructations of gases are concerned, a valuable means 
of relief is absent in cases of severe gastric tympany, in consequence 
of the firmly contracted cardia, which prevents escape of the gases 
by way of the cesophagus, while pressure of the distended stomach 
on the duodenum renders escape of the gases by the pyloric outlet 
impossible. u 

However, except in extreme instances, small quantities of gases are 
expelled by the nostrils in most cases of gastric tympany. The eructa- 
tions may be accompanied by contraction of the cervical muscles, also 
by gurgling sounds in the cesophagus, which are readily audible. In 
some cases a distinct hiccough may be heard with each eructation ; in 
other instances the symptom may be overlooked unless carefully sought 
for. Auscultation over the region of the cesophagus and of the caput 
muscles will enable us to detect the presence of eructations in the earlier 
stages. Regurgitation of small amounts of fluid may accompany the 
eructations in some cases, and distinct waves may be observed passing 
upwards along the course of the cesophagus. The fluid may contain 
small quantities of ingesta, and be expelled without any effort in some 
instances, while in others there are distinct evidences of nausea, the head 
is slightly depressed during the act, and a distinct sound is emitted. In 
severe cases unaccompanied by relief, the quantity of fluid-may be in- 
creased, and actual vomition then takes place. But, as we shall point 
out, there are cases of tympany and of tympany with impaction in which 
neither regurgitation nor eructations occur, and such offer considerable 
difficulty in diagnosis. Again, these symptoms may be sometimes ob- 
served in “twist” of the double colon (see p. 113); hence, it is of 
importance not to jump to the conclusion that a case in which they are 
exhibited must of necessity be a gastric affection. 

As regards other symptoms which are said to be diagnostic of gastric 
affections, such as certain attitudes and postures adopted by the animal, 
pawing, tremors of the superficial muscles, especially those in the region 
of the left shoulder, partial sweating, etc., in our experience they are not 
reliable. 

To F. Smith must be accorded the credit of investigating the various 
gastric affections in the horse, and drawing the attention of clinicians to 
the possibility of differentiating certain conditions. Later on, Caulton 
Reeks, in an admirable little work entitled ‘“‘ The Common Colics of the 
Horse,” added materially to our knowledge of the subject. As the result 
of the facts brought forward by the above observers, more attention is 
now directed to the differentiation of the various gastric disorders, and 
a more rational system of treatment is adopted. Much yet remains to 


96 SYSTEM OF VETERINARY MEDICINE 


be done before our clinical and pathological knowledge on the subject 
can be regarded as satisfactory. 

We shall now proceed to consider the various diseases of the stomach, 
commencing with those which are of a very serious and often fatal char- 
acter. Here we may remark that some authors describe these affections 
together under the heading of Acute Gastric Indigestion—a plan which ~ 
is open to serious objection, as the term includes a number of disorders 
which can—at any rate, in some instances—be differentiated, and from a 
therapeutical point of view an attempt should be made to do so. 

At the same time, we freely admit that in many instances one of these 
conditions may proceed from, or be associated with, another, and when 
such occurs, a combination of symptoms is manifested which renders a 
differentia] diagnosis either very difficult or impossible. 


GASTRIC IMPACTION. 


SynonyMs.—Gorged stomach; Indigestion with engorgement ; 
Stomach staggers. 

GENERAL RemMARKS.—In this affection the stomach is overfilled or 
impacted with food, and the walls of the organ are in a paralysed con- 
dition. When the impaction is complete, tympany does not occur—at 
least we find it absent at the autopsy. But from clinical observation and 
post-mortem evidence, we are convinced that in many instances, when 
the organ is not completely distended by ingesta, a combination of im- 
paction with tympany may be present. We are also convinced that 
nervous phenomena may be absent in certain instances, and are unable 
to explain why cerebral complications should be the leading features in 
some cases, while in others gastric symptoms are chiefly in evidence. 
The term “stomach staggers” is an unfortunate one, as similar symp- 
toms are manifested in connection with cerebral affections, which on 
post-mortem examination do not show engorgement of the stomach. 
In fact, it may truly be said that our knowledge of those diseases vari- 
ously known as stomach staggers, sleepy staggers, mad staggers, grass 
staggers, etc., is in a very unsatisfactory condition, and a perusal of all 
the textbooks, both ancient and modern, will demonstrate the lack of 
definite information that exists on the subject. 

That disturbance of the gastric functions is capable of exerting certain 
influences on the cerebrum must be admitted. This is evidenced in many 
cases by the disappearance of the nervous symptoms when measures are 
adopted to overcome the abnormal condition of the stomach. Again, 
the history of a case pointing to the animal having gorged himself, and 


DISEASES OF THE STOMACH: HORSE oy 


afterwards shown symptoms indicative of cerebral disturbance, is evidence 
of the stomach being the primary seat of the disorder. But in the absence 
of a correct history of the case, it is not possible to state whether the 
nervous phenomena presented in a given case depend on gastric disturb- 
ance or on a primary affection of the nervous system. 

In our present state of knowledge it would seem advisable to eliminate 
the term ‘stomach staggers’ from veterinary nosology, and to speak 
of the nervous phenomena of gastric impaction as cerebral complications 
of this affection. , 

Instead of the time-honoured term, “ staggers,” it would be pref- 
erable to employ designations such as encephalitis, meningo-encephalitis, 
meningitis, cerebral congestion, etc., as the case may be. At the same 
time, we may remark that in many of these acute cases of nervous dis- 
order we have found lesions such as gastritis at the post-mortem examina- 
tions (see Diseases of the Nervous System; also p. 148). 

- Under the term “ grass staggers ”’ or “ enzodtic paraplegia,’’ Robert- 
son described an affection of the spinal cord resulting from the ingestion 
of rye-grass at a particular period of its growth. As no distinct evidences 
of a gastric affection were found on post-mortem examination, we con- 
sider that the affection should be described under the section devoted to 
diseases of the nervous system. No doubt rye-grass, clover, vetches, 
etc., if partaken of in large amount by horses unaccustomed to this kind 
of food, may bring about gastric impaction or tympany in the same 
manner. as other irrational methods of feeding. | 

Dick and also Williams refer to “ grass staggers,” and regard rye- 
grass in a transition stage between grass and hay as possessing narcotic 
principles, and, when ingested, causing the condition variously known as 
encephalitis, mad staggers, etc. Williams* states that encephalitis is 
due to the effect of the narcotic principles alluded to, and that, “ owing 
to this derangement of the great nervous centres, paralysis of the diges- 
tive apparatus is the result, and the stomach becomes sometimes engorged, 
from the fact that the animal continues to feed when the digestive as well 
as other functions are in abeyance.” 

Now, unfortunately for this theory, a large number of cases of en- 
cephalitis occur in which the animals were not fed on rye-grass, nor on 
hay made from this grass, and the etiology of such cases is still unknown. 
Nor can we agree with him when he states that ‘‘ numerous instances of 
engorgement, impaction, even to rupture of the stomach, constantly come 
under the notice of the practitioner, but signs of any brain affection 
scarcely ever occur.”’ 


99 


* “ Principles and Practice of Veterinary Medicine,” 1909. 
VOL. II. 


98 SYSTEM OF VETERINARY MEDICINE 


The nervous phenomena that occur in connection with gastric im- 
paction are not those characteristic of encephalitis. They consist of a 
dull, semicomatose condition and a staggering gait, constituting what 
the older writers described as “ sleepy staggers.” As already remarked, 
similar phenomena may be observed in certain cerebral affections quite 
independent of gastric disorder. But these symptoms have been so fre- 
quently met with by observant clinicians in connection with gastric 
impaction, and the nature of the cases demonstrated by post-mortem 
examinations, that we are justified in regarding them at any rate as 
evidences of cerebral complications of the affection. 

As regards the frequency with which gastric impaction is met with, 
we may state that in consequence of improved methods of feeding this 
affection is not of common occurrence in the present day. In considering 
its frequency, we must remember that rupture of the stomach is usually 
the result of either gastric impaction or gastric tympany, or a combina- 
tion of both ; hence, rupture is more likely to be found as a post-mortem 
lesion than impaction, as the latter is not so often per se the cause of 
death. ; 

In the Report of the Army Veterinary Service for 1910, we find that 
the number of cases of gastric impaction admitted for treatment was 
three, while twenty-five cases of rupture of the stomach occurred. In 
the Report for India the numbers were— gastric impaction, three ; rupture 
of stomach, thirty-eight. 

EtioLocy.—lIt is generally admitted that food-stuffs that are bulky, 
or indigestibile, or of such a nature that little mastication is required, 
are more likely to cause gastric impaction than others. Cooked or 
steamed food, such as barley, wheat, brewer’s grains, also rye-grass, 
clover, vetches, etc., especially if allowed in large amounts to animals 
unaccustomed to these forms of diet, are well-known etiological factors. 
Again, there is a general tendency to give larger rations of boiled foods 
than of ordinary fodder. In addition to these, we must take into considera- 
tion the question of the periods of work and the intervals of feeding. 
Long fasts tend to make the animal swallow his food quickly without 
proper mastication, and, besides, if a large amount be provided, he is 
liable to continue feeding until an excessive quantity is ingested. More- 
over, as the result of long abstinence from food, and prolonged work, 
the stomach becomes unable to perform its functions. Even with 
ordinary food, under such circumstances, gastric impaction may result, 
and we meet with cases in which marked distension occurs when the 
ingesta is composed of oats and hay. Bran, when given in large quan- 
tities, has been known to produce the condition. 


DISHASES OF THE STOMACH: HORSE 99 


While it is easy to understand how the irrational system of dieting 
mentioned brings about imperfect digestion and the sequels of this con- 
dition, there are certain points in connection with gastric impaction that 
require some explanation. When food enters the stomach in a state 
unfit for gastric digestion, either due to the animal being a greedy feeder 
and not masticating his food, or being fed on large amounts of unsuitable 
food, or being subjected to a long fast and then allowed a large amount 
of fodder, or being put to quick work too soon after feeding, certain results 
may follow. Gastric impaction may occur, or gastric tympany, or a 
combination of these conditions, or the food not properly subjected to 
gastric digestion may pass from the stomach into the intestines, and give 
rise to intestinal disorder. Judging by what is known with reference to 
the physiology of gastric digestion in the horse, we must conclude that 
a natural provision exists for the prevention of impaction, as while the 
animal is feeding, food is passing from the stomach into the intestine. 
This provision is necessary in consequence of the small size of the animal’s 
stomach as compared with the amount of food he consumes at one meal. 
It is evident that when impaction occurs this physiological process is 
interfered with, and an abnormal amount of ingesta is retained in the 
stomach. The exact manner in which this is brought about is not 
definitely known, nor can we explain why impaction or tympany should 
result in one case and intestinal disorder in another, although similar 
causes exist in both. In cases where an excess of food is greedily taken, 
one would imagine that the extra amount would always pass into the 
intestine, and bring about intestinal disorder. Some authors get out of 
the difficulty by stating that when food unfitted for gastric digestion 
enters the stomach it is retained in the organ, and, the animal meanwhile 
continuing to eat, the gastric walls become distended and paralysed. 
It seems probable that in such instances, although during the time of 
feeding a certain proportion of the food must pass into the intestine, an 
interruption occurs during the later stages of the process, and an abnormal 
amount of ingesta is retained in the stomach. This interruption is 
probably due to the unfit condition in which the food reaches the stomach, 
to abnormal fermentation, and, in the case of horses subjected to prolonged 
work and an enforced fast, to the depression and weakness of the gastric 
functions. 

Under such conditions, not only are the normal movements of the 
stomach interfered with, but also the secretion of gastric juice, and the 
retained ingesta becomes firmly packed in the organ, the walls of which 
become paralysed. Relief cannot be obtained by vomition, as in the 
case of carnivora; hence, the condition is a very serious one in the horse. 


100 SYSTEM OF VETERINARY MEDICINE 


It is quite evident that the movements of the stomach take a very 
important part in gastric digestion. According to F. Smith, movements 
in the stomach commence very shortly after food is taken. Peristaltic 
waves travel from the middle of the organ towards the pylorus, and 
these waves become stronger as digestion proceeds. The function of these 
waves is to press the peptonised food against the pylorus. Relaxation. 
of the pylorus after the feed is finished only occurs when material is 
ready to pass out, and not with every wave of contraction that passes 
over the organ. : 

Wemay, then, assume that, under the abnormal conditions mentioned 
above, a large amount of food in an unfit condition for gastric digestion 
is retained in the stomach, distending the organ, and inducing paralysis 
of its walls, thus preventing any ingesta from passing through the pylorus. 
As already remarked, gastric digestion is a very important function in 
the horse, but as no absorption is believed to occur from the stomach in 
this animal, the chief rdle of the organ appears to be the preparation of 
the food for intestina] digestion, And there seems little doubt but that, 
owing to the physiological peculiarities of gastric digestion in the horse, 
affections of this organ, such as impaction and tympany, are far less 
frequently met with than similar conditions in the intestine. 

Caulton Reeks* states that impaction does not depend so much on 
the quantity of the food as on its nature, and concludes that “an un- 
limited supply of tasty, succulent provender will cause some animals to 
go on feeding long after their actual wants are satisfied, and the result is 
an impacted state of the stomach with a mass of food it is unable, mostly 
mechanically, to deal with.” He has also met with occasional attacks 
occurring during the winter months, when the provender consisted only 
of dry corn and chopped wheat or oat straw, and is of opinion that when 
one horse out of five or six fed on the same diet suffers from an attack 
the explanation is that this animal is a notoriously “ greedy feeder,”’ 

Robertson} found that boiled barley was a fruitful source of gastric 
impaction, and records instances in an agricultural district where, during 
certain seasons of the year, the evening feed of oats was replaced by a 
feed of boiled barley, the amount of which was greatly in excess of what 
any horse ought to receive at one time. The cooked food was greedily 
eaten, as the animals were hungry after a hard day’s work, and a large 
number of cases of digestive disorders, chiefly gastric, resulted, with a 
high mortality. After an alteration in the system of feeding, and the 
abandonment of cooked food, the number of cases and the death-rate 


* “The Common Colies of the Horse.’’ 
t “The Practice of Equine Medicine.” 


DISEASES OF THE STOMACH: HORSE 101 


fell 50 per cent. He concluded that “ horses, for the full and healthy 
exercise of digestion, do not require their stomachs filled to repletion 
with material nutritious or innutritious ; while to present them largely 
with food requiring little or no mastication, from the mistaken idea that 
this is beneficial to the animals, is the sure way to further gastric derange- 
ment from repletion.” . 

Cadéac* regards engorgement of the stomach as always a secondary 
condition, and due to paralysis of the gastric walls, and considers that 
the essential predisposing cause is a natura] weakness of the muscular 
walls of the organ. While admitting that this atonic condition of the 
gastric walls is a predisposing cause in the case of aged animals, we 
cannot agree that it should be regarded as a common factor in all cases, 
because we have met with cases in young, apparently healthy horses 
when subjected to irrational systems of dieting. No doubt aged animals, 
with imperfect teeth and weak powers of digestion, furnish a large pro- 
portion of the cases of gastric impaction met with. 

Simple indigestion or dyspepsia also predisposes to impaction, as 
gastric digestion and the normal movements of the stomach are inter- 
fered with in this condition. Enforced idleness, with full allowance of 
corn, 18 also a predisposing cause. 

During convalescence from a debilitating affection, unless care is 
exercised in dieting, gastric impaction may result, as the animal may 
develop an abnormal appetite, and the gastric functions are below par. 
Violent exertion or a quick drive immediately after feeding is another 
cause of the affection. 

Morpip ANAtomMy.—There are degrees of gastric impaction, and in 
those instances where the stomach is not completely distended by ingesta, 
tympany will be present. In cases where the impaction is complete the 
ingesta are so firmly packed that on section of the walls of the viscus the 
contents form a mould of the gastric cavity, and may be compared to “a 
pudding boiled in acloth.”” The stomach with its contents may weigh very 
heavy, and the impaction may be so extreme that it is a matter of surprise 
how rupture of the organ has not occurred. The ingesta are dry, and 
show no evidences of digestive changes, with the exception of a thin layer 
of the surface in contact with the mucosa of the right sac of the organ, 
which may be of a whitish appearance and softened. In some instances 
the epithelium of the villous portion is found adherent in parts to the | 
mass of ingesta. On several occasions we have observed the presence of 
gastritis in association with impaction, especially when the course of the 
affection was more prolonged than usual. 


* “ Pathologie Interne.” 


102 SYSTEM OF VETERINARY MEDICINE 


As complications, intestinal catarrh or enteritis may be met with ; 
also broncho-pneumonia, resulting from attempts at administering 
medicinal agents in the form of drenches. Rupture of the diaphragm 
has also been recorded as a complication. 

Symproms.—These vary to a considerable extent. In some instances 
abdominal symptoms are in evidence, in others nervous phenomena pre- 
dominate. From clinical experience, assisted by post-mortem examinations 
on cases of gastric impaction, we are enabled to state that nervous symp- 
toms may be absent in some cases of this affection. When abdominal 
symptoms are present, they are seldom of an acute character, and the pain 
is generally dull and continuous. They appear at a period varying from 
one to three hours after the last feed, and consist of pawing, lying down 
for a brief period, then rising, and again assuming the recumbent position. 
At times the pain may be more marked, and the case may be mistaken 
for one of spasmodic colic. 

As a rule, only a slight degree of intestinal tympanites is present at 
the commencement, but later on it may occur as the result of cessation 
of peristalsis in the intestines. When the impaction is extreme, neither 
eructations of gas nor attempts at vomition occur. But when, as often 
occurs, the condition is one of continued impaction and tympany, 
acute pain and distress are manifested in addition to the symptoms men- 
tioned. In such instances eructations of gas may be observed, and occa- 
sionally attempts at vomition, with a discharge of liquid material from 
the nostrils. In the cases of impaction due to ingestion of large quan- 
tities of haws recorded by Robertson, symptoms of acute pain were 
present, the animals tossed wildly about, occasionally rested on the 
abdomen, and there were continued eructations of gas, with ejection of a 
sour-smelling brown-coloured fluid from the nostrils and persistent 
attempts to vomit. 

Amongst other symptoms which we have observed in cases of gastric 
impaction are—frothing at the mouth, tremors of the superficial muscles, 
partial sweating, and in some instances the animals made continuous 
attempts at micturition. When nervous symptoms predominate, they 
mask any evidences of abdominal pain. The animal carries his head 
low, and has a dull, sleepy appearance. He may rest his head on the 
manger or press his forehead against the wall. If forced to walk, he 
staggers in his gait, and has a tendency to drag the toes of the hind-feet 
on the ground. The breathing may be slow and more or less stertorous ; 
the pulse is full, but slower than normal ; there is complete loss of appe- 
tite ; the visible mucous membranes may be injected and of an icteric 
tinge ; and constipation ie present. The animal offers marked resistance 


DISEASES OF THE STOMACH: HORSE 103 


to the administration of drenches, and the medicaments may be returned 
by the nostrils. 

CoursE.—This is variable, and depends on the degree of impaction 
present. In extreme cases death may result from rupture of the stomach 
or from other complications. Robertson found that the fatal cases were due 
to gastritis, rupture, or cerebral complications. We have observed cases 
in which rupture occurred in the absence of any preliminary evidences 
of acute abdominal pain. In some instances death is preceded by con- 
vulsions. According to Cadéac, the causes of death in this affection are 
multiple. The engorged stomach may exert compression on the heart 
and lungs, and produce dyspnoea and syncope. He is of opinion that 
the nervous phenomena are due to reflex causes; and believes that 
microbic intoxication, contributing to the fatal termination, may result. 

In less severe cases, subjected to rational treatment, recovery results 
when the ingesta causing the engorgement pass from the stomach into 
the intestines. In rare instances relief is obtained by spontaneous 
vomition, 

DIFFERENTIAL D1aenosis.—In spite of the rules formulated by some 
authors. for the diagnosis of this affection, and the assurance that by 
attention to them any chance of error will be small, we have on several 
occasions mistaken impaction of the stomach for other conditions. How- 
ever, it is a solace to find that we are not alone in this respect, as the 
difficulties in diagnosis are admitted by several authorities ; and so 
convinced are they of the inutility of a strict differentiation that they 
consider the various gastric disorders under one heading. Still, there are 
occasions on which a distinction can be made. The history of the case 
is of importance. If a horse is known to be a ravenous feeder, and if 
after a long fast and hard work he is allowed a large feed of material 
likely to induce impaction, and in a short time afterwards presents the 
symptoms we have described, the case is highly suggestive of gastric 
impaction. In cases where the engorgement is extreme, and unac- 
companied by nervous symptoms, an error in diagnosis may be made 
by even the very elect. 

In less severe cases, which present eructations of gas or attempts at 
vomition, attention is at once directed to the stomach, and a tolerably 
correct diagnosis may be arrived at. In the absence of the history of 
the case, the nervous phenomena, when present, may be mistaken for 
those of a cerebral affection. For the differentiation of acute engorge- 
ment from acute gastric tympany, see p. 114. In cases where both 
conditions are associated, the symptoms will be more suggestive of 
tympany than of impaction. 


104 SYSTEM OF VETERINARY MEDICINE 


Prognosis.—In extreme cases this is always grave, and in less 
severe instances should always be guarded. 

TREATMENT.—It is quite evident that when the impaction is extreme, 
and accompanied by paralysis of the gastric walls, medicinal measures will 
fail to prove of any benefit. Relief cannot be obtained by vomiting, nor 
can the ingesta be made to pass through the pylorus into the intestine. 
Moreover, as no absorption occurs from the stomach of the horse, medi- 
cinal agents produce no effect, and in consequence of the paralysis of the 
gastric walls they will fail to reach the intestine. The appearance of the 
stomach and its contents post mortem readily explains the failure of 
drugs in this condition. In our experience, the employment of eserine 
does not succeed in overcoming the paralysis of the organ, although it 
exerts its special action on the intestines. Friedberger and Frohner 
point out that care should be exercised in the administration of eserine 
or arecoline in this condition, as they may cause rupture of the stomach. 

Cadéac draws attention to the danger of attempting to administer 
drenches in cases of extreme distension of the stomach. As the animals 
instinctively resist the process, there is grave risk that portions of the 
fluid will enter the trachea and bronchi, and set up a fatal broncho- 
pneumonia. He advises, as the most successful treatment, the adminis- 
tration of pilocarpine combined with eserine or veratrine by hypodermic 
injection. The object in view is to stimulate the gastric secretions 
and the movements of the stomach, also to act in a similar manner 
on the intestines, and in order to carry out these indications with 
safety and efficiency attention to certain details is necessary, as follows: 
Pilocarpine increases the secretions and contractions of the organ 
simultaneously ; it softens the ingesta, and facilitates their expulsion 
from the stomach without the risk of rupture of the gastric walls. 
Kserine stimulates gastro-intestinal peristalsis, and should be prescribed 
either along with or subsequently to the pilocarpine, but never prior to 
the administration of the latter. Veratrine prolongs the duration of the 
peristaltic contractions, and hence is a useful adjuvant to pilocarpine. 
As the effect of these agents is temporary, it is advised to prescribe them 
in small doses, repeated from hour to hour, until the normal power of 
peristalsis is restored to the gastric walls. By this method, also, the risk 
of inducing rupture of the stomach is minimised. 

The initial dose of pilocarpine advised is 15 to 20 centigrammes (about 
23 to 3 grains) ; of eserine, 5 to 10 centigrammes (about 1 to 12 grains) 
and of veratrine, 15 centigrammes (about 24 grains). When the doses 
are repeated, only 5 centigrammes (# grain) of pilocarpine and 3 centi- 
grammes (} grain) of eserine or veratrine are advised. 


DISEASES OF THE STOMACH: HORSE 105 


Cadeac does not regard chloride of barium as a safe agent to 
prescribe in cases of gastric impaction. He also states that fluids of all 
kinds should be withheld while the above treatment is being carried out, 
but that later on, fluids assist in restoring the gastric functions, and that 
bicarbonate of soda in doses of from 1 to 2} drachms is indicated. 

Lavage of the stomach by means of the double stomach tube is highly 
spoken of by American practitioners in the treatment of gastric impac- 
tion, and many successful cases are recorded. It is said that by the use 
of this instrument the stomach can be washed out and a large amount 
of the ingesta removed during the process. For particulars as to its 
employment, see p. 118. We are doubtful, however, if the use of this 
instrument can prove successful in extreme cases of impaction, judging 
by the state of affairs we observe at post-mortem examinations. 

In less severe cases the time-honoured treatment of a full dose of 
aloes with calomel often proves successful. Some practitioners prefer to 
administer the aloes in solution, as the drug in this form enters the intes- 
tine more quickly, and thus is more likely to exert prompt purgative 
effects. By thus acting on the intestines, it 1s believed that the move- 
ments of the stomach are stimulated in a reflex manner. 

Some practitioners find that a drench composed of 2 ounces of oil of 
turpentine or terebene and 14 to 2 pints of raw linseed oil gives successful 
results, and also prevents the occurrence of tympany.. Enemas of warm 
water assist the action of the purgative. 

As to the treatment of the abdominal pain which may be present, it 
is quite clear that opiates of all kinds should be avoided, as they interfere 
with the peristaltic movements of the stomach and intestines, and tend 
to induce stasis and tympany. If, however, the abdominal pain be acute, 
1 ounce of chloral hydrate should be given in solution, and in our experi- 
ence it does not interfere with the movements of the stomach or intes- 
tines. Some observers, indeed, state that it checks fermentation, and 
thus prevents the formation of gases, in addition to its antispasmodic 
action. 

When nervous symptoms predominate, with a full, slow pulse and 
stertorous breathing, some practitioners advise early venesection in 
addition to the administration of the purgative. The application of cold 
to the region of the head in the form of woollen cloths wrung out of cold 
water is also advocated. Gentle walking exercise should be given, but 
care should be taken to avoid the occurrence of fatigue. In cases where 
there is a combination of tympany and impaction the pain may be violent 
in character.. Care should be taken to keep the horse from throwing 
himself about, as the risk of rupture of the stomach occurring is greatly 


106 SYSTEM OF VETERINARY MEDICINE 


increased by such movements. In such instances the treatment advised 
for gastric tympany should be adopted (see p. 115). 

The after-treatment consists in attention to the diet, and large feeds 
should be avoided. The administration of powdered nux vomica Zss., 
sodium bicarbonate Zii. and powdered gentian 3ii., twice daily in the 
food, assists in restoring the gastric functions. The teeth should also 
receive attention, so as to detect dental irregularities and carry out 
suitable treatment. | | 

As regards the prevention of gastric impaction, it is accomplished by 
attention to rational methods of feeding. No doubt in cases of greedy 
feeders or of animals suffering from chronic disorders of the stomach, this 
affection may occur in spite of all precautions. Still, in the great majority 
of instances, the etiological factor is to be found in a faulty system of 
feeding. 


GASTRIC IMPACTION IN FOALS.* 


This is a most dangerous affection, though it cannot be described as 
of very common occurrence in these animals. 

Etrology.— Almost without exception the cases occur within four or 
five days after weaning. The cases are usually met with amongst those 
animals that for some reason or other have been removed suddenly and 
prematurely from their dams. When a foal three months old or less is 
abruptly weaned, while still relying on its dam for the greater part of 
its subsistence, the first few days that follow constitute a most critical 
period of its life. 

With the removal of its mother it has not only lost its protector and 
companion, but also the fount of its liquid nourishment, so that digestion 
is at once prejudiced alike by the sudden change in diet and the disturbed 
state of its nervous system occasioned by the changed circumstances. 

Some owners, in order to avoid the accidents in the field that are 
liable to occur when a newly weaned foal attempts to make a foster- 
mother of strange animals, isolate the youngster in another field for a 
few days until it becomes reconciled and settles down. If the pasture is 
abundant and coarse, and no precaution is taken to see that the foal is 
periodically visiting the watering-place and drinking a sufficiency of 
water to compensate for its loss of fluid in the milk hitherto available, 
indigestion and impaction of the stomach very readily occur. 

Symptoms.—The animal is seen to be dull, depressed, and stationary, 
or restless and in pain, getting down and up occasionally, after having 


* For this note we are indebted to Mr. H. Begg, F.R.C.V.S. 


DISEASES OF THE STOMACH: HORSE 107 


spent a day or more in unavailing whinnying and romping over the field 
in a state of expectant excitement. 

When down, the animal exhibits with each expiration a suppressed 
moan, which is more or less marked, according as the animal experiences 
relief from a change of attitude. The bowels are irregular, but there is 
no marked tympanites. The abdomen is obviously full in the region of 
the stomach, and manual palpation behind the sternum and in an upward 
direction oppresses the animal. The pulse is at first slow, full, and soft, 
but later becomes frequent and weak. The temperature does not guide 
us much, but after being subnormal in the early stages, it tends to rise 
as the gravity of the symptoms increases. Sometimes cerebral symptoms 
are apparent; the animal reels and staggers when on its feet, but it 
seldom becomes violent. Partial sweating occurs, and the skin is moist 
at the base of the ears, inside the forearms and thighs, and over the centre 
of the trunk. Death follows on gradually increasing exhaustion. 

Lesions.—The stomach is often enormously enlarged, being filled to 
repletion by a doughy mass of green aliment, with little or no gas present. 
The walls of the organ appear thin and anemic. 

Prognosis is very grave. The paralysis of the engorged stomach is 
usually complete, and the tender age of the patient predisposes it to a fatal 
termination. If cerebral symptoms are in evidence, the case is hopeless. 

Prophylaxis.—Avoid the too early weaning of sucking animals, and 
thus secure the gradual and natural change of diet that obtains through 
the progressive diminution in milk secretion by the dam after the third 
month. 

Before separating the dam and foal, provide the latter with one or 
more safe companions. Their presence in the field modifies the sense of 
loss that the foal experiences when the mother is taken away. Changes 
of pasture should be avoided if possible. If the pasture is changed, it 
should not be more luxuriant than that of the first field, 

Treatment.—Place the animal in a comfortable loose-box, envelop the 
trunk in hot-water blankets, and maintain the heat for several hours. 
If thought necessary, a sinapism should be applied to the abdomen, and 
the body warmly clothed. Give repeated small doses of linseed oil, lime- 
water, and tincture of nux vomica, and administer periodically clysters 
of tepid soapy water. 

To induce thirst, place common salt in the mouth, and encourage the 
patient to drink chilled water, hay-tea, etc., with the object of unloading 
the stomach of its pultaceous contents. 

The careful administration of repeated draughts of newly prepared 
coffee is to be recommended. 


108 SYSTEM OF VETERINARY MEDICINE 


ACUTE GASTRIC TYMPANY. 


GENERAL REemMARKS.—This condition must not be confused with 
dilatation of the stomach. In gastric tympany the organ is distended | 
with gases arising from fermentation of the ingesta, and the affection 
may occur in the absence of any morbid alterations of the gastric walls. 
In dilatation of the stomach the organ has its capacity permanently in- 
creased to a varying extent. Within certain limits this may be compatible 
with health. When it becomes pathological it depends on various causes. 
No doubt gastric tympany may be associated with dilatation of the 
stomach, and depend on the etiological factors connected with the latter 
affection or on morbid alterations in the gastric walls. Still, dilatation 
of the stomach, being a chronic condition, is more properly regarded as 
a distinct affection, and receives consideration later on (see p. 128). 

Gastric tympany in the horse corresponds to tympanites of the rumen 
in the ox, but in consequence of the physiological peculiarities of the 
stomach of the horse already mentioned, the affection is a far more 
serious one. Like gastric impaction, it varies in degree, and in its most 
extreme form the stomach assumes enormous dimensions. The condition 
may be associated with a certain degree of impaction, but in some cases 
the amount of ingesta in the stomach, as demonstrated by post-mortem 
examination, does not appear to exceed the normal. Percival]! drew atten- 
tion to the affection under the heading of ‘‘ Tympany of the Stomach, or 
Wind Colic,” and in his description he states that the stomach or intes- 
tines, or both, may become distended by gas, in addition to any alimen- 
tary matters they may contain. He points out that “ the extraordinary 
degree of suffering manifested in these cases, their resistance to all 
ordinary remedies, combined with some perceptible enlargement of the 
belly and its evident tympanitic appearance and resonance on percussion, 
with eructations and vomiting, may serve to distinguish them from 
spasmodic colic or gripes.”” Later on he states that the stomach alone 
may be the seat of the disorder. 

Since Percivall’s time the subject received little attention, until 
I’. Smith directed the attention of the profession to the importance of 
recognising the condition as an affection per se. He pointed out its 
serious nature, its differential diagnosis, and its treatment. As the result 
of his observations, practitioners paid more attention to the diagnosis of 
disorders of the stomach in the horse, and several cases of gastric tympany 
were recorded in the professional journals. In “‘ Veterinary Therapeutics 
and Pharmacology” (1896) we described the affection. In 1902 ‘an 


DISEASES OF THE STOMACH: HORSE 109 


excellent chapter was devoted to the disease by Caulton Reeks in his 
work, ‘‘ The Common Colics of the Horse.”’ 

With these exceptions, gastric tympany is not described as a disease 
per se in British veterinary textbooks, but is considered along with 
impaction of the stomach. As we have already remarked, both condi- 
tions to a varying extent are often associated, but as the result of clinical 
observation and post-mortem examinations we are convinced that in 
many instances the condition of tympany predominates, and hence is of 
sufficient importance to merit a separate description. 

As regards the incidence of acute gastric tympany, there seems little 
doubt but that it is of far more frequent occurrence than extreme im- 
paction of the stomach. We judge of this more by clinical evidence than 
by the results of post-mortem examinations, as in fatal cases the cause 
of death is generally rupture of the stomach ; and. whether this latter 
lesion is due to impaction or to acute tympany cannot be determined in 
a case where the rupture is extensive and the gastric contents have 
escaped into the peritoneal cavity. 

In cases of extreme impaction it is apparent that but little room is 
left for the accumulation of gases, and if the latter form to any extent, 
rupture is likely to follow. | 

On the other hand, we know, as the result of ABAEaOnten examina- 
tions, that the stomach may be enormously distended by gases, with 
only a moderate amount of ingesta present, and yet rupture may not 
occur. The clinical phenomena suggestive of tympany are the occurrence 
of eructations of gas and the peristaltic waves passing up the course of 
the cesophagus, accompanied or not by other symptoms. As we shall 
point out later, in extreme cases these eructations may be absent, but 
such instances are not of common occurrence. It may be taken as a 
general rule that the most common acute gastric affection met with is 
a varying extent of impaction combined with tympany. 

The affection appears to be of more common occurrence in America 
than in the British Isles, judging by the number of clinical cases recorded. 
It is specially prevalent amongst the heavy draught-horses of the United 
States. 

EtT1oLocy.—The causes of this condition are similar to those men- 
tioned as producing impaction. Young succulent herbage—especially 
clover, vetches, etc., if rapidly eaten by horses unaccustomed to this form 
of food—boiled foods, steeped or unsteeped barley or wheat, mow-burnt 
hay, mouldy corn, etc., are recognised as etiological factors. But we meet 
with cases in which the diet consisted of oats and hay of good quality. In 
such instances it generally happens that an irrational system of feeding and 


110 SYSTEM OF VETERINARY MEDICINE 


working is in existence, or that an animal brought from country to town 
work is suddenly allowed a full measure of corn, to which it is unaccus- 
tomed. Cases are also observed in young horses taken off grass for the 
first time, and allowed full feeds of corn. 

In some instances the affection depends on ordinary indigestion, which 
may originate from various causes, such as alterations in the gastric 
mucosa or in the muscular walls of the stomach. Wind-sucking and crib- 
biting are also recognised as predisposing causes of the condition. Mr. 
Knisley, D.V.S., Topeka, Kansas, U.S.A., informs us that amongst heavy 
draught-horses in his district, the affection is met with under the following 
conditions: The animals are fed early in the morning, while on the previous 
night they have been allowed all the hay they could eat. The morning feed 
consists of 8 to 10 quarts of a mixture composed of cracked corn 2 parts, 
and wheat-bran 1 part. As soon as the feed is finished, they are put to 
hard work, which involves some heavy pulling. At the dinner-hour 
they are watered, and another feed similar to the above is given, with 
very little hay. By the time they have eaten the grain and commence 
on the hay the hour is up, and they are put back to work. Between 
2.30 p.m. and 4 p.m. symptoms of illness first appear (see p. 112). 

We have met with cases due to feeding on frozen roots, boiled turnips, 
and potatoes, raw or boiled, and have also seen very serious cases in 
horses the property of a baker, due to giving the animals a feed of stale 
bread steeped in water for the evening meal. 

Dassonville holds the opinion that gastric tympany may depend on 
the presence of certain micro-organisms in the stomach, which exert a 
fermentative action on the ingesta. This view, however, is not generally 
accepted. 

Morpip Anatomy.—tThe striking feature at the post-mortem is the 
enormous size of the stomach, and the extent of the abdominal cavity 
that it occupies. On section of the gullet and the duodenum, it can be 
removed from the body without any of the gas escaping. In some 
instances, on section of the abdominal wall, the stomach ruptures. In 
a series of cases recorded by Gillespie, due to feeding on mouldy grass, 
it was found at the autopsies that “‘no sooner were the abdominal 
walls severed than the stomach, and sometimes the colon, exploded 
with considerable noise, scattering the contents for many yards 
around,’ 

In some of the post-mortem examinations that we conducted we 
found evidences of gastritis, in others we observed that the gastric walls 
were much attenuated. As already remarked, when complete rupture of 
the stomach has occurred, it is not possible to ascertain whether this 


DISHASES OF THE STOMACH: HORSE 111 


lesion was due to tympany or to impaction. Tympany of the intestine 
may be associated with the gastric condition. 

Symproms.—These vary in character according to the time at which 
the practitioner first sees the case, and also in individual cases. 

As a rule, they appear within a few hours after the last feed, but the 
horse may be attacked at night-time, and not attended until next 
morning, when, of course, the case is far advanced. In the early stages 
the animal may present symptoms of ordinary colic, and be treated for 
such, but later on some of the evidences which are suggestive of gastric 
disorder appear. In some instances the pain and distress are very 
marked ; the animal becomes uncontrollable and throws himself about, 
sweats profusely, and shows extreme respiratory disturbance. In others, 
he stands more or less quietly, the respirations are greatly accelerated 
and of a peculiar gasping character, the pulse is weak and very frequent, 
the expression of the countenance is haggard, and salivation and partial 
sweating may be observed. In a variable period frequent eructation of 
gas occurs, the gas escaping by the nostrils. The amount of gas expelled 
is generally small. In some instances the process is carried out quietly. 
Frequent waves are observed passing up the course of the cesophagus, 
and small amounts of gas are expelled at intervals. These are often 
accompanied by a trickling of fluid ingesta from the nostrils. Some- 
times these waves are arrested before they reach the upper region of the 
cesophagus. In other cases spasmodic contraction of the cervical muscles 
is observed, and each expulsion of gas is accompanied by a sound re- 
sembling a hiccough, while a gurgling noise can be detected in the 
cesophagus. 

Here we must point out that in cases of extreme distension of the 
stomach eructations may be absent, and this we have observed on 
several occasions. Such a circumstance is always unfortunate, as the 
real nature of the case may be overlooked in consequence. 

Tympanites, as a rule,-is not well marked in gastric tympany, unless 
the affection is complicated by the presence of gas in the intestines. 
Generally, the abdomen presents a “full”? appearance, and in many 
instances there are evidences of tympany in the anterior region of the 
abdomen on the left side close to the last rib. 

‘Sitting on the haunches” is a frequent symptom, and we have 
observed it in several cases of this affection. In some instances it occurs 
in the early stages, in others it is delayed until the case is far advanced. 
But it may be absent, and, moreover, it may occur in certain intestinal 
affections, such as intestinal calculus, and twist of the double colon, 
Probably this posture is assumed in order to relieve the diaphragm 


112 SYSTEM OF VETERINARY MEDICINE 


from the pressure of the distended stomach. In three cases in our 
experience—viz., a thoroughbred two-year-old filly, a three-year-old 
gelding, and a four-year-old gelding—this symptom was observed at 
our first attendance, and was the most prominent one present. 

Amongst other postures which we have observed in gastric tympany 
are—lying on the sternum, with the fore-legs extended ; resting on the — 
knees for short intervals, with the fore-feet touching the sternum and 
the hind-quarters raised ; frequent stretching out and panel as if 
making attempts to retBEHvaee! 

Salivation is a common symptom. The saliva may be in the form of 
foam around the lips, or in extreme cases may hang in stringy masses. 
Some practitioners have observed pallidity of the visible mucous 
membranes, 

In common with gastric impaction, the victim of acute gastric tympany 
forcibly resists the administration of drenches, and some of the fluid is 
returned by the nostrils ; also, it is found that if sedatives be administered 
they produce no effect, as they are retained in the paralysed stomach. 

The symptoms observed in the cases recorded to us by Mr. Knisley, 
D.V.S., are as follows : ‘“‘ The driver notices that the horse does not seem 
well; the animal, while standing, hangs his head and shifts from one 
hind-foot to the other; but not being very uneasy, is sent for another 
load. When stopped again, the animal becomes more uneasy, paws with 
a fore-foot, makes attempts to lie down, the respirations are accelerated 
and the nostrils dilated, there are general evidences of distress, and 
the animal may make attempts as if to micturate, lies down, rolls, but 
soon rises again. Tympanites next appears, the expression of coun- 
tenance is anxious, the animal staggers blindly against surrounding 
objects, and is constantly changing positions. On auscultation along the 
course of the cesophagus, evidences of regurgitation will be apparent. 
Unless relief be afforded, rupture of the stomach will shortly follow, 
evidenced by apparent ease from pain, cessation of lymg down and 
rolling. Rigors appear and cold sweats cover the body, and death soon 
supervenes.”’ 

Course.—In cases which yield to treatment relief is obtained to a 
slight extent by the eructations, but chiefly by the passage of the gases 
through the pylorus into the intestine, and the restoration of the normal 
functions of the stomach. 

In severe cases, if unrelieved, the distension becomes extreme, symp- 
toms of asphyxia appear, due to pressure on the diaphragm, and the 
animal may succumb from this cause or from rupture of the stomach 
(see p. 121). Cadéac states that death may result from syncope, and 


DISEASES OF THE STOMACH: HORSE 113 


that the very feeble pulse which is often observed is due to microbic 
intoxication ; also that abortion may occur in the pregnant mare as the 
result of compression exerted by the distended stomach on the uterus. 
This interferes with the utero-placental circulation, and leads to expul- 
sion of the foetus. As compared with many intestinal affections, the 
course of the disease is rapid. | 

In some cases a considerable amount of fluid issues from the nostrils, 
and some of this may enter the trachea, giving rise to a rattling sound on 
auscultation of the tracheal region, and often to broncho-pneumonia as a 
complication. 

Tympanites of the intestine may occur as a complication, and adds 
materially to the gravity of the case. Rupture of the diaphragm has 
also been observed, and is due to pressure of the distended stomach and 
to the animal throwing himself about. 

DIFFERENTIAL Diacnosis.—In the early stages it is not possible in 
many instances to differentiate gastric tympany from an ordinary attack 
of colic. Later on, in a case characterised by violent pain, a doubt 
may exist as to whether it is a gastric or an intestinal disorder until 
eructations of gas and regurgitations of small amounts of fluid ingesta 
occur. As already remarked, in some extreme cases these symptoms 
may be absent, and except the animal assumes the posture of “ sitting 
on his haunches,” an error in diagnosis may be made. Caulton Reeks 
points out that in enteritis there is marked injection and redness of the 
conjunctive, and total loss of peristaltic movements of the intestine, 
as discovered by auscultation of the abdominal region. In gastric 
tympany, on the other hand, this injection of the conjunctive is not 
so well marked, while respiratory distress is in evidence, accompanied 
by the peculiar type of breathing already mentioned, and sounds of 
peristalsis may be heard, with the passage of a small volume of gas 
per anum. Again, in volvulus or twist of the intestine, the abdominal 
walls are hard and tense, and tympanites is well marked—conditions 
which are not present in gastric tympany. | 

In cases where gastric and intestinal tympany are associated, some 
assistance will be given by puncture of the intestine by means of the 
trocar and cannula. If gastric tympany be present, a certain degree of 
abdominal distension will persist after relief has been afforded to the 
intestines. 

Caulton Reeks also points out that twist of the double colon at either its 
sternal or diaphragmatic flexure, or both, may simulate gastric tympany 
—so that the former may be confounded with the latter—especially during 
the early stages and on the first examination of the case. In both the same 

VOL. IL. 8 


114 SYSTEM OF VETERINARY MEDICINE 


alterations in the character of the pulse, the peculiar type of respiration, 
the eructations and regurgitations, and “‘ sitting on the haunches,” may be 
present. The probable explanation of the gastric symptoms in the intes- 
tinal affection is, according to the above observer, that the mass of accu- 
mulated ingesta in the colon is anterior to the twist, being closely related 
to the stomach, and exerts pressure thereon, giving rise to the phenomena 
mentioned. He makes the differentiation between the two conditions as 
follows : In twist of the colon, after a period of six or eight hours, the 
animal assumes the recumbent position for lengthy periods, but in gastric 
tympany this does not occur. In the former affection “ the respirations, 
in addition to being catchy and see-saw in their character, are added to 
by a plain and unmistakable sob—not a gasp for breath owing to pressure 
on the lungs, but a sob of pain.” Also, the gradual increase in redness 
of the conjunctive in this condition is of importance in the differential 
diagnosis. We have, however, met with cases of twist of the colon in 
which no gastric symptoms were present. 

As regards the differentiation of gastric tympany from gastric im- 
paction, it is found as a rule that the symptoms in the latter affection 
are not violent, and are often accompanied by nervous phenomena. 
When both conditions are combined, the symptoms of gastric tympany 
predominate. 

It will be gathered from the above remarks that the diagnosis of 
gastric tympany is by no means an easy matter ; hence, any further aids 
to differentiation would prove of marked value. Cadéac advises that a 
probang be passed into the stomach, not only for diagnostic purposes, 
but also for treatment of the affection. He states that the instrument 
can be easily manipulated, and that the resistance met with at the cardia 
can readily be overcome. In cases where the animal does not manifest 
violent pain, we can readily understand that the instrument may be 
passed without much difficulty, but under opposite conditions this 
measure would be impossible.. . 

The employment of the stomach tube should be a valuable aid to 
diagnosis (see p. 118). 

Cadéac states that in horses of small size rectal examination will 
reveal in front of the left kidney and of the base of the spleen, the cul-de- 
sac of the stomach dilated, tense, and spheroidal in form, and moving 
forwards and backwards in unison with the movements of the diaphragm. 

Proenosis.—This must always be regarded as grave, even in cases 
that do not present severe symptoms at the outset. As we have already 
pointed out, the early symptoms are often misleading. The rapid course 
which the affection often runs, the difficulty of adopting successful 


DISEASES OF THE STOMACH: HORSE 115 


treatment in severe cases, the anatomical and physiological peculiarities 
of the horse’s stomach, and the frequency of fatal complications, are all 
matters that render gastric tympany a very dangerous condition. 

The absence of intestinal tympany, the presence of the sounds indica- 
tive of peristaltic movements, the passage of flatus per anum, and the 
eructations of gas by the nostrils, may be regarded as favourable pheno- 
mena. 

It is of importance to remember that the absence of violent symp- 
toms must not be taken as an indication that the case is not a grave one. 
Careful attention should be directed to thé state of the pulse, the general 
symptoms present, and the appearance of the animal, before giving an 
opinion with reference to prognosis. 

TREATMENT.—The indications for the treatment of gastric tympany are 
readily understood. The difficulty in carrying them out in severe cases is 
quickly recognised by those having experience of the affection. These 
indications are to remove the accumulated gas present in the stomach, 
and to prevent the formation of fresh supplies. The gases present are 
similar in composition to those occurring under normal conditions, but 
some of these are largely increased in amount. 

F. Smith points out that the nature of the gases present in the stomach 
under normal conditions largely depends on the food, and that green 
food is most productive, owing to the active fermentation that it under- 
goes. The most important of the gases are—carbonic acid, which is 
derived from the fermentation of food and the action of acids on the 
saliva ; carburetted hydrogen (marsh gas), derived from the decomposi- 
tion of cellulose; and sulphuretted hydrogen. It is these gases in 
greatly increased amounts which distend the stomach in cases of 
gastric tympany. It is obvious that whatever medicinal treatment 
we adopt will have little effect in getting rid of these gases by way 
of the esophagus, although we have imagined at times that in mild 
cases, after the administration of agents such as terebene, the amount 
of gas eructated was increased. But the chief way of exit must be 
the pylorus. In the less severe cases we have obtained good results 
from the administration of oil of turpentine or terebene in doses of 
from 2 to 4 ounces, mixed with 2 pints of raw linseed oil. These 
agents possess an antiseptic action, stimulate the gastric walls, favour 
the expulsion of the gas by the pylorus, and prevent fermentation and 
the formation of further gases from the ingesta. When, however, there 
is marked distension of the gastric walls, this treatment fails, and in 
many instances the animal fights against the administration of the 
drench, and a portion of the latter is returned by the nostrils. Caulton 


116 SYSTEM OF VETERINARY MEDICINE 


Reeks* draws attention to the following important points in connection 
with the therapeutics of gastric tympany: (1) Carburetted hydrogen 
cannot be absorbed by any agent given by the mouth, so that remedies 
should be selected which are likely to act on the carbonic acid and sul- 
phuretted hydrogen. He also points out that carbonate of ammonia | 
should be avoided, as the acid condition of the stomach would cause this 
agent to give off carbonic acid, and so increase the amount of that gas 
already present. He finds that the liq. ammonie fort. (B.P.) is the 
most suitable form of ammonia to employ, as the free ammonia absorbs 
the carbonic acid present in the stomach (forming carbonate of ammonia), 
and, besides, exerts stimulant and antispasmodic effects. In order to 
act on the sulphuretted hydrogen, sulphate of iron is added to the am- 
monia, freshly precipitated hydrate of iron being formed, which absorbs 
the above-mentioned gas. The formula is as follows : 


R. Ferri sulph. pulv. a Le un sgnkak 
Lig. ammon. fort. aie de fyi ely. 
Aquafervens .. O.i1. 


M. Sig.: This mixture, with the resulting precipitate, to be given at once. 


The above may be followed up with a dose of terebene or oil of tur- 
pentine. This treatment has also been found successful by other prac- 
titioners. It is also advised to administer from 2 to 24 grains of eserine 
by hypodermic injection, with a view to “ unlocking the duodenal trap 
by violent and energetic intestinal movements.” The same observer 
has found that even in cases where the abdomen was not tympanitic, the 
effect of the eserine was to cause the expulsion ef immense volumes of 
flatus per anum. This would indicate that eserine overcame the obstruc- 
tion to the passage of gas through the pylorus. 

Whether eserine could act efficiently in extreme cases of gastric 
tympany is problematical. At any rate, we have experience of instances 
of both impaction and tympany in which, although it acted on the intes- 
tine, it failed to produce any effect on the stomach. Moreover, there 
must be a certain risk of the agent producing rupture of the stomach 
when the walls of the organ are in a state of extreme distension. Prob- 
ably the small repeated doses of eserine and pilocarpine advised by 
Cadéac constitute safer treatment (see p. 104). When the case is 
accompanied by tympany of the intestine, it is advisable to employ 
the trocar and cannula, so as to relieve intestinal distension. 

In extreme cases of the affection it is obvious that drugs given by the 
mouth have no effect. The stomach is completely paralysed, and nothing 


* “The Common Colics of the Horse.”’ 


? 


DISHASES OF THE STOMACH: HORSE 117 


can pass from this organ into the intestine. Moreover, the difficulty of 
administering drenches must be remembered, also the danger of fluids 
entering the trachea—an accident not uncommon in connection with this 
disease. The failure of aloes to exert its purgative action is explained 
by the fact that the drug does not pass beyond the stomach. 

In cases characterised by the presence of violent abdominal pain, it 
was formerly considered rational treatment to administer sedatives such 
as opiates. Given by the mouth, they failed to check the pain ; hypo- 
dermic injections of morphine also proved useless in ordinary doses, 
while, if administered in larger amounts, delirium and excitement were 
produced to an alarming extent. 

But there is a more serious drawback to the employment of opiates. 
Administered by the mouth, no doubt they may exert little, if any, effect 
in extreme cases of gastric tympany, but in ordinary cases it is highly 
probable that they may exert a local sedative effect on the gastric walls, 
and increase the paralysis already existing. Moreover, they may pass 
to the intestine and interfere with peristalsis, thus adding a fresh source 
of danger. Caulton Reeks is of opinion that opiates, by interfering with 
energetic intestinal movements, prevent “ the unlocking of the duodenal 
trap,’ which is the only natural means of relief. With regard to hypo- 
dermic injections of morphine, it is quite clear that they interfere with 
the movements of both the stomach and the intestines. 

Law advises in very urgent cases the administration of 1 to 2 ounces 
of chloral hydrate, and states that “it acts as a powerful antiferment, 
checks further formation of gas, and counteracts spasms of the bowels, so 
that gas passes more freely per anwm, vermicular movements are resumed, 
and. recovery may be hoped for.” 

But we have to consider what line of treatment should be adopted in 
cases of extreme tympany showing violent symptoms, as in our experi- 
ence it is practically impossible, and even dangerous, to administer 
drenches under such conditions, and, besides, there is the risk of rupture 
of the stomach resulting from the horse throwing himself about. We 
have found that in such instances it is advisable to administer chloro- 
form, not to the extent of inducing deep narcosis, but sufficient to over- 
come the violent struggling of the patient. To carry this out safely, it 
is essential to have the animal in a very large stall or open space, and to 
have him properly held by assistants, so that he may not injure himself 
during the early exciting stage. By administering the drug slowly to 
the animal in the standing posture, he generally lies down quietly, or, if 
already down, the limbs can be secured, and the administration carried 
out, and repeated at intervals, until the violent symptoms are subdued, 


118 SYSTEM OF VETERINARY MEDICINE 


The relief of the tympany must next be considered, and, judging by the 
favourable reports given by American practitioners on the employment 
of the double stomach tube, there seems little doubt but that the use of 
this instrument is destined to be the most successful treatment for the 
condition. Not having had the opportunity of using this instrument, 
although being in possession of one for a short time, we have asked the 
inventor, Mr. D. O. Knisley, D.V.S., of Topeka, Kansas, U.S.A., for par- 
ticulars of the technique and results, and he has kindly furnished us with 
the desired information as follows : . . 

‘““ The tube is made of the best soft rubber. It is 10 feet in length, is 
double for 7 feet, and has the balance in two separate tubes. Where the 
tube is double the parts are vulcanised together. The separate tubes 
consist of—(1) one with a small opening (4 inch), through which we 
pump in water to the stomach ; the other (2) is larger (4 inch), and is 
the outlet from the stomach through which the food and gases will 
return. The large opening will allow a good-sized kernel of corn or 
particles of hay to come through. A single tube does not prove suc- 
cessful, because it becomes filled up with the solids of the stomach, 
and is only of use when the gastric contents are entirely fluid. The 
technique of passing the tube is as follows : 

1. “ Pour from 1 to 2 ounces of oil into the large opening, so that the 
stilette will work easily. If this is not done, you cannot pull the stilette 
out when the tube enters the stomach. The stilette should always be 
inserted to within 14 inches of the end of the tube, so as to prevent the 
latter from doubling during the passage of the instrument. 

2. “ Lubricate the outside of the tube with a decoction of slippery 
elm-bark, or wet the tube and roll it in the above agent, powdered. (This 
lubricant is far preferable to oil, and, besides, it does not injure rubber 
like the latter agent.) 

3. “ Place a speculum in the horse’s mouth, then place the hand up 
over the tongue, and pass the tube back in the mouth. Pass it slowly 
and gently, and the horse will then start it himself. After it has been 
passed for about 1 foot, draw the stilette back about 6 inches, and then 
pass the tube into the stomach. Next remove the stilette, and fix the 
pump* connection to the larger opening, and pump in enough water to 
form a siphon. When that is started, change the pump connection to 
the smailer opening, pumping slowly, so as to keep a small stream of 
water running.’ When the large tube ceases running, place the pump 
connection back into the larger opening, and pump rapidly about one- 
half to two-thirds of a pail of water into the stomach. 


* The ordinary Winton’s enema pump will suit for this purpose. 


DISEASES OF THE STOMACH: HORSE 119 


“If the tube is passed too far into the stomach, the pump will not 
work freely. When such occurs, draw the tube back about } to 1 inch. 
The pump will then work with facility, and the stomach will be emptied 
of its contents. 

4, “If relief is not obtained in from thirty minutes to one hour, the 
tube should be passed again.’’* 

Mr. Knisley also states that he has used this tube on 5,000 cases, but 
admits that it takes some actual practice to carry out the procedure 
successfully. The value of the instrument has also been demonstrated 
by other practitioners. It will thus be seen that in America this form of 
treatment has long advanced beyond the experimental stage, and it is 
certainly worthy of a trial in this country. It would appear to offer far 
more chances of success in the extreme cases of tympany than treatment 
by drugs, the results of which are at best only problematical, and, besides, 
there is the difficulty of administration and the danger of portions of the 
fluid entering the trachea. Moreover, by the use of the tube immediate 
relief is given, as the gas is rapidly removed from the stomach. This 
instrument is also of value in connection with the diagnosis of gastric 
tympany, which, as we have already pointed out, may present marked 
difficulties in some cases. 

As regards puncturing the stomach through the external abdomina| 
wall by means of a trocar and cannula, the question was discussed by 
Percivall, and he regarded the operation as impracticable. Although the 
operation is described as a comparatively safe one by some observers, the 
technique adopted would certainly lead us to hold the opposite opinion ; 
hence, we do not consider that it should be included in the list of useful 
therapeutic measures. 

It is of importance to prevent a horse suffering from this affection 
from rolling or throwing himself about, as such movements are likely to 
induce rupture of the stomach. This precept, however, is not easy to 
carry out when the patient is suffering violent pain ; hence, in such 
instances we advise the employment of light chloroform anesthesia 
(see p. 117). 

The after-treatment of cases of gastric tympany consists in attention 
to dietary and the administration of gastric tonics, such as a combina- 

* Treman (Missouri Valley Veterinary Bulletin, July, 1909) advises that the 
Knisley stomach-tube should be passed as follows: ‘‘ Draw very tightly around the 
nose a common hame-strap ; this is placed just high enough so as not to interfere 
with the animal’s breathing. Then lubricate the tube and pass it in through the 
interdental space and down the csophagus as usual. The animal breathes much 
easier than it does when a mouth speculum is used, and consequently does not resist 


the operation so strenuously.... The tube is less liable to enter the trachea when 
so used than it is with the mouth held open,”’ 


120 SYSTEM OF VETERINARY MEDICINE 


tion of powdered nux vomica, gentian, and sodium bicarbonate, given in 
the food twice daily. Preventive measures are similar to those advised 
for gastric impaction, 


RUPTURE OF THE STOMACH. 


GENERAL RemarKs.—This condition may be regarded as peculiar 
to the equine species. ‘Tympanites of the rumen in the ox is but rarely 
followed by rupture, and when this lesion does occur, it takes place 
just prior to death, or occurs post mortem. The fatal termination in this 
affection is generally due to asphyxia. The large size of the rumen and the 
situation of the organ permit of a far greater degree of distension than 
can occur in the stomach of the horse. Again, tympanites of the rumen 
is readily diagnosed, and is amenable to treatment, not only medicinal, 
but also surgical, by means of the trocar and cannula ; moreover, medicinal 
agents can be administered with facility, and the anatomical peculiarities 
of the stomach, which render gastric tympany in the horse such a serious 
condition, do not exist in the ox. In the dog, rupture of the stomach is 
unknown, in consequence of the facility with which this animal vomits, 
and thus gets rid of fermenting ingesta. 

As rupture of the stomach in the majority of instances occurs in 
connection with gastric tympany, associated with impaction, and as such 
a condition is far less frequently met with in the present day than formerly, 
by reason of more attention being directed to the rational dieting of horses, 
it follows that the lesion we are discussing is not so often observed. It 1s 
interesting to note that in the Report of the Army Veterinary Service for 
1910, the number of cases of gastric impaction recorded was 3, of rupture of 
the stomach 25, and of rupture of the intestine 19. In the Report of the 
Army Veterinary Service in India for 1910-11, 3 cases of impaction of 
the stomach, 38 of rupture of the stomach, and 15 of rupture of the 
intestine were recorded. As no mention is made of the conditions under 
which the cases of rupture occurred, nor of the incidence of gastric 
tympany, we cannot draw any deductions as to the etiological factors. 

There are certain points in connection with rupture of the stomach 
which must strike the observant practitioner. One is the extent to 
which in some instances the stomach may be distended by ingesta or 
by gases, as presented at autopsies, and still no rupture of its walls occurs. 
Another is with reference to thediagnosis of the condition. We may suspect 
its presence and feel tempted to avoid the administration of remedies, or 
even to order the destruction of the animal, and still the autopsy may 


DISEASES OF THE STOMACH: HORSE 121 


show that the lesion did not exist. It is true that in many such instances 
of erroneous diagnosis an equally fatal condition is present, but we have 
unpleasant experience of gastric affections presenting apparently fatal 
symptoms in which energetic treatment might possibly have proved of 
benefit. It might be imagined by those who do not possess clinical 
experience that a condition such as rupture of the stomach should be 
recognised with facility, but, as we shall point out later on, the symptoms 
are by no means constant or diagnostic—in fact, the more experienced 
the practitioner, the more careful he is in giving a definite opinion as to 
the existence or otherwise of this lesion. 

Et1oLocy.—This is most conveniently discussed under the following 
headings : 

1. The Presence of Certain Gastric Disorders —Of these, gastric 
tympany, or a combination of this condition with impaction, is recog- 
nised as the most frequent etiological factor in the production of rupture 
of the stomach. No doubt the violent symptoms associated with this 
condition—viz., rolling, etc.—have an important influence in bringing 
about the lesion. According to Cadéac, distension of the organ by ingesta 
or gases is not sufficient to induce rupture, when the gastric walls are in 
a normal condition. He believes that external pressure determined by 
contraction of the muscular coat of the organ, associated with contraction 
of the abdominal walls and of the diaphragm, may produce the condition 
when the walls of the stomach are altered by disease. Robertson regarded 
a full meal, followed at once by continuous and severe labour, as an 
exciting cause of the lesion. Begg met with a case in which a horse 
was sent a distance of three miles for a load of coals, and at the pit, 
while waiting, the animal ate a good portion of a green sheaf of oats. 
He showed symptoms of pain after leaving the pit, but was urged on 
by the driver, and the journey home was uphill. In half an hour later 
symptoms suggestive of gastric rupture were in evidence, and death was 
rapid ; and the animal during the entire period of illness did not assume 
the recumbent position, or rollabout. Fuller* recorded a case that occurred 
in a horse at pasture, due to the stomach becoming distended with grass. 
Spooner} related a case in a cart-horse that was a greedy feeder. The diet 
consisted mostly of dry bran, of which the animal had a large meal in 
the morning, and the first symptoms of illness occurred after he had gone 
six miles on a journey. Miles met with a case of gastric rupture in a 
horse, occurring after a full drink of water and a rapid gallop. Good- 
wortht related a case due to the horse eating large quantities of haws. 


* Veterinarian, 1834. t Ibid., 1835. { Ibid., 1886. 


122 SYSTEM OF VETERINARY MEDICINE 


2. Alterations in the Gastric Walls.—Although rupture may occur in 
a stomach with perfectly healthy walls, there is abundant evidence to 
show that morbid alterations therein are important etiological factors in 
connection with the lesion. 

Robertson* was of opinion that “ structural change probably always 
precedes the occurrence of the lesion.” He pointed out that, although 
the rupture may possibly take place when the organ is perfectly healthy, 
still, in many instances the viscus, previous to the fatal lesion, has been 
‘“ repeatedly the seat of derangement and distension and organic changes, 
and the rupture can only be regarded as a natural sequel of chronic 
indigestion. In such cases the walls of the organ have become not only 
attenuated by the continued stretching process to which they have 
been subjected, but the muscular tissue of which they are made up has 
become somewhat altered in its elementary structure.” This careful 
observer also brought forward, in corroboration of the above view, the 
fact that the lesion rarely takes place in the young animal, but is more 
frequently met with in aged, exhausted, and hard-worked subjects. 

Alterations in the gastric walls due to the presence of large numbers 
of larvee of Gastrophilus equi are recognised by many observers as etio- 
logical factors. These parasites may cause attenuation and ulceration of 
the walls of the viscus, and thus induce indigestion, fermentative changes 
in the food, and tympany as a result. The presence of the Spiroptera 
megastoma has more rarely produced similar effects. 

Crib-biting and wind-sucking have been found by some authorities 
to cause atrophy of the gastric walls, and to predispose to rupture. 
Percivallf recorded a case that occurred in an inveterate crib-biter, and 
believed that the rupture had occurred through the swallowing of large 
amounts of air. 

Dupuy, quoted by Percivall, held that the two causes of gastric rupture 
were—an increased friability of the tunics of the stomach due to inflam- 
mation, and the practice of giving a copious amount of water after a full 
meal, 

Dilatation of the stomach and chronic gastric catarrh are also recog- 
nised as predisposing causes. Amongst the rare predisposing causes we, 
may mention ulcer of the stomach and phlegmonous gastritis. Caulton 
Reekst states that occasionally, when the walls of the stomach are 
weakened by previous disease, an attack of ordinary colic may, in conse- 
quence of the paroxysms of pain, cause the animal to throw himself 
violently on the ground and bring about rupture. 


* «The Practice of Equine Medicine.” t ‘ Hippopathology.” 
t ‘* The Common Colies of the Horse.”’ 


DISEASES OF THE STOMACH: HORSE 123 


3. Falls, Contusions, Rolling, etc., are regarded as exciting causes. We 
have already referred to the influence of such in cases where the stomach 
is distended. But instances are recorded in which gastric disorder was 
absent, and the lesion was produced by the accident. Broad* related 
an instance of an aged horse in weak condition, in which a sudden heavy 
fall during work produced rupture of the stomach, and the coats of the 
organ were found attenuated. Percivall states that blows, falls, and 
violent straining may bring about the lesion when the stomach is full. 
D’Arboval, quoted by Percivall, met with a case in which the horse, after 
a full meal and drinking plentifully at a watering-place, happened to slip 
upon his left side in returning to the stable. He showed evidences of 
acute pain some time afterwards, and succumbed. The autopsy revealed 
a rupture through the great curvature of the stomach, 8 inches in length. 

We have met with one instance in which a horse bolted with his rider, 
and came into contact with the shaft of a car, which penetrated the 
abdominal wall, and produced a rupture of the stomach. 

4, Attempts at Vomition.—According to Cadéac, attempts at vomition 
may produce rupture of the stomach. Friedberger and Frohner state 
that the lesion may result from spasmodic contraction of the abdominal 
walls during vomiting, and when vomiting is prevented by the firmly 
closed cardia, rupture of the stomach may be produced by the excessive 
muscular contractions of the gastric walls. It must be remembered, how- 
ever, that in extreme cases of impaction and likewise of tympany, the 
walls of the stomach are in a paralysed condition, hence it is difficult 
to understand how muscular contractions can take place under such 
circumstances. 

Morsip ANAToMy.—The carcass is found greatly distended. On 
opening the abdominal cavity portions of alimentary material may be 
found distributed amongst the convolutions of the intestines, and mixed 
with a hemorrhagic exudate. Evidences of acute peritonitis are present, 
and the peritoneum is covered by a pseudo-membraneous exudate. In 
some cases the ingesta remain enclosed in the omentum, and the peri- 
toneum is not involved unless the omentum becomes ruptured. Generally, 
the rupture in the gastric walls is complete ; it may measure from 6 to 
10 inches in a longitudinal direction, and is usually found in the greater 
curvature. According to Dupuy, its occurrence in this region is accounted 
for by the change of position of the stomach due to distension, and also to 
the greater curvature being the part least supported after that change has 
taken place. In exceptional cases the rupture may occur at the lesser 
curvature, and even through the cardia. Some observers have found an 


* Veterinary Journal, vol. ii. 


124 SYSTEM OF VETERINARY MEDICINE 


extensive rent in the peritoneal and muscular coats, but only a small 
rupture in the mucosa. Dupuy and others observed rupture of the peri- 
toneal and portion of the muscular coat, but the mucosa was intact ; 
occasionally the serous coat only was ruptured. The edges of the rupture 
are irregular, swollen, and covered with blood. Some authorities observed _ 
the occurrence of cicatrisation of the rupture. Cadéac met with a case 
in which the fibres of the muscular coat were disassociated at the level 
of the cardia, permitting the folds of mucous membrane to insinuate 
themselves into the rupture, and to come into contact with the serous 
coat ; the ingesta were thus prevented from escaping, and cicatrisation of 
. the rupture occurred. He observed in another case an old cicatrix 
resulting from a rupture of the muscular and serous coats, and separated 
from the sound tissues by a well-marked elevation or ridge. Jobson* 
recorded a case where, in addition to a recent rupture of the stomach, 
there were evidences of an old lesion in the form of a cicatrix 7 inches long. 

The amount of ingesta found free in the abdominal cavity varies 
according to the extent of the rupture and the fluidity of the ingesta. 
In some instances a certain quantity remains in the cardiac portion of 
the organ, while the pyloric portion is empty ; in others, very little is 
found in the stomach. The ingesta may reach the pelvic cavity, and 
instances are recorded by Dupuy in the stallion in which alimentary 
matters found their way into the scrotum by way of the inguinal canal, 
so that the case resembled one of inguinal hernia. Various alterations 
may be observed in the gastric walls ; in some cases there are evidences 
of gastritis. Occasionally intestinal lesions are found associated with 
rupture of the stomach. 

Symptoms.—Although a combination of certain symptoms is highly 
suggestive of rupture of the stomach, it may be stated that as a general 
rule individual cases present a variety of symptoms. Dealing first with 
gastric tympany and impaction, which, as already mentioned, furnish the _ 
majority of cases of this lesion, the evidences of violent pain are succeeded 
by a sudden change in the character of the symptoms—a change which 
may be mistaken by those lacking clinical experience for an improvement 
in the case. The animal stands persistently, violent symptoms disappear, 
he presents a haggard expression of countenance, the extremities are cold, 
profuse sweating occurs, succeeded by rigors and cold sweats, while 
tremors of the superficial muscles, especially those of the limbs, are 
observed. The pulse shows a marked alteration in character ; it becomes 
small, very quick, and gradually imperceptible; the respirations are 
greatly accelerated, short and quick in character; the visible mucous 


* American Veterinary Review, 1896. 


DISEASES OF THE STOMACH: HORSE 125 


membranes are at first slightly injected, but later on become pallid. The 
animal can only be made with difficulty to change his position, but in 
some cases observed by Robertson the horse moved feebly around the 
box with his nose towards the ground. Vomiting is a fairly common 
symptom, but there are many instances in which it is absent (see p. 93). 
In some cases the ingesta may issue from the nostrils without any distinct 
effort on the part of the animal ; in others the act may be well marked, 
and accompanied by retching. “Sitting on the haunches ” is a symptom 
present in some cases, but it is by no means diagnostic of rupture of the 
stomach, as it occurs in other conditions ; vomiting may occur while the 
animal is in this position. Various other postures are recorded by 
different observers, such as stretching out the fore-legs, arching the back, 
leaning backwards and downwards until the abdomen nearly touches the 
ground, curving of the neck, and holding the head between the fore-legs. 
Tympanites is generally present, accompanied by a hard, tense condition 
of the abdominal muscles ; but occasionally it is absent, and the abdomen 
may be contracted. The administration of medicines is resisted by the 
animal, and when drenches are forcibly given, the distress that is present 
is markedly increased, and a portion of the fluid is returned by the nostrils. 
In those cases where the gastric walls suffer from pre-existing disease, 
and rupture occurs during an ordinary attack of colic, the early signs of 
gastric disorder are absent, and the symptoms of rupture follow the occur- 
rence of colicky pains. Such instances are very apt to prove deceptive 
as regards diagnosis and prognosis in the early stages. 

Robertson pointed out the various phases under which gastric rupture 
may occur. Thus, when the lesion develops from steady pressure 
within the stomach, marked uneasiness and pain may be absent, and when 
seen by the attendant, rupture may have occurred without the usual pre- 
liminary symptoms suggestive of that condition; they indicate the 
presence of peritoneal or visceral inflammation rather than of rupture. 
Or the lesion may take place suddenly as a primary affection, and may 
occur while the animal is at work. Marked uneasiness may not be observed 
at first, but very shortly it becomes a prominent symptom, due to the 
entrance of ingesta into the peritoneal cavity and the resulting peri- 
tonitis ; the other phenomena already mentioned then appear. Robertson 
has also observed cases in which violent symptoms persisted to the last, 
the patient gradually becoming unconscious. 

Course.—When the rupture is extensive, symptoms develop rapidly, 
and collapse, with death, may follow in a few hours. When the rent in the 
organ is not extensive, and the amount of ingesta entering the peritoneal 
cavity is small in amount, the patient may last for forty-eight hours. 


126 SYSTEM OF VETERINARY MEDICINE 


In the case that we observed, which was due to a wound caused by a shaft, 
the symptoms were very distressing, and collapse appeared imminent, 
but death did not occur until eight hours after the injury. Cadéac met 
with instances in which the animals lived for some days, the autopsy 
showing that the gastric contents were retained between two layers of _ 
the mesentery; consequently, the peritoneum was not involved or infected. 
Sequens observed two cases in which appetite and thirst persisted, although 
the stomach was ruptured. 

As death approaches, the muscular tremors increase in severity, the 
surface of the body and extremities become very cold, and the animal 
falls down, and may die almost immediately ; in some instances a stream 
of fluid ingesta may issue from the nostrils. 

DIFFERENTIAL D1racnosis.—Most clinicians agree that, although the 
presence of certain symptoms is highly suggestive of rupture of the 
stomach, yet, if we wish to avoid errors in diagnosis, a guarded opinion 
must be given. 

Robertson remarks :* “‘ That in no case can we satisfy ourselves or 
others that the lesion has occurred. ... When an animal suffering from 
gastric engorgement and distension, with much abdominal pain, being 
very uneasy and tossing himself about with violence, suddenly becomes 
quiet for a short time, with a distinct change in the expression of his 
countenance, in which is now marked great anxiety, with short, quick 
respirations, regurgitation of fluid or more solid ingesta from the mouth 
and nose, with attempts at vomition, the pulse becoming quicker and 
more feeble, the probability is that the walls of the stomach have become 
torn.” 

F. Smitht states : ‘ Diagnosis of the affection is anything but easy ; 
we have no diagnostic symptoms, and no two cases of the lesion present 
the same appearances. I think the symptoms on which we can place the 
most reliance are—paroxysms after the administration of medicines, 
extreme anxiety of countenance, in some cases the presence of particles 
of ingesta in the peritoneal sac, detectable on examination per rectum, 
running-down pulse, cold sweats and rigors, with coldness of the surface ; 
and should vomiting and sitting on the haunches occur in conjunction 
with these, it only strengthens the diagnosis, but their absence in no 
wise weakens it.” 

Caulton Reekst remarks : “* We have no really diagnostic symptoms of 
ruptured stomach.” 

* On. cit. 


+ Proceedings of the Fifth General Meeting of the National Aiea, Association. 
{ Op. cvt. 


DISEASES OF THE STOMACH: HORSE 127 


Percivall* states : ‘‘ We possess no certain diagnostic of the lesion. . . , 
Our guides must be the history of the case, the subject of it, the circum- 
stances attending it, the inflated or enlarged condition of the abdomen, 
the symptoms of colic ceasing and becoming succeeded by cold sweats and 
tremors, the pulse, from being quick, small, and thready, growing still 
more frequent, and at length running down and becoming altogether 
imperceptible ; the countenance denoting gloom and despondency of the 
heaviest character, with or without vomiting. I do not think that any 
peculiar or strange posture the animal may throw himself into in a fit of 
pain can be relied upon as worth much.” 

Cadéac points out that if a trocar and cannula be inserted in the inferior 
aspect of the abdomen, a blood-stained fluid of an acid or neutral reaction, 
and containing particles of ingesta, may be drawn off. This procedure 
would prove of assistance in the diagnosis of gastric rupture, when the 
ingesta are set free in the peritoneal cavity. 

The employment of the stomach-tube would also give indications of 
the presence of a rupture, as on injecting fluid the latter would not be 
returned by the larger end of the tube, such as occurs when the stomach 
is intact. But as the procedure would add greatly to the distress and 
suffering of the animal it cannot be recommended. 

The differentiation between rupture of the stomach and rupture of the 
intestine is impossible in many cases. If symptoms suggestive of a gastric 
disorder were present at the commencement of the attack, they would 
no doubt be of assistance in diagnosis as regards ascribing the later phe- 
nomena toa lesion of the stomach. But once rupture of either the stomach 
or the intestine has occurred, similar symptoms may be presented in both. 

Proenosis.—Although with a case presenting the series of symptoms 
described we must give a grave prognosis, still, in consequence of the 
difficulty of arriving at a definite diagnosis, we seldom or never feel justified 
in ordering the destruction of the animal on the plea that the case is a 
hopeless one, and that the friendly bullet should be employed from 
humanitarian motives. We have met with instances in which the 
symptoms taken collectively rendered us positive that rupture had 
occurred, and yet the post-mortem showed that our opinion was erroneous, 
as the condition found was that of marked tympany, with a certain degree 
of impaction of the organ, sometimes associated with gastritis. Probably 
some at least of such cases would have recovered had we employed the 
stomach-tube. 

TREATMENT.—It is obvious that treatment of any kind cannot prove 
of avail when rupture has occurred. The administration of medicines 


* Op. ctt. 


128 SYSTEM OF VETERINARY MEDICINE 


only adds to the pain and distress of the patient. But we must admit 
that we are often placed in a dilemma in consequence of being unable to 
decide definitely that rupture has taken place. If we withhold treatment, 
and find at the post-mortem that this lesion is absent, we cannot persuade 
ourselves or the owner that therapeutical measures might not have proved 
successful. On the other hand, if we administer remedies and discover 
the lesion at the autopsy, we upbraid ourselves with causing the animal 
unnecessary pain and distress. | 

With reference to the prophylaxis of rupture of the stomach, the 
measures to be adopted are similar to those advised in the case of impac- 
tion and tympany of the organ, as these conditions are the usual causes of 
the lesion. It is also of importance in cases of animals suffering from 
violent abdominal pain to prevent them rolling and throwing themselves 
about. As itis often impossible to carry out this advice, and as sedatives 
are not only harmful, but also impossible, to administer per os in many 
of these instances, we advise that violent cases be placed under light 
chloroform anesthesia in the manner indicated on p. 117, until relief is 
obtained. 


GASTRECTASIS (DILATATION OF THE STOMACH). 


GENERAL Remarks.—In this condition the size and capacity of the 
stomach are greatly increased, the organ extends beyond its usual limits 
in the abdominal cavity, and its muscular walls undergo certain morbid 
alterations. Some authors state that variations in the size of the stomach 
may occur within physiological limits, and depend on the nature of the 
food ; thus in an animal fed constantly on bulky material the organ is 
more capacious than when corn is the staple diet. It has also been 
observed that in many instances dilatation of the stomach has been 
found at autopsies, although no symptoms attributable to gastric dis- 
order were present during life. As regards the incidence of this condition 
it is difficult to judge, because the symptoms presented are common to 
those of other gastric affections, and, as the morbid alterations in struc- 
ture and function render the animal liable to an attack of impaction or 
tympany, with rupture as a sequel, it is this latter that is more com- 
monly found as a post-mortem lesion. 

If, as some authorities believe, rupture of the stomach is always 
preceded by morbid alterations in the gastric walls, then, indeed, we 
should expect dilatation of the organ to have been present for some time 
prior to the occurrence of the fatal lesion. Probably many of these cases 
vaguely ascribed. to “chronic indigestion,” “chronic gastritis,’ and 


DISEASES OF THE STOMACH: HORSE 129 


intermittent attacks of colic, depend in reality on dilatation of the 
stomach. It must be remembered that during an attack of gastric 
impaction or tympany, a varying degree of dilatation of the stomach is 
present, which, however, disappears in the event of recovery from the 
first-named condition. In cases of tympany that tend to recur, it is 
highly probable that permanent dilatation of the stomach to a varying 
degree exists. But the affection we are now discussing is essentially a 
chronic one, depending on a variety of causes, and associated with 
important alterations in the gastric walls and considerable interference 
with the functions of the organ. 

Et1otogy.—Dilatation of the stomach may depend on an atonic 
condition of the gastric walls, which arises from organic alterations in 
the muscular coat, and interferes with the normal movements of the 
organ. Old age and constant feeding on indigestible, bulky food are 
regarded as important etiological factors in the production of these 
alterations in the gastric walls. The results of these abnormal conditions 
are imperfect digestion, retention of the ingesta in the organ for too long 
a period, and chronic distension, increased by the excessive fermentation 
which occurs. 

Chronic gastritis may induce atony of the muscular coat of the 
stomach, and thus be an etiological factor in the prodiction of dilatation, 
while ulceration of the organ is an occasional cause of the condition. 
According to Cadéac, wind-sucking and crib-biting induce dilatation by 
distension of the gastric walls due to the air swallowed, the effect of the 
latter being exaggerated owing to it becoming heated in the stomach ; 
anemia of the distended coats of the stomach results, and the muscular 
fibres undergo fatty degeneration. 

Chronic hepatitis is regarded by some authors as an occasional cause 
of the affection, probably by influencing the circulation in the gastric 
walls. Cases are recorded in which the presence of foreign bodies, such 
as sand or gravel taken in with the drinking water, has brought about 
gastric dilatation. Congenital cases of atony of the gastric walls, pro- 
ducing dilatation, have also been observed. 

As etiological factors of a different type, we may mention mechanical 
obstruction of the pyloric region or of the duodenum, which prevents the 
passage of ingesta from the stomach to the intestine. This obstruction 
may depend on the presence of duodenal ulcer, carcinoma of the pylorus, 
and tumours affecting the duodenum or other portions of the small 
intestine. These intestinal obstructions may induce reversed peristalsis, 
or prevent the exit of ingesta from the stomach. In some instances 
stenosis of the pylorus or duodenum may not be accompanied by much 

VOL. II. 9. 


130 SYSTEM OF VETERINARY MEDICINE 


gastric dilatation at first, as hypertrophy of the muscular coat of the 
stomach occurs in order to overcome the obstruction. 

Amongst rare causes which have been recorded, we may mention 
disordered innervation, due to a tumour in the jugular furrow or in the 
mediastinum, which presses on the vagus. 

Morsip AnaTomy.—On examining the abdominal organs, the large | 
size of the stomach first attracts attention. As death generally results 
from a combination of gastric tympany and impaction, the external appear- 
ances of the viscus resemble those met with in cases of that affection. Of 
course, when the fatal termination is due to rupture of the stomach, the 
evidences of dilatation of the organ may not be very apparent. In 
some instances dilatation may be found post mortem, although its presence 
was not suspected during life. In well-marked cases the capacity of the 
stomach is enormously increased, and we met with one instance in which 
the organ was altered in shape, and resembled to some extent the rumen 
of an ox. It generally contains a large amount of ingesta, and is 
very heavy. On removal of the gastric contents there is, according to 
Cadéac, a disproportion between the surface of the right sac and that of 
the left sac. The mucosa of the former is four times larger in extent 
than the latter, and the mucous folds show thickening and evidences of 
chronic catarrh. When the condition is due to a chronic narrowing of the 
pyloric opening, the muscular coat is hypertrophied, especially in the 
region of the lesser curvature. In some instances the gastric walls are 
attenuated and anemic. 

Law has observed cases in which the stomach was largely dilated at 
the greater curvature, and contained concretions and quantities of gravel. 

SyMProms.—These vary according to the morbid conditions present. 
In some instances a capricious appetite, loss of condition, and inaptitude 
for work, are observed. Intermittent attacks of gastric indigestion may 
occur. When tympany results, the symptoms of that condition will be 
in evidence. In other cases dilatation of the cardia is present, as well 
as of other parts of the organ, and eructations and vomiting occur with 
facility. Tympany may occur to a varying extent shortly after feeding, 
and cases are recorded in which the pressure on the diaphragm was so 
intense that respiratory phenomena similar to those occurring in “ broken 
wind ” were observed. Rupture of the stomach may take place during 
an attack of colic, or the lesion may occur in the absence of painful 
symptoms, when the organ becomes distended by ingesta. 

DIFFERENTIAL Diacnosis.—There are no special symptoms by which 
the affection can be recognised during life. Recurring attacks of gastric 
disorder shortly after feeding may enable us to suspect the presence of the 


DISEASES OF THE STOMACH: HORSE 131 


condition, but they are by no means conclusive. Chronic gastric catarrh 
presents similar symptoms. We cannot, in the horse, make use of the 
diagnostic methods employed for the recognition of the affection in 
man, such as inspection, palpation, percussion, auscultation, mensuration, 
and the inflation of the stomach with carbonic acid gas. 

TREATMENT.—As the diagnosis of the affection is attended with so 
much difficulty, it generally happens that treatment is directed to the 
most prominent symptoms present. As in all other gastric affections, 
attention to diet is of first importance. Nux vomica or strychnine is 
indicated in order to give tone to the gastric walls. Cadéac advises the 
administration of wood charcoal, combined with calcined magnesia, so 
as to absorb the gases that are formed in the stomach ; also gastric anti- 
septics, such as a combination of salicylate of bismuth, benzo-naphthol, 
and cream of tartar. | 


ULCERATION OF THE STOMACH. 


SyNoNyM.—Gastric ulcer. 

GENERAL ReMARKS.—This condition is described by Cadéac under the 
heading of Ulcerative Gastritis. Other authors regard it as a special 
affection arising from a variety of causes. Friedberger and Froéhner state 
that it is seldom observed as a disease per se, but occurs chiefly as a 
secondary phenomenon in the course of other diseases. The forms usually 
recognised are ulcers of inflammatory origin, also known as “ catarrhal 
ulcers ’’; the round or peptic ulcer is less frequently met with. With the 
exception of cases occurring in connection with certain diseases, or due 
to the effects of toxic agents, gastric ulcer must be regarded as a com- 
paratively rare condition in the horse, if we judge by the number of 
cases recorded. 

Et1otogy.—Catarrhal ulcers may originate from the ingestion of 
irritant and corrosive substances, such as corrosive sublimate, arsenic, the 
mineral acids, etc. The lesions occur as a secondary condition in con- 
nection with infectious diseases, such as joint-ill of foals, strangles, 
purpura hemorrhagica, and influenza. According to Cadeéac, in con- 
tagious pneumonia and all affections of the blood the toxins and microbes 
can be diverted to the gastric walls, and bring about necrosis of the super- 
ficial layers of the mucosa. In such cases a variety of micro-organisms 
may be responsible for the production of the lesions. In acute gastritis 
ulcers may develop, when the inflammatory infiltration is well marked, 
or hemorrhage into the mucosa is extensive. Tumours of the stomach 
may be followed by ulceration, the explanation being that the tissue 


132 SYSTEM OF VETERINARY MEDICINE 


of the neoplasm becomes altered by the action of the gastric juice. 
Parasites, such as the larve of the G. equi and the Spiroptera megas- 
toma, produce erosions of the mucosa, which may be followed by 
ulcers. 

The round or peptic ulcer is believed to follow nutritional disturbance 
‘in a limited region of the mucosa, which results in an auto-digestion of 
this area by the gastric juice. Superacidity and an increased secretion 
of the gastric juice are said to occur, but it would appear that the mucosa 

must be enfeebled by an associated disease, such as anemia, before the 
~ lesion can be produced by this cause. 

According to Friedberger and Froéhner, gastric ulcer is believed to 
originate from specific wound infection of the mucosa. Experimentally 
the lesion has been produced by injuries of the spinal cord, medulla 
oblongata, and corpora quadrigemina. 

Morsip AnAatomy.—The lesions consist of catarrhal erosions and 
ulcerations. 

Catarrhal Erosions are small abrasions of the mucosa, and are generally 
multiple ; they are of variable depth, or may even extend through the 
entire mucous coat, and eventually be converted into ulcers. Their 
usual seat is in the right sac of the stomach close to the pylorus, their 
edges are well defined and smooth, and their bases are often heemor- 
rhagic. 

Catarrhal ulcers are larger in extent than the erosions, and may arise 
from the coalescence of the latter. When confined to the mucous 
and submucous coats, they are termed s¢mple ulcers; but when they 
perforate the submucous coat, they are designated true ulcers. 

Simple ulcers occur in various forms. They have irregular jagged 
edges, and their bases may be smooth or irregular. Healing may occur, 
and a white or pigmented cicatrix results, fibrous in character, and of a 
radiate appearance. | 

True ulcers comprise a superficial and a deep form. The superficial 
is circular or elliptical in shape and variable in extent, but in some cases 
is very small; its borders are not raised or indurated, its walls are not 
thickened, and its floor is not excavated. 

The deep, perforating, or round ulcer may involve all the tunics of 
the stomach, and bring about perforations of the gastric wall, leading to 
peritonitis. It may occur at the commencement of the duodenum as 
well as in the pylorus. It is usually small in size, has a punched-out 
appearance, with clean-cut edges and smooth floor, and generally occurs 
singly. In the horse perforation is rarely met with ; cicatrisation often 
occurs, with the formation of a thickened sclerosed tissue. The stomach 


DISEASES OF THE STOMACH: HORSE 133 


may become attached to neighbouring organs by peritoneal adhesions. 
When perforation occurs, evidences of septic peritonitis are present. 

The chronic ulcer is characterised by its large size, indurated edges, 
and sinuous border. / 

Hemorrhage, due to erosion of bloodvessels, may take place in the, 
acutely formed ulcer, but it occurs more commonly in the chronic form, 
when ulceration occurs at the base of the lesion. 

Rupture of the stomach due to the presence of ulcers has been observed 
on several occasions by Wesikopf. 

Symptoms.—These are by no means constant or characteristic. In 
some cases evidences of chronic gastritis are present, and the two con- 
ditions may be associated. In others, emaciation, loss of appetite, in- 
satiable thirst, and general weakness, are observed. According to 
Friedberger and Frohner, periodic attacks of colic, recurring at certain 
times after feeding, the vomiting of blood-stained material, and the 
presence of dark-coloured or tarry blood in the feces, are symptoms 
which have been met with. 

CoursE.—The course of the disease is generally slow, and death 
may result from) hemorrhage, perforative peritonitis, or from gradual 
exhaustion and cachexia. 

DIFFERENTIAL DiAGNosis.—Except in those rare cases in which 
hematemesis is present, a differential diagnosis is impossible. All 
authors agree that the affection may be confounded with gastro-enteritis. 

TREATMENT.—This can only be symptomatic, as the affection is 
seldom diagnosed. Attention to diet is of first importance ; all coarse 
or indigestible food should be interdicted, and the diet should be re- 
stricted to bran-mashes, oatmeal or linseed gruel, and milk. Cadéac 
advises benzo-naphthol, cresyl, or naphthaline, to act as gastric disin- 
fectants, and to promote healing of the ulcers ; also bicarbonate of soda, 
to act as a cholagogue and to neutralise the gastric acidity which is 
present. In order to absorb the gases which are usually formed he 
prescribes prepared chalk or calcined magnesia. When hematemesis is 
present, he advises the administration of extract of opium in order 
to prevent movements of the stomach, and also prescribes ergotin by 
hypodermic injection to bring about constriction of the gastric vessels, 
and thus to arrest hemorrhage. 

Friedberger and Froéhner advise artificial Carlsbad salt, to neutralise 
excessive acidity of the stomach and to cause evacuation of the gastric 
contents. This can be prepared by combining sulphate of soda 1 part, 
chloride of soda 2 parts, and bicarbonate of soda 4 part, the dose of the 
combination being 14 ounces twice daily in the food or drinking water. 


134 SYSTEM OF VETERINARY MEDICINE 


HEMORRHAGE OF THE STOMACH. 


This is in reality a symptom of various morbid conditions of the 
stomach. 

It may depend on the presence of sharp-pointed foreign bodies in the 
organ, also certain parasites, chemical irritants, injuries due to kicks or 
falls, gastric ulcer, venous congestion depending on diseases of the heart 
or liver, neoplasms, etc. Gastric hemorrhage may be evidenced by hema- 
temesis ; the blood is dark in colour, acid in reaction, mixed with ingesta, 
and discharged through the nostrils. When this phenomenon is absent, 
the blood passes into the intestines, and gives the feces a dark or 
tarry appearance, in which instance the condition cannot be differen- 
tiated from hemorrhage of the bowels. 

Hemorrhage of the stomach and hematemesis are rarely met with 
in the horse, but occur with greater frequency in the dog. 

The treatment consists in the administration of opiates, and styptics 
such as ergot, acetate of lead, etc. Adrenalin proves useful in some cases. 


ACUTE GASTRITIS. 


Synonyms.—Acute gastric catarrh; Acute inflammation of the 
stomach ; Acute dyspepsia. 

GENERAL RemMarkKS.—The majority of authors state that acute gas- 
tritis, as a disease per se, is of rare occurrence in the horse. In cattle 
and dogs it is frequently met with, and in these species it often proves 
fatal ; but in the horse, except as the result of irritant or corrosive poisons, 
we seldom find that death occurs from gastritis alone. On the other 
hand, it is well known to those who conduct systematic post-mortem 
examinations that gastritis in varying degrees of intensity is by no means 
an uncommon lesion, associated with certain fatal conditions. We can- 
not assume that because evidences of the affection uncomplicated with 
those of other conditions are not observed at autopsies that the disease 
does not occur in the horse. There is no valid reason why this animal 
should not suffer from gastritis to a modified extent, and recover in a 
similar manner to cattle, dogs, and human beings. 

But we must admit the difficulties in the diagnosis of the disease in 
the horse. In some cases the clinical phenomena are suggestive of the 
presence of the affection, while in others the symptoms cannot be dis- 
associated from those arising in connection with the complications which 
are present. 


DISEASES OF THE STOMACH: HORSE. 135 


Percivall* held that “nothing is more common than to find the 
vascular gastric membrane reddened,” but he attributed this condition 
to the administration of medicaments of an irritating nature. Probably 
the drastic treatment that was adopted in his day rendered this statement 
justifiable, 

Robertson} stated that ‘‘in the horse gastritis rarely shows itself as 
an idiopathic or independent affection, and is only known probably as 
the result of irritation of the mucous membrane.” He pointed out the 
various conditions under which irritation is apt to develop this inflam- 
matory action. 

Williams} did not devote any space to the subject, but simply re- 
marked that “true gastritis, except from the action of direct irritants, 
such as poisons, is but seldom seen in the horse. Its stomach may be 
distended even to rupture without any marks of inflammation being dis- 
coverable after death.” 

Friedberger and Froéhner§ state that “it is hardly possible in horses 
to distinguish between gastric catarrh and intestinal catarrh, which 
diseases very often succeed each other, or are simultaneously produced by 
one and the same cause.” These authors differentiate clinically simple 
gastro-intestinal catarrh from severe gastro-enteritis, and deal with them 
under separate headings. They admit that in actual practice there 
are many transition stages between the two conditions, but point out that 
in gastro-enteritis evidences of severe illness are present, with fever 
and grave general disturbance, while in sate catarrh such symptoms 
are absent. 

From a consideration of the literature on the subject, and judging 
from our clinical experience of the affection, we venture to put forward 
the following conclusions : : 

(2) Uncomplicated gastritis, of a serious and often fatal nature, such 
as is met with in cattle and dogs, seldom occurs in the horse except as 
the result of irritant poisoning, either mineral or vegetable. 

(6) Gastritis in varying degrees of intensity is not uncommon in con- 
nection with certain gastric and intestinal affections. In such it may be 
the primary disorder, or in the case of gastric impaction it may be the 
result of irritating ingesta in the stomach. It may also be associated 
with a catarrhal condition of the intestines. 

(c) It may exist as a simple catarrh of the stomach, without intestinal 
lesions, and present symptoms attributable to a gastric disorder, but not 
specially diagnostic of gastritis. — 

* “* Hippopathology.” t ‘‘ Practice of Equine Medicine,” 


t ** Principles and Practice of Veterinary Medicine,”’ 
§ ‘* Veterinary Pathology.” 


136 SYSTEM OF VETERINARY MEDICINE 


(d) Cases of gastritis associated with meningitis are met with, the 
etiology of which is obscure, but the clinical phenomena are fairly con- 
stant (see p. 148). 

(e) Occasionally a very acute and severe form of gastritis occurs in the 
horse, not due to toxic causes, and associated with gastric impaction or 
tympany. 

(f) Gastritis may occur in connection with certain diseases of the 
heart and of the liver. | 

From a clinical point of view it seems desirable to discuss acute 
gastritis under the following headings: (1) Acute Gastric Catarrh ; 
(2) Phlegmonous Gastritis ; (3) Towic Gastritis ; (4) Acute Gastro-Intestinal 
Catarrh ; (5) Acute Gastro-Enteritis. 

This classification is by no means an ideal one, as it necessitates the 
description of intestinal lesions and symptoms, as well as those in con- 
nection with the stomach. But as the intestinal and the gastric symp- 
toms are often associated in the clinical picture, we consider that catarrh 
and inflammation of the gastro-intestinal canal are best considered in this 
section. 

1, Acute Gastric Catarrh.—This condition is also known as simple 
gastritis and as acute dyspepsia. It is generally admitted that individual 
degrees of intensity occur in the affection, and that we do not possess 
reliable diagnostic means to recognise the exact pathological condition 
that is present. 

Kriotocy.—Various causes have been suggested to account for the 
occurrence of gastric catarrh. These may be classified as follows : 

(1) Dietetic—These include errors in feeding, giving rise to re- 
peated attacks of dyspepsia and to distension of the stomach from 
ingesta. 

All the etiological factors mentioned under the heading of gastric 
impaction and gastric tympany may induce gastritis. According to 
Cadéac, when digestion is interfered with, the products of fermentation, 
such as butyric and lactic acid, become more abundant. Under normal 
conditions these products are inhibited by the gastric secretion, but when 
the latter is deficient, they cause irritation of the stomach, and gastritis 
results. 

(2) In debilitated and anemic subjects the gastric functions become 
weakened, dyspepsia results, abnormal fermentation occurs, and irritant 
products are formed, which induce gastric catarrh. 

(3) Damaged foods, such as mouldy hay and oats, also impure water, 
are regarded as causes of gastric catarrh; but Cadéac states that no 
definite evidence exists as to the part they play in the production of this 


DISEASES OF THE STOMACH: HORSE 137 


condition (see p. 147). Potatoes, when sprouting, green, or spoiled, may 
also induce gastritis. 

(4) The presence of foreign bodies in the stomach, such as sand or 
eravel taken in with the food, may set up gastritis. 

(5) Certain parasites, such as the larve of G. equt, also Roneniaras if 
present in large numbers, may by mechanical action irritate the gastric 
mucosa, and induce gastric catarrh. Some authors, however, consider 
that the condition in such cases results from microbic infection of the 
small punctures caused by the parasites. 

(6) Secondary forms of gastric catarrh occur in connection with 
influenza, contagious pneumonia, and purpura hemorrhagica. 

The lesion is also met with during the course of chronic affections of 
the heart or liver, the interference with the venous circulation bringing 
about a catarrhal condition of the gastric mucosa. 

(7) Certain vegetable irritants, such as the foliage of yew and rhodo- 
dendron, induce gastritis. Cases are recorded in the Veterinarian (1838) 
in which a very acute gastritis resulted from the ingestion of large quan- 
tities of haws from the hedgerows. Robertson also met with several 
cases arising from a similar cause. 

Some Continental authors regard microbic infection as playing an 
important part in the etiology of gastritis. Thus, mechanical irritation 
of the gastric mucosa is believed to permit the entrance of micro-organisms. 
As we shall point out later on, there are forms of gastro-enteritis which 
appear to be microbic in their nature. 

Morpip ANATOMY.—The lesions vary in intensity, being superficial in 
some cases and deep-seated and extensive in others. Many authors 
describe the presence of a closely adherent, tenacious layer of mucus on 
the villous portion of the stomach as one of the lesions in gastritis. But, 
according to F. Smith,* this condition is a normal one in the horse, and 
he points out that ‘‘a very remarkable amount of mucin is secreted by 
the villous sac of the stomach, and forms over the inner surface of the 
viscus a thick, gelatinous, firmly adherent coating like white of egg, 
which cannot be washed away even by a powerful jet of water.” 

The abnormal condition in connection with this layer of mucus is 
that it is blood-stained, and contains numerous cell-elements, including 
mucous corpuscles, leucocytes, and desquamated epithelial cells. The 
villous mucosa shows swelling and redness, which may be diffuse or in 
patches. In severe cases the colour is of a deep red, the submucosa may 
be somewhat cedematous, and ecchymoses may be present. The hemor- 


* “ Veterinary Physiology.” 


138 SYSTEM OF VETERINARY MEDICINE 


rhages are of various sizes, and give the mucosa a spotted appearance. 
In some cases small erosions may be present. 

On microscopical examination a varying degree of epithelial desqua- 
mation is observed, the columnar epithelium of the excretory ducts of 
the glands is swollen, and undergoes mucous degeneration, the imter- 
tubular tissue is infiltrated with leucocytes, and the capillaries are con- 
gested. 

In some cases the catarrhal inflammation extends to the duodenum, 
and the mucous fold surrounding the opening of the bile-duct and pan- 
creatic duct becomes so swollen that the flow of bile into the intestine 
is impeded. 

Symproms.—These vary according to the intensity of the gastric 
lesions and the associated affection which may be present. In every 
instance it may be said that the symptoms are of an indefinite character, 
and common to many conditions associated with disturbance of the 
gastric functions. 

In mild cases the appetite is either capricious or in abeyance, or a 
depraved appetite may be present; the animal is dull, easily fatigued, 
and sweats on being subjected to slight exertion. The tongue is generally 
“ furred,” and the buccal mucosa covered with a frothy mucus, while in 
some instances a catarrhal condition of the buccal membrane is present, 
and the mouth exhales a sour unpleasant odour. Intestinal peristalsis 
may be interfered with, the feces being hard, dry, and passed in small 
amounts at frequent intervals; but in some cases diarrhoea occurs. 
When the duodenum is involved, an icteric tint in the visible mucous 
membranes may be observed. Fever is generally absent, but in some 
cases a rise in temperature of 1° F. is present. — 

In more severe cases uneasiness, often amounting to actual pain, is 
observed, evidenced by pawing and intermittent colicky pains, especially 
soon after feeding. In some cases the pain may be continuous, and the 
expression of countenance anxious. Partial sweating, especially on the 
sides of the neck and shoulders, and an intermittent turning of the head 
towards the side, are symptoms that are described by Robertson. As 
acute gastric catarrh may be complicated by other affections of the 
stomach, the symptoms of the latter are then in evidence. 

We have met with cases in which persistent regurgitations of ingesta 
and eructations of gas were the prominent symptoms presented, and 
the autopsies revealed very acute gastritis, the etiology of which could 
not be determined. As already mentioned, acute gastritis may be 
complicated by meningitis—a type of affection which needs to be 
investigated. 


DISEASES OF THE STOMACH: HORSE 139 


CoursE.—In mild cases the symptoms disappear within a few days. 
but if the dietetic irregularities which induce the affection are repeated, 
a condition of chronic gastric catarrh may result. at 

In severe cases the course will depend on the associated conditions or 
complications that are present. A guarded prognosis should always be 
given. 

DIFFERENTIAL Dracnosis.—From the fact that the symptoms in mild 
cases are similar to those met with in the various forms of dyspepsia, it 
may be impossible to differentiate the affection from others depending 
on disturbance of the gastric functions. When the gastritis is more 
severe, the symptoms already mentioned may lead us to suspect its 
presence, but a positive diagnosis is seldom possible. When complicated 
with intestinal catarrh, the symptoms presented are more suggestive of 
a lesion of the intestine than of the stomach. The presence of regurgita- 
tions and eructations, in the absence of any further evidences of gastric 
tympany, would lead us to suspect gastritis. When gastritis accom- 
panies gastric impaction or gastric tympany, we are unaware of any 
means by which ‘we can detect its presence. 

To sum up, we may state that acute gastric catarrh is frequently found 
as a surprise at autopsies, as its presence is not readily recognised 
during life. 

TREATMENT.—Recognising that we have an inflamed gastric mucosa 
to deal with, it is of importance to give the stomach as much rest as 
possible ; hence the diet should be restricted to oatmeal gruel, linseed 
eruel, barley water, hay tea, milk, etc. 

In mild cases, artificial Carlsbad salt (see p. 133) may be given in the 
drinking water twice daily. Sodium bicarbonate in doses of $ ounce is 
indicated to check acid fermentation. Some authors advise the adminis- 
tration of 2 drachms of pepsin, two or three times daily. 

In severe cases, accompanied by uneasiness or actual pain, small 
doses of extract of belladonna may be combined with the sodium bicar- 
bonate. These exert a sedative effect on the gastric mucosa. When 
constipation is present, a dose of raw linseed oil is indicated. Colicky 
pains are best treated with chloral hydrate, administered well diluted, so 
as to avoid any possible irritating effect on the stomach. Opiates should 
be avoided, as they interfere with intestinal peristalsis, hinder digestion, 
and lessen appetite. 

After-treatment consists in the administration of gastric tonics with 
vegetable bitters, such as nux vomica and gentian, given in the food. 

2. Phlegmonous Gastritis (also known as submucous or purulent 
gastritis) is a very rare condition, and is characterised by the occurrence 
of suppurative processes in the submucosa. 


140 SYSTEM OF VETERINARY MEDICINE 


Ettotocy.—It is generally a secondary condition, occurring as the 
result of strangles or py#mic conditions. According to Cadéac, the 
abscesses result from the presence of microbic emboli in the terminal 
arteries of the gastric walls. When the affection is a primary one, the 
micro-organisms are believed to gain entrance by an abrasion of the gastric 
mucosa. Parasites, such as the larves of G. equi, and the Spiroptera, are 
regarded as etiological factors. They penetrate the mucosa, and thus 
permit the entrance of micro-organisms. Amongst other causes recorded 
are wounds of the mucosa, due to the presence of foreign bodies taken in 
with the food. According to Cadéac, the abscesses are almost always 
situated in the cardia, and this is the usual location of the larve of 
G. equi. The condition may also be found associated with gastric ulcer 
or tumours in the gastric walls. 

Morpip Anatomy.—Two forms of the affection have been met with 
—viz., a diffuse purulent infiltration, and a localised abscess formation. 
In the diffuse form the pus extends beneath the mucosa to a greater or 
less extent, and separates the mucous from the muscular coat. It may 
gain entrance to the cavity of the stomach, or, on the other hand, may 
reach the peritoneal cavity and set up peritonitis. Cases are recorded 
where adhesions have existed between the stomach and the diaphragm, 
or the spleen, or even the costal wall. The gastric walls show thickening, 
and the mucosa presents openings from which pus exudes; the sub- 
mucous tissue is infiltrated with a greyish sero-fibrinous or purulent 
material, 

In the localised form there may be one or several abscesses. They 
vary in size, and may be situated either in the submucous or in the sub- 
peritoneal tissue. The submucous abscess may open into the stomach 
either by several small openings or by a single large orifice. When such 
occurs, a large amount of pus, varying in character, is found within the 
stomach. Cases are recorded in which rupture of the stomach has 
occurred as the result of the damage to the gastric walls caused by the 
suppurative process. The abscess has also been found to open from the 
pyloric sac into the duodenum. The subperitoneal abscess may induce 
localised peritonitis, with numerous adhesions, or it may rupture into 
the abdominal cavity and cause septic peritonitis. Cadéac states that 
the latter result is rarely met with, and only occurs when the abscess is 
situated in the right sac close to the pylorus. Howel records a case in 
which a large abscess formed on the external wall of the stomach, and 
was composed of several pockets containing dark-coloured fcetid pus. 

Symproms.—There are no symptoms special to this condition, the 
phenomena recorded being similar to those occurring in other forms of 


DISEASES OF THE STOMACH: HORSE 141 


gastritis. Some authors state that fever, pain, and prostration are more 
marked, and that when the abscess ruptures into the stomach vomiting 
may occur, and the material ejected is composed of ingesta mixed with 
pus or blood. Evidences suggestive of gastric rupture have’ also been 
observed. Cases are recorded in which horses dead from tetanus have 
shown on post-mortem an abscess in the stomach. Probably the tetanus 
bacilli gained an entrance through the lesion in the mucosa. 

DIFFERENTIAL D1aGNosis.—We have no means by which a diagnosis 
may be made, except in those cases where vomiting takes place and 
pus is detected in the material ejected. The occurrence of gastric 
Symptoms associated with a severe attack of strangles would be 
suggestive of the condition, but this complication is very rarely met 
with. 

TREATMENT.—Even if it were possible to arrive at a definite diagnosis 
of phlegmonous gastritis, little or nothing could be done in the way of 
treatment. It is probable that if a case came under our notice, it would 
be treated as one of obscure gastric trouble ; or, in the absence of symp- 
toms directly pointing to the stomach, it would be mistaken for a lesion 
of the intestines, and treated accordingly. 

3. Toxic Gastritis—As already mentioned, irritant and corrosive 
poisons induce the most intense forms of gastritis. Lesions of the intes- 
tine are usually associated with the morbid changes in the stomach. 
The subject properly belongs to the section on poisons, in which the 
symptoms and lesions of the more common toxic agents are described, 
and to this section the reader is referred. Here we shall only direct 
attention to toxic gastritis in a general manner. 

The lesions found in the gastric mucosa will vary according to the 
nature of the poison and its degree of concentration. In mineral irritants, 
such as arsenic, the gastritis generally occurs in patches, which may be 
of an intense red or dark purple colour. The lesions occur chiefly in the 
mucosa of the right sac of the organ. Acute degeneration of the glan- 
dular elements is present, and also hemorrhage. When powerful corrosive 
agents are swallowed, there may be extensive destruction of the mucosa, 
and the formation of eschars. In less severe cases areas of necrosis sur- 
rounded by inflammatory reaction may be observed, with a hemorrhagic 
and infiltrated condition of the submucosa. In the case of the mineral 
acids the coloration will vary according to the nature of the toxic agents. 
Lesions also occur on the mucous membranes of the mouth, pharynx, 
cesophagus, and intestines. In some cases the lesions may extend beyond 
the mucosa, and involve the muscular and even the serous coat of the 


stomach. 


142 SYSTEM OF VETERINARY MEDICINE. 


Symptoms.—The general symptoms of all irritant and corrosive 
poisons are similar, but there are special phenomena in connection with 
certain of these agents, for which see the section on Poisons. In the case 
of arsenic, the prominent symptoms are nausea, evidences of abdominal 
pain, the presence of frothy saliva in the mouth, cold extremities, marked 
prostration, short and frequent respirations, a feeble pulse, purging 
and tenesmus, patchy perspiration, a staggering gait, and in some 
cases paralysis of the hind-limbs. When corrosive sublimate is the 
toxic agent, profuse salivation is observed in addition to the above 
Symptoms. 

TREATMENT.—In addition to the treatment advised for acute catarrha] 
gastritis, suitable antidotes must be employed in the case of toxic gas- 
tritis. These receive consideration in the section on Poisons. 

In the case of mineral irritant poisons, it may be stated that, in addi- 
tion to the suitable antidotes, it is always safe treatment to administer 
demulcents, oleaginous materials, milk, raw eggs, etc., and that gastric 
sedatives are generally indicated. 

4. Acute Gastro-Intestinal Catarrh.—As already remarked, some 
authors do not attempt a differential diagnosis between gastric and intes- 
tinal catarrh, although admitting that the two conditions may occur 
independently of one another. As, however, we are aware, as the result 
of post-mortem examinations, that the conditions may in some cases be 
associated, we think it advisable to describe acute gastro-intestinal 
catarrh as a separate affection, admitting at the same time the difficulty 
in connection with diagnosis. 

The etiological factors are similar to-those mentioned for acute gastric 
catarrh, and we cannot explain why the intestine should be involved in 
some instances, while it escapes in others. 

Morzsip AnAatomy.—The lesions in the stomach are similar to those 
occurring in uncomplicated gastric catarrh. The intestinal lesions may 
be limited in extent, or a large area of the intestine may be involved. 
The mucosa is swollen and inflamed, and the submucosa shows serous 
infiltration. In some cases the intestinal villi are chiefly involved, 
becoming hyperemic, cedematous, swollen, and very prominent. In 
others, the lymph-follicles are swollen, Peyer’s patches are prominent, 
and the solitary follicles stand out with distinctness, and may show small 
erosions in their centres, which are termed “‘ follicular ulcers.” Increased 
intestinal secretion is present, and the mucous membrane is covered with 
mucus. In some instances, although symptoms attributable to intestinal 
disorder were present during life, the lesions found post-mortem were 
not well marked. 


DISEASES OF THE STOMACH: HORSE 143 


Symproms.—In gastro-intestinal catarrh the intestinal symptoms 
generally predominate. Constitutional disturbance may be more marked 
than in ordinary cases of gastric catarrh. The feces are covered with 
mucus, and are very foetid, and a slight degree of tympanites may be 
present. Diarrhoea appears later on, and may be associated with great 
weakness, but in some cases this symptom may be absent. As pointed 
out by Friedberger and Frohner, if the catarrh is confined to the small 
intestine, the excess of fluid may be absorbed in the large bowels, so that 
the feces may be more or less solid. In severe cases the diarrhoea assumes 
a, dysenteric character, colicky pains manifest themselves, marked depres- 
_ sion and weakness are present, there is total loss of appetite, and a fatal 
termination may result, especially in the case of aged animals. When 
the duodenum is specially involved, jaundice is often present, due either 
to the swollen condition of the mucosa, which occludes the opening of 
the bile-duct, or to extension of the catarrh to the duct itself. 

DIFFERENTIAL D1acnosis.—To differentiate gastro-intestinal catarrh 
from gastric catarrh per se is by no means an easy matter, as in the 
latter affection diarrhcea may be present in some cases. The predomi- 
nance of symptoms attributable to an intestinal disorder will assist in 
the diagnosis. 

TREATMENT.—A moderate dose of raw linseed oil is indicated at the 
outset. If diarrhcea be a prominent symptom, it is advisable to admin- 
ister opium or chlorodyne, the latter being preferable. If the diarrhoea 
be persistent, tannoform in doses of 3 to 4 drachms daily has been found 
useful by some practitioners. 

The other details of treatment are similar to those advised for acute 
gastric catarrh. 

5. Acute Gastro-Enteritis——This may be divided into the following 
forms: Toxic, Semple, and Mycotic or Infectious. 

The Toxic form occurs as the result of ingestion of various irritant 
or corrosive poisons, which produce their effect on the intestines as well 
as on the stomach. The symptoms are similar to those described as 
occurring in cases of toxic gastritis, with the addition of phenomena 
attributable to intestinal lesions. The effects produced vary according 
to the nature of the toxic agent, and for further information on the 
subject the reader is referred to the section on Poisons. 

Simple Gastro-Enteritis.—In this affection the stomach and intestine 
simultaneously suffer from inflammation. It may be regarded as an 
advanced stage of gastro-intestinal catarrh, the causal factors acting 
with a greater degree of intensity, so that the catarrhal condition may 
be followed by the affection we are discussing. Moreover, it is difficult 


144 SYSTEM OF VETERINARY MEDICINE 


and, indeed, may be impossible in a given case to recognise the border- 
line between the two conditions. 

Again, in an individual case, even by the most’careful observation of 
the symptoms presented, there may be considerable doubt as to the exist- 
ence of associated lesions of the stomach and intestines. In some instances 
gastric symptoms may predominate, while in others the phenomena 
point to the intestine as the seat of the lesions. At the same time, we 
must admit the frequency with which both organs are simultaneously 
involved, as demonstrated by post-mortem examinations. But we can- 
not ignore the fact that either gastritis or enteritis may exist as ,a 
disease, per se, iN some cases ; and in our present state of knowledge we | 
are unable to explain this variation in the location of the lesions. As a 
secondary condition, gastro-enteritis may occur during the course of 
diseases such as influenza and purpura hemorrhagica. 

ErroLocgy.—Similar causes may produce gastro-intestinal catarrh and 
gastro-enteritis, but they evidently act with a greater degree of intensity 
in the case of the latter affection. In many instances the etiological 
factors cannot be determined. 

Morsip AnatoMy.—As compared with gastro-intestinal catarrh, the 
lesions are more extensive and deep-seated. The mucosa of the right 
sac of the stomach shows marked redness, which may be diffused or in 
patches. It is swollen and infiltrated, and may be studded with petechie, 
or present areas of a dark red colour. In some cases the mucous mem- 
brane may show numerous folds. Hemorrhagic erosions or even ulcers 
may also be observed. The intestinal mucosa is swollen and infiltrated, 
shows dark red patches, and desquamation of the epithelium over large 
areas. Swelling of the solitary follicles, and sometimes follicular ulcers, 
also occur. The submucosa is swollen, cedematous, and hemorrhagic to 
such an extent that 1t renders the mucous membrane very thick to the 
touch. The muscular coat shows a slight extent of serous infiltration, and 
the serous coat 1s injected. The intestinal contents vary in character. 
They may be fluid, very foetid, and blood-stained ; in some instances they 
are distinctly hemorrhagic. 

Symproms.—These are more severe and urgent than those occurring 
in gastro-intestinal catarrh. Constitutional symptoms are well marked ; 
the internal temperature is raised to 104° or 106° F.; the pulse is 
quick and small at first, and gradually becomes weaker; the visible 
mucous membranes are injected ; the abdominal walls are tense ; and a 
variable degree of tympanites is present. Obstinate constipation, due to 
paralysis of the intestinal walls, is observed ; a small amount of hard 
feeces covered with mucus or blood may be passed in some cases, the act 


DISEASES OF THE STOMACH: HORSE 145 


being accompanied by severe straining. Towards the fatal termination 
the constipation may be succeeded by a foetid diarrhoea, associated with 
paralysis of the sphincter ani. Evidences of abdominal pain, varying in 
degree, are generally present. These disappear shortly before death, 
which generally occurs from collapse or coma. In some cases the fatal 
termination is preceded by violent convulsions. The course of the disease 
is generally rapid, death occurring in from two to three days, sometimes 
within twenty-four hours. A chronic form is recognised, in which re- 
current attacks occur, and may continue for a period of two or three 
weeks. The prognosis is unfavourable. The majority of the cases suc- 
cumb, either from general septicemia, due to necrotic lesions of the 
intestine, or from cerebral complications. 

DIFFERENTIAL DraqNosts.—As intestinal symptoms generally pre- 
dominate, the case is often diagnosed as ordinary enteritis, and the 
presence of gastric /lesions is only discovered at the autopsy. The affec- 
tion may be differentiated from gastro-intestinal catarrh by the greater 
intensity of the symptoms, but, as already remarked, it is often difficult 
to draw the border-line between the two conditions. 

As regards the differential diagnosis between toxic gastro-enteritis 
and the simple type, the history of the case and the presence of certain 
symptoms must be taken into consideration ; but, in order to arrive at a 
definite conclusion, when suspicious circumstances exist, a chemical 
analysis of the contents of the stomach and intestines must be carried 
out. For further details the reader is referred to the section on Poisons. 

TREATMENT.—The indications for treatment are similar to those men- 
tioned for gastro-intestinal catarrh. Unfortunately, a fatal termination 
generally results, in spite of therapeutic measures. In the majority of 
instances the affection is diagnosed as enteritis, and treated as such with 
opiates. A combination of chlorodyne with raw linseed oil is commonly 
employed. Some authors advise the administration of calomel with 
opium. When nervous symptoms predominate, opiates should not be 
employed, but chloral hydrate may be prescribed instead. Whether this 
agent exerts an irritant action on the gastro-intestinal mucosa when the 
latter is inflamed is a doubtful matter ; at any rate, the drug should be 
well diluted with a mucilaginous basis. That any form of sedative may 
fail to exert its action in severe cases is well known, and probably depends 
on the lack of absorption by the inflamed mucosa. In such instances, 
when the pain and the nervous phenomena demand a sedative agent, we 
advise the employment of light chloroform anesthesia. 

Mycotic Gastro-Enteritis (also known as acute infectious gastro- 
enteritis, gastro-encephalitis, abdominal vertigo).—This affection would 

VOL. II. 10 


146 SYSTEM OF VETERINARY MEDICINE 


appear to be of more common occurrence on the Continent than in Great 
Britain, if we judge by the number of cases recorded in British veterinary 
literature. From time to time we meet with cases characterised by the 
presence of symptoms attributable to meningitis, and which on post- 
mortem examination present the lesions of gastritis. In some instances — 
a series of cases occurred in the same locality, but the etiology was 
wrapped in obscurity, although the symptoms and lesions were very 
similar to those described by Continental authors as being characteristic 
of mycotic gastro-enteritis. But considerable difference of opinion exists, 
even amongst authorities who describe this affection, as to the réle which 
foods damaged by fungi, moulds, etc., exert as etiological factors. Some 
observers state that evidence is still wanting to demonstrate the patho- 
genic action of such agents in the horse, although experimentally, toxic 
effects and certain lesions have been induced in laboratory animals. It 
is assumed that certain toxic principles are contained in damaged foods, 
which, when ingested, cause irritation of the stomach and gastritis, then 
pass on to the intestine, become absorbed, and produce nervous disorder, 
the symptoms of which predominate over those originating from the 
stomach and intestines. In some instances it is believed that the toxic 
principle may be absorbed directly into the blood without affecting the 
gastro-intestinal mucosa. In our experience cases have occurred in the 
absence of any dietetic causes so far as could be discovered, as the food 
was. of good quality. 

According to Cadéac, the affection may arise from an “ intestinal 
auto-intoxication,’ depending on products originating during digestion 
of foods which have commenced to ferment prior to ingestion, and con- 
tinue to do so afterwards under the predisposing effect of fatigue, over- 
work, arrest of the secretions and the peristaltic movements of the gastro- 
intestinal canal. He believes that a microbic influence is also at work 
in association with the above, and that the micro-organisms normally 
present in the stomach and intestine may, under altered conditions, 
become pathogenic. 

Amongst the etiological factors which are regarded as being capable 
of producing mycotic gastro-enteritis, the following may be mentioned : 

Mowlds.—These include the various species of Mucor, also Aspergillus, 
and Penicillium. They occur in damp and badly-saved oats, barley, hay, 
straw, etc., and are believed by some authorities to give rise to ptomaines. 

Rusts, of which Puccinia graminis is the most important. They affect 
grain crops, and are said by many authorities to prove pathogenic ; but 
Cadéac does not agree with this view. 

Smut Fungi include several varieties, such as Tilletia caries, known 


DISEASES OF THE STOMACH: HORSE 147 


as the greasy smut of wheat, but which can also attack grasses ; Ustilago 
carbo, known as dusty or flying smut, attacks small grains ; and Ustilago 
maidis, the smut of maize. According to Friedberger and Frohner, 
irritant ptomaines are developed in the affected grain as waste products 
of the fungi, and are capable of exerting intense toxic effects when such 
grain is ingested by animals. Cadéac, however, is of opinion that these 
fungi possess no toxic action. 

The evidence with regard to the pathogenic action of the above fungi 
is of a very contradictory nature, as it is admitted that in many instances, 
although the clinical phenomena and lesions are present, the fungi cannot 
be detected in sufficient amount in the food to account for the occurrence 
of the affection. Moreover, experiments have been conducted by Pusch, 
which demonstrated that the spores of Tilletia caries and Puccinia 
graminis may be present in fodder without any toxic effects resulting 
therefrom when ingested by animals. 

Friedberger and Frohner state that “it is not improbable that these 
cases of so-called fungus poisoning in herbivora are really infectious 
diseases, the nature and origin of which are at present unknown.” 

Micro-Oreanisms.—According to Cadéac,* the micro-organisms 
which produce fermentation have not been shown to be capable of causing 
disease in herbivora. He has, however, observed more or less serious 
effects after the ingestion of fermenting rye, damaged maize, and heated 
fodder. But these effects, he believes, are due to a secondary intoxication, 
as the toxines originating from the fermenting ingesta produce a general 
disturbance, and prepare the way for secondary infection. In damaged 
maize the Bacillus maidis and the B. mesentericus fuscus are found, and 
the Bacillus colt in heated and damaged fodder. These are believed to 
produce various toxic substances in cereal plants, the most important 
being matsine and pellagrozeine, the former possessing a similar action to 
strychnine, the latter having a narcotic and paralysing action, as proved 
by experiments on rabbits. It 1s believed that similar toxins may 
develop in various kinds of fodder, and are capable, when ingested, of 
inducing gastro-enteritis in animals. According to Reynal and Galtier 
stagnant putrid water may contain various micro-organisms capable of 
producing a similar affection. 

Morpip ANATOMY.—Gastritis in varying degrees of intensity may be 
observed. Ecchymoses of various shapes occur on the mucosa, giving 
the part a spotted appearance. In most of the cases that we have 
examined post mortem there were no intestinal lesions. The intestinal 
mucosa, according to Continental observers, is oedematous, ecchymosed, 


* “ Pathologie Interne.” 


148 SYSTEM OF VETERINARY MEDICINE 


and covered with mucus, and the submucosa is infiltrated. Congestion 
and softening of the liver, and swelling and infiltration of the mesenteric 
glands, may also be observed. According to some authors, the liver is 
affected by acute yellow atrophy. The brain and spinal cord may show 
hyperemia and cedematous infiltration. In our experience the nervous - 
lesions appear very slight in comparison with the violence of the symptoms. 
In some cases no lesions can be detected in the nervous system. 

Symptoms.—The early symptoms are suggestive of a gastric or intes- 
tinal affection, but nervous phenomena soon appear, and predominate 
over the others. In the cases that we observed the animals presented at 
first evidences of continuous abdominal pain, injected visible mucous 
membranes, a very high degree of fever, and a haggard expression of 
countenance. They generally assumed the recumbent position, and after 
a short time were unable to rise. Violent struggling next occurred at 
short intervals, with a tendency to force the head in a backward direc- 
tion, and nystagmus was a prominent symptom. In many of these 
instances the nervous symptoms appeared at the outset, and it was only 
at the autopsy that the presence of gastritis was discovered. Very often 
the practitioner is not called to attend in the early stages, and, when his 
services are requisitioned, he finds the patient showing all the evidences 
of acute meningitis. 

Continental authors describe the affection as occurring in an enzootic 
form, and presenting the following symptoms: Obstinate constipation, 
succeeded by a profuse, foetid, sanguineous diarrhcea ; high fever ; general 
muscular paralysis ; occasionally the lingual and pharyngeal muscles are 
paralysed ; cerebral spasms ; evidences of nephritis ; cardiac palpitation ; 
dyspnoea, etc. A subnormal temperature is sometimes observed after 
the occurrence of diarrhcea. In some instances the nervous symptoms 
are very violent, and the animal rushes wildly against surrounding objects 
prior to going down. 

CouRsE.—lIn the cases that we met with, death occurred within twelve 
to twenty-four hours, the violent symptoms either continuing up to the 
fatal termination, or being succeeded by a comatose condition. Con- 
tinental authors state that in milder forms of the disease the symptoms 
may disappear after a few days, and recovery results. According to 
Friedberger and Frohner, the affection may continue in some instances 
from eight to fourteen days. 

DIFFERENTIAL Dragnosts.—The affection which bears the closest 
resemblance to mycotic gastritis 1s meningitis, or meningo-encephalitis. 
As, however, the etiology of the latter is also obscure, and as mycotic gas- 
tritis may occur in the absence of gastric symptoms, a differentiation may 


' DISEASES OF THE STOMACH: HORSE 149 


be impossible. A history of the animal having been fed on damaged food, 
and presenting preliminary symptoms of gastric or intestinal disorder, 
is suggestive of the mycotic affection we are discussing.~ But further 
investigation on these diseases is desirable, as at present we are in the 
dark as regards their etiology and pathology. 

Certain types of influenza presenting nervous symptoms may be 
confounded with mycotic gastritis, when a number of cases of the latter 
occur in the same stable, and the differentia] diagnosis must be based on 
the history of the cases and the surrounding circumstances. 

TREATMENT.—In the cases that we encountered treatment of any 
kind proved useless. Indeed, when convulsions are present, the most 
desirable course is to order the destruction of the animal. Continental 
authors advise the administration of purgatives, such as aloes with 
calomel, sulphate of soda, or sulphate of magnesia, so as to promote 
expulsion of deleterious alimentary material, and thus to prevent the 
further absorption of-toxic substances. It appears to us, however, that 
if gastro-enteritis be present, drastic purgatives should be avoided, and 
dependence placed on raw linseed oil. Gastric and intestinal antiseptics 
are advised, such as naphthaline, salol, and creolin, in order to check 
fermentation and gastro-intestinal auto-intoxication. According to 
Cadéac, blood-letting is contra-indicated, and only increases the tendency 
to a fatal termination. 


CHRONIC GASTRITIS. 


Synonyms.—Chronic gastric catarrh ; Chronic indigestion. 

Some of the older authors described chronic indigestion, or dyspepsia, 
as a distinct affection, characterised by the presence of a train of symp- 
toms attributable to disturbance of the gastric functions, but revealing 
on post-mortem no perceptible lesions of the stomach. Robertson, under 
the heading of “‘ chronic gastritis,” described a separate condition, although 
admitting that the functional disorder known as chronic dyspepsia was In 
many instances a symptom, or the outcome of the former affection. Fried- 
berger and Froéhner state that formerly the mildest type of gastric disease 
was termed “‘ dyspepsia,” which signified a disturbance of the physio- 
logical function of the stomach, without any demonstrable changes in 
the structure of the gastric mucosa. They admit that such a form of 
dyspepsia may be suspected, but cannot be proved, and that it is im- 
possible to draw the border-line between dyspepsia and gastric catarrh, 
especially as the former, if present for a long time, may develop into the 
latter. For this reason they do not classify dyspepsia as an indepen- 


150 SYSTEM OF VETERINARY MEDICINE 


dent disease, but include its description with that of chronic catarrh of 
the stomach. In reality the term “indigestion,” or “ dyspepsia,” is a 
very favourite diagnostic appellation when symptoms attributable to the 
presence of a gastric disorder are present. But these symptoms may 
depend on the presence of chronic gastric catarrh, while per contra the 
conditions associated with dyspepsia, and not depending on organic 
alterations in the gastric mucosa, are very likely to induce such alterations 
if long continued. Hence the close relationship between the two afiec- 
tions, and we may remark that the symptoms, as described by those 
authors who attempt a distinction between them, are almost identical. 
Whether the condition recognised in the human subject as nervous 
dyspepsia, and included by medical authorities under the heading of 
Neuroses of the Stomach, ever exists in the horse, is a doubtful matter. 
At any rate, there are no symptoms by which we can recognise it clinically, 
or differentiate it from chronic gastric catarrh. Another condition 
occurring in man, in connection with neuroses of the stomach—viz.. 
gastralgia—characterised by the presence of severe pains of a paroxysmal 
nature in the epigastrium, is not recognised as an equine ailment ; if 
it did occur in the horse, the symptoms would probably be attributed 
to an intestinal disorder. While admitting that the horse may suffer 
from a temporary attack of dyspepsia of a mild character, which may 
not recur if attention be devoted to proper dieting, and also that such 
an attack may not be accompanied by any alterations in the gastric 
mucosa, we think it is desirable, from a clinical point of view, to include 
all forms of chronic indigestion under the heading of “‘ chronic gastritis.” 
As we shall point out farther on, the alterations in the gastric mucosa 
vary in degree, intensity, and extent, while the symptoms are by no 
means constant or regular. Moreover, not having the assistance afforded 
by subjective symptoms, we are placed at a great disadvantage as com- 
pared with the practitioner of human medicine in the diagnosis of affec- 
tions of this kind. It is not uncommon to discover lesions of chronic 
gastritis at autopsies, when no evidences of the affection were apparent 
during the life of the animal. As regards the incidence of the disease, 
we are of opinion that, judging by the frequency with which we meet 
with it at post-mortem examinations, associated, no doubt, with other 
affections, it occurs more commonly than is imagined. In general 
terms the condition may be described as one of disturbed digestion, 
associated with increased formation of mucus, alterations in the quan- 
tity or quality of the gastric secretion, morbid changes in the mucosa, 
weakening of the muscular coats, and retention of the ingesta in the organ 
for an abnormal time. Robertson was of opinion that many recurring 


DISEASES OF THE STOMACH: HORSE 151 


cases of colic could be directly traced to ‘‘ digestion imperfectly carried 
out in the stomach, because of some manifestation of chronic gastric 
inflammation.” The result is that food materials only partially broken 
down are passed along the intestinal canal and induce irritation therein. 

ErTroLoGy.—The causes of chronic gastritis are very similar to those 
inducing acute gastric catarrh, but the action is less intense and more 
prolonged. Continued errors in dieting, irritating or indigestible foods, 
damaged fodder, imperfect mastication due to dental irregularities, 
debility arising from old age, etc., are well-recognised etiological factors. 
When digestion is interfered with from any cause, irritating products are 
formed, which tend to induce chronic gastric catarrh. Crib-biting and 
wind-sucking are believed to bring about dilatation of the stomach, 
attenuation of the gastric walls, and chronic gastritis. Permanent con- 
gestion of the gastric mucosa induces chronic gastric catarrh. This 
occurs in chronic affections of the liver, which interfere with the portal 
circulation. It occurs, too, in valvular disease of the heart, and in 
pulmonary emphysema, by reason of the congestion -these conditions 
cause in the posterior vena cava. It is believed by Friedberger and 
Frohner that in such instances the catarrh is not the immediate con- 
sequence of the congestion, but is a secondary condition, as nutritive 
disturbances in the mucosa result from the abnormal distribution 
of the blood, and the resistance of the structure to the effects of 
irritants becomes lessened. Robertson found chronic gastritis, with 
attenuation of the gastric walls, frequently associated with cases of 
‘broken wind.” Probably the abnormal appetite that is present in 
this condition, causing distension of the stomach, plus the interference 
with the pulmonary circulation due to the morbid changes in the lungs, 
will account for the alterations in the gastric mucosa. Dilatation of the 
stomach, the presence of ulcers, new growths, and foreign bodies, may 
also induce chronic gastritis, Parasites, such as the larve of Gastrophilus 
equi, or Spiroptera megastoma, may, by mechanical injury, set up the 
morbid condition. 

Morzip Anatomy.—The lesions occur in the right sac of the stomach, 
especially towards the pylorus ; but in very severe cases the mucosa of 
the left sac may be involved. The mucosa may show various shades of 
colour. In some cases it is of a dull red or a reddish-brown tint; in others, 
it presents a greyish or a marbled appearance. In others, again, it may 
be discoloured and irregularly pigmented, due to pigment granules 
originating from the hemoglobin of extravasated red blood-corpuscles, 
or from-ruptured capillaries. The layer of mucus (which is normally 
present in the equine stomach) becomes increased in amount, ropy and 


152 SYSTEM OF VETERINARY MEDICINE 


clairy in appearance, and of a light grey colour, due to the presence of 
a large number of desquamated epithelial cells. The muocsa may show 
considerable thickening, and its surface presents an irregular appearance, 
which in some instances may be wrinkled or corrugated, or even mam- 
millated. Hypertrophy may be well marked, and occasionally the 
elevation in the mucosa may be polypoid in character. Ecchymosed 
patches may be observed, and, in the chronic catarrh of portal obstruc- 
tion or of chronic cardiac disease minute hemorrhagic erosions may be 
present. Microscopical examination shows the presence of a parenchy- 
matous and an interstitial inflammation. Partial erosion of the gland- 
cells is observed, or they may show cloudy granular swelling or atrophy. 
The tubules become pressed apart by an abundant small-celled infiltra- 
tion, and extensions of connective tissue from the submucosa pass between 
the glands. Mucoid transformation of the cells of the tubules is also 
observed. 

Atrophy of the mucous membrane may result from the parenchy- 
matous and interstitial changes in the structure. The secreting tissue 
may be destroyed to a considerable extent by the progressive growth of 
interstitial tissue ; also the mucosa is pale, smooth, and cuticular in 
character. According to Friedberger and Fréhner, atrophy of the 
mucosa is rare as compared with the frequency of hypertrophy of this 
structure. In the latter condition the thickened tissue is generally 
compact and inelastic, the submucous connective tissue is much in- 
creased, and the muscular coat hypertrophied. In other instances 
dilatation of the stomach is present, the muscular coat is relaxed and 
attenuated, and the gastric walls yield to the pressure of the ingesta 
and accumulated gases. 

Symproms.—As already mentioned, the symptoms of chronic gastric 
catarrh are similar to those occurring in the condition popularly known 
as “chronic indigestion,” or dyspepsia. They are referable to interference 
with the normal functions of the stomach, and to the results of such inter- 
ference. Although in the horse a large proportion of the food only remains 
for a comparatively short period in the stomach, still, it is a fact that 
at the completion of the feed the organ is about two-thirds full under 
normal conditions, and this degree of repletion is the most favour- 
able for gastric digestion. Also, gastric digestion 1s proved to be a 
slow process. Hence it would be rational to expect that interference 
with this process would not only affect the nutrition of the animal, but 
also bring about intestinal disorder. But the effects are not limited to 
simple abnormal conditions of the stomach and intestines, as chronic 
gastritis predisposes the animal to an attack of impaction or tympany, 





‘DISEASES OF THE STOMACH: HORSE 153 


should the etiological factors of these affections be present. Again, by 
reflex action, the nervous system becomes involved (see below). The pro- 
ducts of imperfect digestion become absorbed, and exert a deleterious 
effect on the system, evidenced by lassitude, unfitness for exertion, and 
functional cardiac disorder, depending on a form of auto-intoxica- 
tion. 

The symptoms are by no means constant, and they vary in severity 
according to the extent of the alterations that are present in the gastric 
mucosa. Here we must point out that cases occur which during life 
presented symptoms suggestive of chronic indigestion, but on post- 
mortem examination no lesions were apparent in the gastric mucosa. 
Per contra, we have frequently met with well-marked evidences of chronic 
gastric catarrh at autopsies on horses that have died of various affections, 
but during life no symptoms of stomach trouble were manifested. Of 
course, it must be remembered that horses seldom die of chronic gas- 
tritis or chronic dyspepsia per se ; such cases, when the opportunity for 
a post-mortem examination is presented, have generally succumbed 
from other diseases, in which dyspepsia is only an associated condition. 
The symptoms usually suggestive of chronic gastritis or chronic dyspepsia 
are as follow: A capricious appetite, a tendency to eat unnatural 
materials, such as clay, feces, etc., and to lick the walls of the stall. 
Thirst is also present, and a sour, pasty condition of the mouth. The skin 
is dry and scurfy, and has lost its normal pliable condition, the animal 
being what is popularly known as “hide-bound.’’ The bowels are 
irregular, constipation is often present, and the faces that are passed 
are hard in consistence, very offensive, and covered with mucus. In 
some instances, however, diarrhcea occurs, especially when the horse is 
put to work or to exercise. The animal is dull, disinclined for exertion, 
and sweats readily, and if the affection continues for any length of time, 
he gradually loses flesh. In some cases the appetite is completely lost, 
marked depression is present, and the loss of condition is rapid, especially 
in pampered animals. In others, although the appetite is maintained, 
the animal’s condition is poor, and the feces are found to contain a large 
amount of undigested material. As already mentioned, intermittent 
attacks of colic occurring in an hour or two after feeding are sometimes 
observed as the result of chronic gastritis. An irregular or intermittent 
pulse is also not uncommon, while some of those obscure cases known as 
“vertigo,” or “‘ megrims,” can be traced to stomach disorder—at least, 
we have often found that gastric symptoms are associated with these 
nervous phenomena, and when suitable treatment for the former is 
adopted, the latter disappear. 


154 SYSTEM OF VETERINARY MEDICINE 


CoursE.—In mild cases subjected to proper treatment perfect re- 
covery generally results; but if deep-seated lesions occur in the gastric 
mucosa, the symptoms will persist, very often in spite of treatment. 

DIFFERENTIAL DraGNnosis.—As we cannot adopt the measures used 
with such success by human physicians in the diagnosis of dyspeptic 
conditions in man, it is clear that we are placed at a great disadvantage 
in ascertaining the actual cause of the symptoms that are presented. 
Not only is it difficult to decide whether the symptoms present in a given 
case depend on an excess or on a deficiency of the normal gastric secre- 
tion, but also we are unable to gain information as to the presence or 
absence of organic alterations in the walls of the stomach. Moreover, 
the symptoms presented do not always enable us to state whether the 
intestines participate in the production of the symptoms or otherwise. 

TREATMENT.—Attention to dietetics is of first importance. Suitable 
food, with regular hours for feeding, is a sine quad non in the treatment. 
The teeth should be carefully examined, and, if necessary, should receive 
surgical attention. Many cases of chronic indigestion depend on dental 
irregularities interfering with mastication, and this matter is often 
overlooked. 

It is well to commence treatment with a mild purgative. Some prac- 
titioners advise the administration of an aloetic physic ball, with calomel; 
others prefer raw linseed oil. We prefer the latter, and if sufficient 
purgative effects are not produced, salines, such as a combination of 
sulphate of soda, chloride of soda, and bicarbonate of soda, may be given 
in the food or drinking water twice daily. It will generally be found that 
an alkaline treatment succeeds best in this affection, and we have had 
good results with bicarbonate of soda in 4-ounce doses, administered 
twice daily. But in cases depending on a deficiency of the gastric juice 
dilute hydrochloric acid, in doses of 2 to 3 drachms, may be prescribed, 
in combination with quinine. 

In cases where the appetite is not in abeyance, probably the time- 
honoured combination of nux vomica, bicarbonate of soda and gentian, 
given twice daily in the food, proves as useful as any. 

When there is total refusal of food, on no account should drenching 
with gruel, etc., be resorted to, as by waiting for a time and tempting the 
animal with suitable diet, the appetite will gradually be restored. Prepara- 
tions of iron are generally contra-indicated, but in cases associated with 
anemia and loss of tone in the gastric walls we have seen good results 
from the administration of the carbonate of iron or the ammonio-citrate 
of iron, combined with small amounts of nux vomica and Fowler’s 
solution of arsenic. Rock-salt should always be placed within reach of 


DISEASES OF THE STOMACH: HORSE 155 


the animal, and a plentiful supply of water allowed. In obstinate cases 
we have often seen the best results from sending the horse on good 
pasture. i 


FOREIGN BODIES IN THE STOMACH. 


These are of rare occurrence in the horse as compared with the ox. 
Blavette* reported a case in which the horse was a notorious “ crib- 
biter’ and a depraved feeder, and for many years had been subject 
to violent colics, which became more and more frequent, and eventually 
caused death. “In the stomach after death 44 pounds of earth and 
sand were found, while a brass wire, 8 or 9 inches long, was found sticking 
in the intestines, through whose walls it had penetrated, and had run 
into the lumbar muscles.” Various observers have found sand and 
gravel in the stomach of horses that had been pastured on loose sandy 
lands, or in those drinking from shallow streams when the water-bed 
contained much sand; but such materials are much more frequently 
encountered in the large colon. The eating of roots taken from the 
fields in wet weather, and not properly cleaned, is another source of 
sand in the stomach. Needles, pins, nails, and portions of wire, have 
occasionally been met with in the horse’s stomach ; but more commonly 
such pass into the large intestine. 

Concretions, also known as “‘ oat-hair balls,” composed of the fine 
hairs covering oats, and solidified by mucus, have been observed in the 
stomach of horses fed on the dust of oatmeal mills (Law). Percivall 
quoted a case where a concretion was found in the stomach of a horse 
that died of old age, after having worked in a clay-mill for a number of 
years. The concretion was as large as an ostrich’s egg, and was doubtless 
formed of the fine dust of the clay which the horse was continually taking 
in with his food. The nucleus was the large end of an old nail. 

There are no symptoms by which the presence off oreign bodies can 
be detected in the stomach of the horse, and, obviously, treatment of 
any kind cannot be attempted. 


TUMOURS OF THE STOMACH. 


These are of more interest to the pathologist than to the clinician, 
because of the absence of diagnostic symptoms, and also from the fact 
that, even if their presence could be discovered during life, treatment 
of any kind would be impossible. Malignant tumours are only met with 
as a rule, in aged animals. 


* Veterinarian 1887, 


156 SYSTEM OF VETERINARY MEDICINE 


Epithelioma.—According to Cadéac, this variety of tumour is not 
uncommon in the horse, as several cases have been recorded. It generally 
occurs in the region of the cardia, and may attain a large size. It may 
partly occlude the cardia, and even extend into the cesophagus, or it may 
extend through the gastric walls and bring about adhesions between the 
stomach and the diaphragm, or other structures in the vicinity. The 
neighbouring lymphatic glands may be involved. and generalisation 
may take place. Epithelioma of the pyloric region is of rare occurrence 
in the horse. 

According to Friedberger and Fréhner, no case of carcinoma of the 
stomach in the horse has been recorded in Germany. McFadyean 
recorded a case of primary carcinoma in the stomach of a pony, with 
secondary growths in the liver, peritoneum, and mesentery. 

Sarcoma.—This is said to be far less frequently met with than epi- 
thelioma. It occurs in various types, and may occupy the cardia, the 
pylorus, or the great curvature of the organ. Cases are recorded in which 
the tumour caused obstruction and dilatation of the duodenum, also 
impaction, dilatation, and rupture of the stomach. 

Amongst other tumours which have been met with in the stomach 
we may mention papilloma, adeno-sarcoma, myoma, and lipoma. 

Percivall quotes a case, recorded by Brown, of polypus in the stomach 
of an old horse. No inconvenience was caused to the animal until the 
polypus formed a mechanical obstruction to the pylorus. The growth 
weighed 74 ounces, and was found plugged into the duodenum. The 
symptoms observed were great pain and cold sweats. 

Symproms.—It is generally admitted that the symptoms presented 
in cases of neoplasms of the stomach are obscure, and that the presence 
of the lesions is only discovered post mortem. Amongst the symptoms 
mentioned by Cadéac as occurring in the case of carcinoma are gradual 
emaciation, loss of energy, a pallid condition of the visible mucous mem- 
branes, cachexia, total loss of appetite, regurgitations, attempts at 
vomition, or actual vomition. In some cases the food after entering the 
stomach is quickly ejected by the nostrils ; fluids are regurgitated in a 
similar manner. In rare instances the vomited material contains blood, 
which originates from softening and ulceration of the malignant tumour. 
Colicky pains have also been observed a short time after taking food or 
water, and in some instances the feces are of a blackish colour and san- 
guinolent, due to ulceration of the tumour and hemorrhage therefrom. 
Death occurs in a variable period, and may be due to cachexia, internal 
hemorrhage, perforation of the stomach, or rupture of the organ. Cadiot 
records a case in which no symptoms were apparent until two days prior 


DISEASES OF THE INTESTINES: HORSE 157 


to death. Septic pleurisy was present, and the evidences of this con- 
dition were observed. On post-mortem an enormous ulcerated swelling 
was found in the anterior wall of the left sac of the stomach, which was 
much thickened. The organ was very large and heavy, and was attached 
to the diaphragm by adhesions. We may remark that we met with one 
case of parasitic gastritis in a mare (due to a parasite closely resembling 
the Strongylus gracilis of cattle), in which the symptoms were marked 
emaciation, cachexia, loss of appetite, pallidity of the visible mucosa, and 
pain after feeding ; the post-mortem showed an enormously thickened. 
corrugated condition of the stomach, with ulceration. Such a condition 
might easily be mistaken for a malignant disease of the stomach. 

With regard to non-malignant tumours of the stomach, symptoms 
may be absent unless mechanical interference with the functions of the 
organ is induced. As, however, this rarely occurs, it follows that such 
neoplasms are generally discovered at autopsies, without any symptoms 
having been observed during the life of the animal. 


PARASITES OF THE STOMACH. 


These include the larve of various species of Gastrophilus, also 
several species of nematode worms. 

For information on these parasites and the lesions and symptoms 
they produce, the reader is referred to the section on Parasites. 


DISEASES OF THE INTESTINES. 
GENERAL REMARKS. 


A consideration of the anatomy and physiology of the intestines 
in the horse suggests the importance of these organs, and the serious 
effects which are likely to follow when they suffer from disorder or 
disease. We have already drawn attention to the large mortality 
resulting from certain grave affections of the intestines, and to the fact 
that, although from the early days of veterinary science many of these 
conditions have been recognised post mortem, there still remains much 
to be learned with reference to their etiology, diagnosis, prevention, and 
treatment. The subject is one of peculiar interest to the veterinary 
surgeon, because it includes the consideration of a variety of affections 


158 _ SYSTEM OF VETERINARY MEDICINE 


which occur in everyday practice. It deals with what might justly be 
described, so far as volvulus and allied conditions are concerned, as the 
bane of horseflesh, and it offers a wide field for investigation and clinical 
observation which can be undertaken by the ordinary practitioner. 
Moreover, there are no diseases which cause more anxiety and demon- | 
strate more clearly the necessity for improved methods of diagnosis and 
treatment than those we now propose to discuss. It cannot be said that 
advantage is always taken by those practitioners who possess abundant 
opportunities for research and observation to improve the existing know- 
ledge of these affections. Owing to the difficulties in diagnosis, and the 
fact that post-mortem examinations too often reveal the facility with 
which erroneous opinions can be given, there is a tendency to treat cases 
of the kind in a routine fashion, and to neglect the careful observation 
of symptoms and the systematic performance of autopsies. Some, 
indeed, do not admit the possibilities of error, but persuade themselves 
that they are gifted with superior powers of diagnosis, and give dogmatic 
opinions, unsupported, however, by the crucial test of post-mortem 
examinations. The number of practitioners who devote special atten- 
tion to the subject is, unfortunately, limited, and, as a result, progress in 
the diagnosis and treatment of intestinal affections leaves much to be 
desired. 

Amongst those who, by their researches, observations, and writings 
have contributed largely to the knowledge we at present possess of 
intestinal diseases, we may mention Walley, F. Smith, and Caulton Reeks. 
By careful clinical observation and systematic post-mortem examinations 
they succeeded in demonstrating certain facts which previously were 
overlooked, and in drawing attention to certain fallacies that existed 
in connection with the pathology, diagnosis, and treatment of these 
affections. It is highly probable that, if practitioners who have ample 
opportunities for continuing the good work initiated by the above 
observers were to follow their example, much useful information 
would be collected, and by a comparison of individual experiences 
and results the subject of intestinal affections would be raised from its 
present obscure position, and we should be enabled to diagnose and treat 
these affections in a more satisfactory manner than at present obtains. 
The ubiquitous term “colic” is still adopted to cover a multitude of 
conditions characterised by the presence of abdominal pain, without 
sufficient attention being directed to ascertain the source of this pain. 
Again, there is a tendency to imagine that further investigations will not 
succeed in adding to our knowledge of these affections, and a prevalent 
idea that the system of treatment at present in vogue suffices for the 


DISEASES OF THE INTESTINES: HORSE 159 


needs of the clinician. Such views are inimical to progress, and a very 
moderate amount of consideration will convince the observant practi- 
tioner that further investigation is urgently required. Indeed, it may 
with truth be stated that, owing to the lack of knowledge with reference 
to diagnosis and rational treatment, there are few diseases which give 
more cause for anxiety and show more prominently the limits of the 
therapeutist than those serious affections of the intestines which, unfor- 
tunately, are of far too common occurrence. 

In discussing diseases of the intestines, it is of advantage to briefly 
draw attention to some anatomical and physiological details in connec- 
tion with these organs in the horse. A knowledge of these points will 
assist In explaining some of the phenomena that are met with in disease. 
We have already drawn attention to the peculiarities in shape and in 
position of the duodenum, and the practical points to be deduced there- 
from in connection with certain affections of the stomach. 

THe SMA InrEsTINES.—Dealing now with the free or floating portion 
of the small intestines, the following points merit attention : The organs 
are suspended by means of the mesentery from the inferior aspect of the 
spine, and arranged in the form of festoons. They are situated in the 
centre of the body, but the terminal portion crosses to the right side, 
and enters the cecum, the opening into the latter being close to, but 
below, the entrance of the colon. 

The length of the mesentery is believed by some observers to favour 
the occurrence of volvulus (twist of the intestine), but F. Smith* believes 
that the chief cause of this condition is tympany, as artificial distension 
of the intestines with air causes loops of them to “‘ behave in such a way 
as would lead to twist in the living animal.” The ileum is characterised 
by the thickness of its walls, and at its opening into the cecum it is 
furnished with a sphincter formed by the thickened condition of its 
wall. 

The most important and interesting physiological points in connection 
with the small intestines are as follows, and for the following information 
we are indebted to the excellent work on “ Veterinary Physiology ” by 
F. Smith; (1) The contents are always in a liquid condition, except in 
the ileum. (2) Material passes very rapidly through them, or, as sug- 
gested by F. Smith, it is possible that only small amounts of chyme are 
propelled into them at a time. According to observations made, the 
rate at which the chyme passes through the small intestines and reaches 
the cecum varies according to the nature of the food and the frequency 
of feeding. It is said to reach the cecum in six hours after feeding, but 

* “Veterinary Physiology.” 


160 SYSTEM OF VETERINARY MEDICINE 


the entire amount does not enter this viscus until twelve to twenty hours. 
F. Smith, however, has known instances in which chyme reached the 
cecum in four hours. (3) The contents of the ileum are dry, as com- 
pared with the material found in the anterior portion of the intestine, 
and it is believed that one of the functions of the ileum is to control the 
passage of material into the cecum. (4) Active absorption occurs in the 
small intestines, and, according to Colin, a reversed peristaltic action 1s 
necessitated, because of the rapid passage of the chyme, in order to 
expose the latter sufficiently to the absorbent surface. (5) It has been 
shown experimentally that when water is drunk by the horse it passes 
from the stomach to the cecum in the space of from five to fifteen 
minutes. 

Toe Larce INTESTINES are characterised by their voluminous size, 
by the fact that the contents are large in amount and more or less solid, 
and are retained for a considerable period of time. These points indicate 
the importance of the process of digestion in these organs, and, as might 
be expected, the majority of serious intestinal disorders occur in this 
region. Moreover, as we shall point out later on, the peculiar form of 
the large colon and the direction it takes are important features in con- 
nection with the diseases of this organ. 

MovEMENTS OF THE INTESTINES.—A consideration of the peristaltic 
movements of the intestines is of great importance to the clinician, as 
when, from the result of disease, these movements are in abeyance a 
serious condition is brought about. In addition to this, there is strong 
presumptive evidence that disordered muscular action plays an im- 
portant part in the production of twists and displacements of the intes- 
tines. These points will receive attention later on, when we are dealing 
with such affections. 

As regards the nervous mechanism of the intestinal canal, local 
ganglia exist in the intestinal wall; but the intestinal nerves convey 
impulses for contraction and for inhibition, which are described by 
F. Smith as follows : Contraction of the small intestine is carried out by 
the vagus, while in the large intestines it is effected through branches of 
nerves which issue from the sacral portion of the spinal cord and pass to 
the hypogastric plexus. Fibres run from this plexus in the coats of the 
large intestines, which on stimulation cause active contraction of both 
circular and longitudinal coats. 

Inhibition of the contractions produced by stimulation of the vagus 
is brought about by stimulation of certain branches of the sympathetic 
nerve. The inhibitory nerves of the small intestine are derived from the 
dorso-lumbar portion of the cord. They pass to the main sympathetic 


DISEASES OF THE INTESTINES: HORSE 161 


chain, and from thence through the large and small splanchnic nerves to 
the solar plexus, from which the final distribution to the intestines is 
made. | 

In the large intestines the inhibitory nerves are derived mainly from 
the lumbar portion of the cord. They pass to the inferior mesenteric 
ganglion, and from thence inhibitory fibres are given off to both longi- 
tudinal and circular coats. 

This nervous mechanism of the intestines is a matter of importance 
in connection with the therapeutics of intestinal obstruction, as it explains 
the value of the stimulant treatment as opposed to the employment of 
sedatives. | 

Amongst other physiological points in connection with the intestines 
that are of importance to the clinician, the following deserve mention : 
The period of time occupied in the passage of food through the digestive 
canal is stated to be on an average four days ; some observers have found 
that such may occur in a far shorter period. The most of this time is 
occupied in the passage of the ingesta through the large intestines. The 
average amount of feces passed in twenty-four hours was found by 
observations to be about 30 pounds. In other observations the average 
daily amount was 24 pounds. The amount varies according to the 
quantity and nature of the food. The average healthy horse will de- 
feecate about ten or twelve times in the twenty-four hours.* 

These points have a most important bearing on the subject of obstruc- 
tive colic, and the serious results that are likely to ensue when the 
normal peristaltic movements of the intestine are in abeyance. 

In former times the variety of intestinal affections recognised was 
limited as compared with those described in the present day. More 
attention to clinical phenomena, but especially more diligence in the 
systematic performance of autopsies, have resulted in a clearer concep- 
tion of many affections concerning which irrational views were formerly 
held. The term “colic”? has now come to be recognised rather as the 
designation of a symptom than to indicate a disease per se, and we seek 
to ascertain the pathological conditions which bring about the phenomena 
presented. Feecal accumulation in the double colon, producing obstruc- 
tion, has, as the result of careful observation, been shown to be responsible 
for a large number of those cases vaguely described as “ colic,” and the 
appreciation of this fact has led to a very important modification in the 
treatment of such conditions, and more successful results. Again, acute 
enteritis, which was at one time regarded as a very common affection, 
has, owing to more carefully conducted post-mortem examinations, been 


* F. Smith, ‘‘ Veterinary Physiology.” 
VOL. IT. Il 


162 SYSTEM OF VETERINARY MEDICINE 


demonstrated to depend in many instances on the presence of twists or 
displacements of the intestines. 

It is in connection with the large intestines, however, that special 
advancement has been made, so far as the pathological conditions are 
concerned. Unfortunately, as regards diagnosis, there is still much to 
be learned, and, with reference to the treatment of those conditions 
which are now invariably fatal, further research is urgently required. 
As already remarked, the large intestines, especially the double colon, 
are more frequently the seat of disease than any other region of the 
digestive canal. 

Again, we shall point out further on that, while there are certain 
affections which yield to rational treatment, there are others which may 
not only be erroneously diagnosed, but their real nature may even be 
overlooked at post-mortems. The latter affections include displace- 
ments of the double colon, giving rise to acute enteritis. The inflam- 
matory condition is likely to be regarded as a disease per se, whereas it 
is in reality the result of the displacement of some portion of the organ. 
Hence the necessity for an intimate knowledge of the normal position 
and relations of the intestines, and the need for a careful post-mortem 
examination, if we wish to avoid overlooking the true nature of the case. 
Every practitioner who has experience will admit that twist of the small 
intestine can be recognised post mortem with comparative facility, but 
displacement and twist of the double colon require anatomical know- 
ledge and a careful examination in order to detect the lesion. Moreover, 
the conditions under which post-mortem examinations have often to be 
conducted are not conducive to accurate observation. Far too frequently 
it happens that a case is diagnosed as acute enteritis, and a perfunctory 
autopsy is held, the inflammation of the intestine is discovered, but the 
real lesion is overlooked. It is equally unfortunate for the advancement 
of knowledge when, in the routine of busy practice, the performance of 
autopsies is neglected, and practitioners are satisfied with their ability to 
diagnose twist or enteritis, but never take the trouble to verify their 
opinions by the only real test—viz., a comparison of the diagnosis given 
with the lesions found post mortem. 

There are certain general symptoms in connection with intestinal 
affections which merit attention. A clear conception of these symptoms 
will prove of value in the consideration of the various disorders in this 
section. Such symptoms, although not being by any means diagnostic, 
are of importance as signs or indications of the gravity of a case. It 
must be remembered that in intestinal as well as in gastric affections 
cases occur in which recovery is rapid, provided rational treatment be 


DISEASES OF THE INTESTINES: HORSE 163 


adopted ; indeed, in some instances spontaneous recoveries are observed. 
But, on the other hand, the early symptoms, although mild in charaster, 
may be misleading, as they may be the forerunners of a serious if not 
fatal affection. Hence there is no class of diseases in which more dis- 
crimination is necessary in arriving at a diagnosis or prognosis if we are 
to avoid the commission of errors. 

Here we may draw attention to the importance of a careful systematic 
examinaton of the patient in all cases of abdominal affections. While 
we readily admit that even the most experienced clinician, adopting 
every diagnostic means that he possesses, may arrive at erroneous con- 
clusions, still we are convinced that by a careful clinical examination 
we are enabled to recognise signals of danger, even though it may not be 
possible to arrive at a positive diagnosis. The symptoms we now pro- 
pose to discuss in a general manner are those presented to the clinician 
at his examination of the case. 

Pain.—In our patients we have to depend on objective symptoms ; 
hence we must judge of the presence of pain and of its character and 
extent by the observation of certain phenomena. The symptoms indica- 
tive of pain arising from abnormal conditions of the stomach, intestines, 
and other abdominal organs, are more or less similar. Moreover, in 
acute pleurisy phenomena simulating abdominal pain may be observed 
in the early stages. Abdominal pain varies in character, and the symp- 
toms indicative of its presence are modified accordingly. It may be 
acute and intermittent, evidenced by the horse pawing vigorously, 
throwing himself down violently, rolling, looking towards his flanks, 
stamping with the hind-feet. These symptoms appear in paroxysms, 
and are met with in what is termed “simple spasmodic colic.” The pain 
may be acute and persistent, no intervals of ease being observed ; this 
variety occurs in acute enteritis, and in the early stages of twist of the 
intestine. 

Again, the pain may be of the character known as “ dull,” in which 
the animal shows uneasiness, walks round his stall, paws occasionally 
with the fore-feet, or stamps the ground with the hind-feet. When lying 
down, he does so carefully after several crouching movements, and 
stretches himself out, emitting a deep sigh or a long-continued groan. 
The recumbent position may be assumed for a variable period, during 
which he looks frequently towards the flank, the inspiratory movement 
is prolonged, and expiration is accompanied by a sigh or groan. After 
a variable interval he gets on his feet, and the phenomena mentioned are 
repeated. This type of pain is continuous, and is met with in cases of 
impaction of the double colon and other conditions. 


164 SYSTEM OF VETERINARY MEDICINE 


It must be remembered that intermittent pain may be followed by 
the persistent form ; also that the type known as “ dull” may be suc- 
ceeded by pain of a violent character during the course of an attack. 

The point has been raised as to why in the case of acute abdominal 
pain the horse rolls and throws himself about. It is well known that 
the animal may suffer very acute pain in other conditions, and yet does 
not manifest violent symptoms. Probably the explanation is that the 
animal endeavours by rolling to relieve pressure on the affected organ, 
and this, failing to give relief, is frequently repeated. In some of these 
cases it would appear as if the pain is so agonising that the animal loses 
all control of his movements, and throws himself about in a helpless 
manner. No doubt the element of fright is associated with the pain, 
and it is well known that under such conditions the horse becomes un- 
controllable. While violent movements indicative of pain must always 
be regarded as serious symptoms, it must be remembered that such may 
be manifested in cases that ultimately recover. Again, as already re- 
marked, the pain manifested at the commencement of a case may be of 
the “dull” type, but as the affection progresses violent symptoms may 
develop. Sudden cessation of pain, in a case that previously showed 
violent symptoms, associated with serious alterations in the character 
of the pulse and other grave phenomena, must be regarded as a fatal 
omen. It occurs in cases of volvulus, enteritis, or allied conditions, and 
indicates that gangrene is taking place in the inflamed or strangulated 
portion of the intestine. A similar cessation of pain is observed in cages 
of rupture of the intestine and rupture of the stomach. 

As regards the actual cause of the pain, it is not possible in all cases 
to give a definite opinion. We shall have occasion later on to deal with 
the affection which is so widely known as “ spasmodic colic,” and attri- 
buted by the majority of authors to the presence of spasm of some por- 
tion of the intestines unassociated with impaction or structural lesions 
of these organs. It is assumed that muscular spasm is the cause of the 
pain, but the etiological factor is not determined (see p. 169). 

In the subacute form of obstructive colic the cause of the pain, 
according to Caulton Reeks,* is partly due to pressure on, and consequent 
irritation of, the delicate nerve-endings in the intestinal walls. But 
when, in addition to the impaction, gases are evolved from the accumu- 
lated feecal masses, causing further distension of the bowel, tonic spasm 
or cramp results, depending on the ineffectual attempts of the muscular 
coats of the organ to deal with the excessive amount of material present. 
This condition is accompanied by cessation of peristalsis and paralysis of 


* “The Common Colics of the Horse.” 


DISEASES OF THE INTESTINES: HORSE 165 


the bowel. The same observer holds that in acute cases of obstruction, 
such as volvulus, the cause of the pain is the occurrence of “‘ active peris- 
talsis, followed by spasm of the bowel, either on both sides of, or before, 
or behind, the point of obstruction,” and that the pain may be designated 
as “cramp.” | 

From the above remarks it will be apparent that, although the presence 
of pain must be regarded as an important general symptom, its gravity 
must be determined by a consideration of the phenomena with which it 
is associated. 

Alterations in the Character of the Pulse.—All clinicians of experience 
agree that a careful examination of the pulse gives valuable indications 
with reference to the gravity of a case. Its frequency and its general 
character should be specially noted, not only in the early stages, but also 
during the course of the affection. In the so-called “ spasmodic colic ” 
the pulse becomes frequent during the paroxysms of pain, but in the 
intervals of ease it returns to normal. In the early stages of subacute 
obstruction of the double colon there is little alteration in the character 
of the pulse, but later on it may be greatly increased in frequency. In 
this affection the pulse, taken into consideration with the respirations 
and temperature, is a valuable guide. In serious conditions the pulse is 
not only greatly increased in frequency, but it becomes irregular, flutter- 
ing, and weak, and in fatal cases indistinct and finally imperceptible 
In severe intestinal tympany the pulse is very quick, small, and weak, 
In enteritis it is hard, wiry, and very quick, but soon becomes small, 
thready, and in the later stages imperceptible. 

The Respirations—In cases of intermittent abdominal pain the 
respirations are accelerated during the paroxysms, but in the intervals of 
ease they return to the normal. Jn acute intestinal tympany, also in 
enteritis, the action of the abdominal muscles is suspended, and respira- 
tion is carried on by the chest and diaphragm alone, the breathing being 
of the ‘“‘ thoracic’ type. In extreme cases of tympany the respirations 
are very much accelerated, and accompanied at intervals by a sigh. In 
all cases of serious intestinal affections the respiratory movements are 
greatly increased, and each respiration is accompanied by a gasp or sob. 
We observe in enteritis short, quick respirations, resembling painful sobs 
in character. 

The Temperature.—Some practitioners regard the presence of fever 
as a serious indication in intestinal affections, but clinical experience 
teaches us that the temperature should be considered in conjunction with 
the pulse and respirations in venturing to arrive at a prognosis. In a 
series of seventeen cases of subacute obstruction of the double colon 


166 SYSTEM OF VETERINARY MEDICINE 


observed by Caulton Reeks, there was one instance in which the tem- 
perature reached 104°4° F., and two in which 103° F. was recorded. 
Recovery ensued in all the cases. A subnormal temperature was 
observed in three of the above series ; in the majority of instances the 
temperature varied from 101° to 101°4° F. 

The Visible Mucous Membranes.—An injected condition of the con- 
junctiva and nasal mucosa is an important symptom. This condition 
varies in degree. In subacute obstruction of the doubie colon the visible 
mucous membranes are of a deep red hue, and frequently tinged with 
yellow, while in enteritis and volvulus they are an intense livid red colour. 
In subacute obstruction of the small intestines Caulton Reeks has observed 
a well-marked muddy yellow staining of the conjunctiva. 

The Surface of the Body and Extremities.—In obtaining the history of 
the case it is important to ascertain if the attack has been ushered in 
with rigors. This in a case of abdominal pain is generally a premoni- 
tory symptom of enteritis. Profuse sweating, if accompanied by marked 
coldness of the ears and legs, is a very serious symptom, while the 
presence of “cold” sweats diffused over the body is to be regarded as 
a fatal omen. 

PuysicaAL EXAMINATION OF THE ABDOMEN.—The evidence obtained 
from an examination of the abdomen by palpation, percussion, and 
auscultation, often proves of value with reference to diagnosis and prog- 
nosis. 

A hard, tense condition of the abdominal walls is met with in cases of 
serious intestinal affections. 

Tympanites—t.e., the presence of an abnormal amount of gas in the 
intestines—is discovered by percussion, which gives a clear drum-like 
sound. It is a symptom observed in various intestinal diseases. It 
varies in degree, and may occur in the early stages of an attack, and be 
the most prominent symptom present—e.g., in flatulent colic—or it may 
not appear until the later stages—e.g., in acute enteritis. Although 
tympanites must always be regarded as a serious symptom, there are 
fatal cases in which it may be absent. 

A contracted condition of the abdominal muscles, giving the animal 
a “tucked-up ” appearance, occurs in enteritis, also in peritonitis in the 
earlier stages. 

Palpation is said by some authors to elicit symptoms of pain in cer- 
tain conditions, but there is considerable difficulty in distinguishing the 
uneasiness and restlessness produced by palpation, especially in nervous 
horses, from evidences of pain. Owing to the thickness and firmness of 
the abdominal walls in the horse and the large size of the viscera, we are 


DISEASES OF THE INTESTINES: HORSE 167 
unable to locate definite painful areas or seats of obstruction,-such as is 
possible in the dog, by palpation. 

Auscultation.—This is a diagnostic measure of importance, as by 
auscultating the flanks we obtain evidence as to the presence or absence 
of peristaltic sounds. The absence of peristaltic sounds points to a para- 
lysed state of the intestines—a condition met with in cases of intestinal 
obstruction resulting from various causes. Not only is it an important 
general symptom, but also its presence is an indication for the employ- 
ment of a special line of treatment. 

Rectan Expioration.~This procedure should be carried out in 
every case of intestinal disease, as 1t affords very valuable information 
from a diagnostic point of view. Caulton Reeks,* who has devoted 
special attention to this subject, states that by a careful and intelligent 
use of this means of diagnosis we can arrive at an accurate knowledge of 
the condition of the bowels.. In carrying out the procedure he advises 
attention to the following points: (1) The fulness or otherwise of the 
rectum ; the character of the feeces, whether semifluid, or hard and solid, 
or covered with mucus, or stinking and offensive. (2) The condition of 
the rectum, whether dilated (‘‘ ballooned”’), or exerting a clinging move- 
ment on the operator’s arm, and accompanied by a painful straining on 
the part of the patient. The “clinging action” and straining, together 
with the presence of tympanitic or impacted intestines in the pelvis, are 
met with in cases of obstruction depending on various causes. (3) As 
an important clinical feature he points out that “‘ any case of colic is to 
be regarded as serious if distended coils of intestine are to be found in 
the pelvis.” (4) The following structures should be located and palpated 
by rectal exploration : To the right side, the head of the ceecum and the 
colon ; to the left side and centre, the pelvic flexure of the colon. The 
intestinal contents should not be hard. Towards the centre some of the 
small intestines may be found ; they should not be distended with gas. 
Pain or tenderness on pressure should not be exhibited by any of the 
intestines. 

We give the above extracts from Caulton Reeks’s excellent work, as 
they indicate in a manner that cannot be surpassed the evidences that 
can be obtained from a careful rectal exploration. | 

Certain Attitudes and. Postures, etc., assumed by the Patient.—Clinical 
experience teaches us that symptoms such as “sitting on the haunches,” 
* lying on the back,” constant efforts at micturition, etc., although taken 
in conjunction with other phenomena, may be of assistance in diagnosis, 
yet in themselves they are by no means diagnostic of special conditions. 


* ** The Common Colics of the Horse.”’ 


168 SYSTEM OF VETERINARY MEDICINE 


Walking round the box continuously, which has been termed the 
“circus” mode of progression, is commonly regarded as a symptom of 
persistent abdominal pain, such as occurs in acute enteritis. But while 
admitting that some horses present this symptom, we are well aware 
that it is best marked after the administration of large and repeated — 
doses of opium or morphine (see p. 272). The practitioner who attempts 
to give dogmatic opinions based on the presence of such symptoms is 
soon convinced of his errors if he makes it a rule to keep a case-book, 
and to compare the diagnoses he makes with the results of the autopsies. 

ConcLusions.—In attempting to arrive at a correct diagnosis we 
must make a careful inquiry into the history of the case, take a general 
survey of the patient, consider the symptoms collectively, and pay 
attention to the expression of the animal, the haggard look and sunken 
eye being significant omens to the practical observer. It is of great 
importance to watch in a careful manner the course and progress of 
the case, as in many instances the early symptoms are not suggestive of 
a fatal affection, but later on evidences of the existence of a serious con- 
dition appear. Errors can be made in two directions. On the one hand, 
the early symptoms may lead us to the opinion that the case is not a 
serious one, but after-events prove the opposite ; while, on the other 
hand, the presence of what we regard as fatal symptoms may induce us 
to state that the case will succumb, but instead of this the animal may 
recover. So the practical deduction is that, not only must we exercise 
great care in giving a definite diagnosis, but also protect our reputation 
by giving a guarded prognosis, in spite of the client’s desire for a dogmatic 
opinion on the case. 

Finally will come the question of treatment—a subject that requires 
all the discrimination possessed by the practitioner. Unfortunately, in 
too many instances his skill will prove unavailing, but his abilities will 
be taxed to the utmost in distinguishing the curable from the incurable 
cases, and in deciding the rational treatment to be adopted. 

We shall now discuss the various intestinal affections, commencing 
with those which are more commonly met with in ordinary practice. 
This seems preferable to the plan of considering the diseases of each 
division of the intestine in its anatomical order. 


COLIC. 


We have already drawn attention to the fact that the term “colic” is 
applied in a very wide and loose manner to a variety of affections in which 
the patients present abdominal pain as a prominent symptom, and as this 


DISEASES OF THE INTESTINES : HORSE 169 


symptom is an exceedingly common one in equine practice, it follows 
that colic as a diagnostic term is very frequently employed, not only by 
horse-owners, but also by practitioners. Even the earliest authors in- 
cluded under the heading of “colic” a number of conditions differing 
widely in their nature, and although generations of practitioners have 
had ample experience in clinical observation and post-mortem examina- 
tions, the subject is still in a very unsatisfactory state. A careful con- 
sideration of all that has been written on the subject by prominent 
authors, combined with our own clinical observation, leads us to the 
belief that in reality colic should be regarded as a symptom rather than 
as a disease. Evidences of abdominal pain occur in such a large number 
of affections that it does not seem rational to include such conditions 
under the general heading of “colic.” Rather should an attempt be 
made to differentiate such affections, and to regard the evidences of 
abdominal pain as symptoms, or they might with propriety be described 
as colicky symptoms, common to various diseases of the abdominal 
organs. Attention to this matter would result in more successful methods 
of treatment, because, as we shall point out later on, measures directed 
to the relief of the pain, irrespective of its cause, cannot be regarded as 
rational therapeutics, and, in fact, they prove in many instances dis- 
tinctly harmful. 

Many authors have attempted to describe spasmodic colic as a disease 
per se. They regard it as a functional disorder depending on a spas- 
modic contraction of the muscular coats of the intestines. This view 
has been handed down from early times, and is accepted with com- 
placency by many writers and practitioners in the present day. We are 
quite prepared to admit that in many instances a diagnosis of spasmodic 
colic is a very convenient one for those cases presenting symptoms of 
abdominal pain that recover more or less rapidly, with or without treat- 
ment; but, unfortunately, similar symptoms may be presented in cases 
that do not terminate so happily, and the therapeutic measures adopted 
for the relief of the “spasm” prove inimical to the condition present. 
We have already remarked that in obstruction of the double colon, the 
pain is in part due to spasm or cramp of the intestinal walls, and the 
evidences of such pain may be similar to those exhibited in spasmodic 
colic. Moreover, we are aware that at the commencement of a case 
showing symptoms of abdominal pain it is impossible to foretell what 
the ultimate result is likely to be. 

The practitioner who ventures to express a dogmatic opinion in such 
an instance, although he may be admired by the owner of the animal for 
his temerity, is likely to suffer later on for his lack of prudence, as a case 


170 SYSTEM OF VETERINARY MEDICINE 


¢ b) 


diagnosed as “‘ spasmodic colic”? and treated with opiates often proves 
to be one of intestinal obstruction, or some equally serious condition. 
The existence of uncomplicated spasm of the intestines is presumed 
rather than proved, as no practitioner in the present day has found such 
a condition post mortem ; nor is it believed that death could result from - 
this cause. We must admit that many cases presenting acute symptoms 
of abdominal pain recover more or less rapidly without any evidences of 
tympany or of loss of intestinal peristalsis. The exact nature of such 
cases we are unable to determine. Probably, spasm of the intestine, due 
to the presence of irritating ingesta, or a mild degree of obstruction from 
this cause, which is removed by natural means, is the most likely ex- 
planation of such cases. Even the large majority of those authors who 
describe uncomplicated spasm of the intestines advise that, in addition 
to the sedatives administered for the relief of the condition, a purgative 
should be given, showing clearly that they suspect the cause of the pain 
to be the presence of irritating ingesta. It will prove instructive and 
interesting to compare the views of various authors on the subject of 
spasmodic colic. Percivall* described spasm of the bowels as a disease 
per se, and defined it as “a contraction of some portion or portions of 
the intestinal tube, . . . the muscular coat being affected with spasm 
‘orcramp. The intestinal canal is locally contracted to that degree that 
the aliment is arrested in its course, and the pain, while the cramp or 
gripe continues, becomes poignant in the extreme.” 

The cause of the affection, ordinarily, he found to be “a draught of 
cold water, especially when the horse’s body is heated.” Amongst other 
causes he included “ sudden chill of the skin ; a common dose of physic ; 
the administration of linseed and castor oils ; vetches and other green- 

Meats; new straw, particularly wheaten —in fact, any irritating or 
acidulous matters in the bowels—and occasionally costiveness, and ster- 
coraceous and calcareous concretions.” 

The seat of the spasm was generally in the small intestines, and some- 
times in the large bowels. In one case the cecum was exceedingly dis- 
torted by contraction, and contained “‘ dung-balls instead of being full 
of water.” In some cases the contracted portions of intestine were very 
extensive, the intermediate parts preserving their natural appearance. 
Occasionally the alimentary or fluid matters between two of these con- 
tractions so distended the intermediate portion of the gut that conges- 
tion, even progressing to gangrene, occurred. But in two instances, not 
connected with abdominal disorder, Percivall found similar contractions 


* “ Hippopathology,”’ 1840. 


DISEASES OF THE INTESTINES: HORSE ' 171 


in the intestines at the post-mortem, although no symptoms of spasmodic 
colic were evinced during life. He also observed that, unless relief be 
obtained in spasm of the intestine, death may occur in about twenty- 
four hours ; that ordinary cases are relieved by a single dose of medicine, 
and many without any medicine at all. Percivall also stated that cases 
of “ pure colic’ will every now and then occur, in which all treatment 
fails, and death results. He cited one instance in which a horse that 
had suffered from several attacks of colic ultimately succumbed, the 
fatal attack lasting from 3 p.m. on Wednesday to 9 a.m. on the following 
Saturday. The case all along appeared to be one of “‘ pure colic accom- 
panied by complete stoppage of the bowels, and such it proved.” In 
the jejunum and ileum were at least a dozen places contracted from 4 to 
6 inches in extent ; the uncontracted portions of the intestine and the 
stomach were tympanitic. | 

The treatment advised was to combine with the antispasmodic a full 
dose of purgative medicine, so that “all spasm and flatulent and fecal 
obstruction must succumb.” 

Now, the evidence derived from a consideration of Percivall’s remarks 
is by no means convincing as to the propriety of regarding spasm of the 
intestine as a distinct disease. In the first place, if spasmodic colic were 
capable of causing death, it seems surprising that other writers did not 
draw attention to the fact, and describe the lesions found post mortem. 
Again, Percivall does not state the number of cases in which he found 
these contractions of the intestines, nor does he give us any idea as to 
the condition of the intestinal contents—i.e., whether impaction was 
present or otherwise. Indeed, in some of the lesions described, one is 
led to believe that obstruction of the intestine was present, and was the 
cause of the spasm. Moreover, amongst all the intestinal affections men- 
tioned by this author, obstruction of the double colon does not appear, 
beyond a few lines devoted to the presence of “collections of hardened 
masses of dung within the colon, which block up the passage through it 
as effectually as if there had existed a calculus.” 

It seems hardly likely that colic due to impaction could have been so 
rare in those days, and we can only conclude that the condition was not 
recognised. It is possible, too, that the drastic cathartics administered 
may have contributed to the contracted state of the intestines found at 
the autopsy. In discussing the differentiation of colic from enteritis, 
Percivall made one significant remark—viz., that as the treatment for 
both conditions was similar, diagnosis was losing much of its interest for 
him. This would probably account for the fact that obstructive colic 
due to impaction was overlooked by him. 


172 SYSTEM OF VETERINARY MEDICINE 


Robertson* does not describe spasmodic colic as a special affection, 
but defines colic as ‘“‘a painful abdominal affection, usually of an inter- 
mittent character, unassociated with fever, and not aggravated by manipu- 
lation or pressure from without, arising from functional disturbance of 
the intestinal canal.” True colic he regards as being restricted to those 
cases where the exhibition of pain is indicative of intestinal changes and 
disturbance ; false colic when the phenomena are attributable to organic 
changes or functional disturbance of organs and structures connected 
through function or contiguity with the intestinal tube, or in organs not 
connected with the intestines. 

True colic, according to this author, may be regarded as “‘ immediately 
originating from a spasmodic condition of the intestinal tube, as not 
essentially inflammatory, nor largely disposed to run on to inflammatory 
action of the bowel, unless.improperly treated.” The disturbance of 
function owes its origin to a variety of causes. The causes of the affec- 
tion he groups under the following headings : (1) Dietetic errors ; (2) in- 
testinal obstruction from various causes ; (3) parasitic invasion of the 
bowels ; (4) organic disease of the intestines ; (5) irritant poisons ; (6) in- 
fluence of cold and damp on the general surface of the body. He points 
out that the number of fatal results from simple colic, apart from com- 
plications, is not great, but that in some cases constriction or contraction 
of one or more portions of the bowel, due apparently to persistent con- 
traction of the muscular structure, has been noticed, while accompanying 
this state of continued spasm there may exist degenerative changes of 
the mucosa and submucosa. 

It seems evident from the above description that Robertson regarded 
spasmodic colic as the result of certain conditions rather than as a disease 
per se, as the anatomical characters he mentions are of a chronic character, 
and not what one would expect to find in ordinary spasm of the intestine 
—if, indeed, this condition ever proves fatal or presents any lesions. 

Is it not possible that the lesions described by Percivall were chronic 
conditions, especially as in the cases he records the animals suffered from 
repeated attacks of colic ? 

With regard to treatment, Robertson states that as by far the greater 
number of cases of colic are directly due to functional disturbance of the 
alimentary canal, the result of dietetic causes, the modes of treatment 
which have for their end the removal of offending material are indicated. 
Hence he advises the administration of aloes, but in all cases where pain 
is distressing relief must be procured by the administration of opium or 
chloral hydrate. He also states that ‘“‘ the beneficial results of the ad- 


* “ Practice of Equine Medicine.” 


DISEASES OF THE INTESTINES: HORSE 173 


ministration of aloes in colic are not to be estimated by, nor do they 
appear to be dependent merely upon, the evacuant action in the bowel, 
for it is certain that in infinitely less time than is requisite to secure this 
the beneficial influence of the drug may be shown.” 

Williams* devotes a very short section to colic. He states that colic 
is of two kinds—viz., spasmodic and flatulent. The spasmodic form 
depends on “‘ a spasmodic contraction of the muscular coats of the intes- 
tine, which may run on to inflammation.” The causes are “ improper 
food, sudden changes of diet, exhaustion from overwork, particularly if 
associated with long fasting ; also other circumstances trivial in them- 
selves, and quite insufficient-as causes, if uncombined with other disturb- 
ing influences.” He does not regard a drink of cold water as capable of 
causing colic, but states that “if an animal be exhausted by a long 
journey or bathed in profuse perspiration, cold water may then cause 
disturbance and abdominal pain.” Colicky pains, he admits, are symp- 
tomatic of various intestinal affections ; also of diseases of other organs, 
such as the pleura, kidneys, liver, etc. 

The seat of the spasm is said to be sometimes in the small, often in 
the large, intestines, but a differentiation cannot be carried out with cer- 
tainty. No further evidence is offered to demonstrate that spasmodic 
colic can exist as a special affection, but under the heading of treatment 
tincture of opium with sweet spirit of nitre and linseed oil is advised, 
one dose being often sufficient to give permanent relief, if the attack be 
a slight one. It is admitted, however, that the pains may recur, and no 
certain dependence can be placed on this treatment ; hence, unless the 
case can be watched for some time afterwards, an aperient should always 
be administered in order to remove the source of irritation. 

From this we gather that spasmodic colic really depends on the 
presence of irritating ingesta, and should be regarded as a symptom and 
not as a distinct affection. 

F. Smith? states that, “‘ when muscular spasms of the intestines occur, 
the disease is spoken of as colic. In many cases the pain which is ex- 
hibited is in no respect due to muscular spasm, and is only a symptom. 
Still, by far the majority of intestinal cases are of this kind—viz., simple 
muscular spasms of some part of the intestinal tract, but of which part 
we are certainly ignorant. It is obvious that either the stomach, the 
small or the large bowels, may be so affected, but there are no definite 
symptoms which enable a positive diagnosis of location to be established.” 

This observer also points out that, although it is not possible to dis- 


* “Principles and Practice of Veterinary Medicine,” 1909. 
+ ‘‘ Veterinary Physiology.” 


174 SYSTEM OF VETERINARY MEDICINE 


tinguish colic of the small intestines from a similar affection in the large 
bowels, yet on physiological grounds there is evidence that the latter 
region is more frequently the seat of the disorder. The rapid passage’ of 
the ingesta through the small intestines, and the fact that they are found 
empty, or their contents are in a fluid condition, while the large bowels © 
always contain ingesta, as the material passes through them very slowly, 
justify the conclusion “that in cases of pure uncomplicated disordered 
muscular action of the bowels the large intestine in the majority of cases 
is at fault.” He also concludes that “death from pure spasm of the 
bowels is unknown, and that there is no reason for believing that the 
pain of colic per se is capable of causing death.” 

Friedberger and Fréhner* describe simple spasmodic or nervous colic 
as a distinct affection, “‘ caused by internal or external chill, which cannot 
be traced to any change of the tissue or other material cause beyond a 
painful contraction of the bowel.” The pain is said to be probably 
traceable to compression of the sensitive nerves of the bowels by contrac- 
tion of their muscular walls. It is described by some observers as similar 
to rheumatic muscular pain, and by others as due to the movements of 
intestinal gas. The pain is intermittent, appears quite suddenly, and, 
when not of long duration, is usually very violent. Cessation of peris- 
taltic action may be absent, and the bowels may be unusually active and 
noisy, the case ending even in diarrhea, owing to their spasmodic con- 
traction. The pain generally passes off after a few hours, but when it 
lasts more than twelve hours serious complications may follow, especially 
volvulus. It is admitted that some of the cases are of embolic nature, 
but the majority are said to be due to previous chill. In the treatment 
of the affection morphine is advised, to remove the spasmodic and painful 
contraction of the bowels, and to prevent the serious risk of volvulus 
occurring. Physostigmine is said to be contra-indicated, because of its 
tetanic and spasm-producing effect. 

No post-mortem evidence is adduced to prove the existence of this 
affection, hence we must conclude that if it is really a disease per se, it 
does not prove fatal. The same authors state in another section in 
connection with colic that “‘ heart-shock from extreme pain, which at 
one time was held to cause death, has little probability to recommend it.” 

We may here remark that in our experience it is quite common to 
find cases of intermittent abdominal pain, but chill could be excluded 
from the etiological factors. We think it is more rational to conclude 
that digestive disturbances are the cause of such colics, and that chill 
only acts as a predisposing factor. Moreover, the same authors, when 


* “Veterinary Pathology.” 


DISEASES OF THE INTESTINES: HORSE 175 


discussing colic in a general manner, state : “It is very difficult in most 
cases to recognise the nature of the particular affection to which the 
symptom is due, and for this reason, especially at the beginning of an 
attack, diagnosis is frequently confined to the establishment of colic as 
the chief symptom.” Also we find, under the heading of prognosis: “‘ In 
no case of colic can the result be anticipated with certainty. Cases which 
are apparently sight may, owing to intestinal displacement, terminate 
fatally. With the same case prognosis may vary from minute to minute.” 

Law* describes spasmodic colic and enteralgia. Enteralgia he defines 
as “a neuralgic pain of the bowel, which may therefore be free from 
spasm or any other appreciable structural or functional change.” He 
admits that its existence is somewhat problematical, but states that the 
occurrence of spasm is undeniable, and regards both conditions as func- 
tional nervous disorders, with similar causative factors. As causes he 
cites exposure to cold and wet, especially in nervous animals, or the 
presence of a local irritant may induce spasm or nervous pain. Animals 
in good condition and well cared for, and unaccustomed to hardships, or 
those debilitated by overwork, underfeeding, exhausting disease, etc., are 
said to have a tendency to nervous disorder under comparatively slight 
causes, such as a drink of cold water, exposure to cold and wet, especially 
when sweating and fatigued. In other cases a slight indigestion unat- 
tended by impaction or tympany, or the ingestion of an irritant, may, 
under the conditions named above, produce an attack of nervous colic. 
The diagnosis is based on the suddenness of the attack, the intermittent 
character of the pain, and the normal condition of the pulse and tem- 
perature during the intermissions. The treatment advised is the hypo- 
dermic injection of morphine, and if this fails, a moderate dose of aloes 
is to be prescribed, with chloral hydrate, etc. As the aloes takes some 
time to act, it may be necessary to keep up a moderate action of the 
morphine as a palliative. The aloes is said to bring permanent relief in 
four hours at the latest. ‘“‘ This appears to come as soon as the active 
principles have been absorbed, the nauseating effect operating at once 
on the over-excited nerve-centres.”’ 

We may remark that such a theory requires some confirmation before 
it can be accepted. 

We have thought it advisable to give the above extracts from various 
authors in order to show the limits of knowledge with reference to the 
subject we are discussing. An analysis of the various views leads us to 
the opinion that it is not desirable to describe spasmodic colic as a dis- 
tinct disease. It is not rational to do so from the point of view of diag- 


* “Textbook of Veterinary Medicine.”’ 


176 SYSTEM OF VETERINARY MEDICINE 


nosis or prognosis, because we are unable to give a positive opinion, when 
attending a case presenting symptoms of intermittent abdominal pain, 
as to the cause of the condition or the probable result. No doubt, when 
the case recovers rapidly, we are “ wise after the event,” and are inclined 
to state definitely that the animal suffered from spasm of the intestine. 
But from the therapeutical point of view, a diagnosis of spasmodic colic 
may prove a very unfortunate one, as, if we follow the advice of many 
of the authors quoted, and administer opiates for the relief of the spasm, 
we are likely to convert a curable condition into a very serious, if not 
fatal, one. The symptoms of the spasm—viz., the evidences of inter- 
mittent pain—may depend on the presence of irritating ingesta in the 
intestine. The opiate no doubt relieves the pain, but in addition it 
interferes with intestinal peristalsis, and is likely to induce paralysis of 
the wall of the bowel, and impaction as a result. This subject will again 
be referred to (see p. 197). 

We have already drawn attention to the symptoms of intermittent 
abdominal pain (see p. 163). It seems desirable to consider here the 
indications for treatment in a case presenting such symptoms in the 
early stages, and before we can form an idea of its true nature. Then the 
subject of flatulent colic will be taken up, and after this the various forms 
of obstructive colic. 

When called to attend a case that has suddenly shown symptoms of 
acute abdominal pain of an intermittent character, a great responsibility 
is placed on the practitioner. He is expected to give an opinion as to 
whether the animal is suffering from an attack of ordinary “ colic” that 
will recover in a short space of time, or whether a serious condition is 
present. Above all things, he is expected to prescribe suitable treat- 
ment. This, according to the view of the layman, should be directed to 
the relief of the pain that is present. 

Now, we are aware that many cases showing acute symptoms of 
abdominal pain may recover rapidly after the administration of a dif- 
fusible stimulant, or without any treatment. It is not uncommon for 
the practitioner to be called hurriedly to a case of acute abdominal pain, 
and to find on arrival that the symptoms have disappeared spontane- 
ously. Attention to this and to the following facts has considerably 
altered what was the routine practice—viz., to administer opiates in 
every case of abdominal pain. When recovery ensued, the happy result 
was ascribed to the sedative, and the idea was prevalent that if the pain 
was not relieved, the patient would succumb from exhaustion or from 
enteritis. The true cause of death in many cases was overlooked—viz., 
obstruction of the double colon. The relief of the pain was the chief 


DISEASES OF THE INTESTINES: HORSE | 177 


object in view, the cause of the pain was ignored ; and although the 
practitioner was well aware of the importance of a free action of the 
bowels as an indication of the favourable progress of the case, he over- 
looked the fact that opiates in any form brought about the very condi- 
tion he would wish to avoid. Some, indeed, were inclined to recognise 
this point, and combined aloes with the opiate—a therapeutical measure 
which seems irrational, as to give a purgative with one hand and an 
astringent and intestinal sedative with the other cannot be regarded as 
common-sense treatment. It-is of importance to remember that a large 
proportion of the horse’s food is of an indigestible nature, and a very 
considerable amount of the ingesta is excreted unchanged ; also that 
defeecation occurs normally ten or twelve times in the twenty-four hours. 
As might be expected, any interference with this normal excretion is 
likely to bring about serious results, and is one of the commonest causes 
of an attack of colic. Itis quite apparent that, in adopting therapeutical 
measures in cases of abdominal pain, we should avoid agents which inter- 
fere with intestinal peristalsis, and tend to induce stasis of the bowel. 

The question then arises : “ What course is the practitioner to adopt 
when he is called to attend a case in the early stages presenting symptoms 
of acute intermittent abdominal pain?” Such a case may be one corre- 
sponding to what is usually termed “ spasmodic colic.” It may tend to 
recover quickly, with or without treatment; or, on the other hand, it 
may be the commencement of a serious condition ; or it may be altered 
from a simple spasm of the intestine depending on the presence of irri- 
tating ingesta into a case of obstruction of the bowel by the administra- 
tion of opiates. If we possessed an agent that was capable of relieving 
the pain without interfering with the peristaltic movements of the intes- 
tine, and combined this with a laxative, the ideal indications for treat- 
ment would be fulfilled. Although there may be some difference of 
opinion as to the effect of chloral hydrate on the intestines, we have 
invariably found that it does not interfere with peristalsis or intestinal 
secretions, and that, combined with a dose of raw linseed oil, it con- 
stitutes the most reliable treatment for the cases we have mentioned 
above. The usual dose is 1 ounce dissolved in 6 ounces of water, and 
shaken up with 1 pint of raw linseed oil. If tympany be present in 
addition to the abdominal pain, it is advisable to add 2 ounces of oil of 
turpentine or terebene to the above drench. Some practitioners state 
that when chloral hydrate is combined with raw linseed oil, its analgesic: 
effects are not observed. This, however, is not our experience. Amongst 
other reasons why chloral hydrate is to be preferred to opiates, we may 


mention that it possesses an antiseptic action ; it does not tend to bring 
VOL. It. 12 


178 SYSTEM OF VETERINARY MEDICINE 


about tympany, such as opium is likely to do; it is not followed by 
nausea ; and it can be repeated without inducing delirium, such as often 
results from continued doses of opiates. 

Enemas of warm water should be administered in order to remove the 
contents of the rectum, and thus indirectly to promote action of the | 
bowels and removal of irritating ingesta. 

If the pain continues, and a second dose of chloral fails to give relief, 
we may rest assured that a more serious condition than simple spasm of 
the intestine is present, and we must adopt therapeutical measures 
accordingly, for particulars of which the reader is referred to the section 
dealing with the various forms of obstructive colic. 

Some practitioners administer a dose of aloes in every case showing 
symptoms of abdominal pain, with the object of removing the irritating 
ingesta, and thus influencing directly the cause of the symptoms. Gam- 
gee adopted this as routine treatment, and a reference to the quotations 
which we have made from several authors will show that, with certain 
modifications, it is a widely accepted therapeutical measure. In the 
present day a combination of aloes in solution, with chloral hydrate, 1s 
largely employed in the routine treatment of simple colic, especially in 
heavy draught-horses. The drawback to aloes is that it necessitates 
leaving the horse idle for the following day, or even longer, in order to 
avoid serious consequences from the purgation which ensues. It is well 
known that many simple cases of colic recover rapidly, and the horse 
can go to work with safety on the following day. If, however, the 
attack is in any way severe, we find that it is safer practice to administer 
the aloes and keep the animal from work. 

There was a prevalent idea that aloes might induce enteritis, should 
there be a tendency to the occurrence of this condition, but the bulk of 
evidence goes to show that this affection originates sui generis (see p. 268). 
After a fairly extensive use of aloes, we cannot say that we have ever 
observed any evil effects resulting from its administration in cases of 
simple colic ; but we admit that the employment of this drug is contra- 
indicated in cases of enteritis, twist, etc., and that the symptoms of these 
latter conditions are not always diagnostic in the early stages ; hence 
there are occasions in which we administer aloes, and afterwards find out 
our error and repent. Similar remarks apply to the employment of 
eserine. But, as we shall point out later on, errors even more serious 
may occur in the opposite direction—viz., mistaking cases of colic which 
show alarming symptoms for enteritis, then prescribing potent sedatives, 
and thus interfering materially with successful results, or altering a 
curable into an incurable condition. 


DISEASES OF THE INTESTINES: HORSE . 179 


INTESTINAL TYMPANY. 


Synonyms.—Flatulent colic ; Wind colic; Acute gaseous intestinal 
indigestion. 

GENERAL RemMarKs.—This affection corresponds to acute gastric 
tympany. As it possesses special characteristics in regard to its nature, 
symptoms, and treatment, it is properly regarded and described as a 
disease per se. Although tympany of the intestine may occur as a 
symptom in various ‘affections of the intestine, the condition we now 
propose to describe depends on the presence of a large amount of gases, 
especially in the double colon, and also in the cecum, originating as the 
result of ingesting unsuitable and fermenting foods, and causing marked 
distension of the bowel that is involved. Similar dietetic errors can 
cause gastric tympany and intestinal tympany, and it is difficult to explain 
why the stomach should be involved in one instance and the bowel in 
another. Occasionally the tympany occurs in both organs simultane- 
ously, in which instance gastric symptoms will be associated with the 
intestinal phenomena. In cases of intestinal obstruction, tympany to a 
varying extent may occur during their course, but more especially during 
the later stages, and must be regarded as a very unfavourable symptom. 
It is also met with towards the termination of cases of rupture of the 
stomach or intestine, peritonitis, twists, etc. In such instances it arises 
from paralysis of the bowel, and the accumulation of gases resulting 
from fermentation of the ingesta. 

Intestinal tympany in its severe form is characterised by its sudden 
appearance, its rapid course, and its tendency to a fatal termination unless 
early and rational treatment is adopted. It is not so frequently met with 
as other forms of colic, but milder degrees of tympany are by no means 
uncommon, associated with or following the so-called spasmodic colic, 
so that in many instances it is difficult to draw the border-lme. The 
presence of irritating ingesta may induce not only symptoms of inter- 
mittent abdominal pain, but also, owing to the cessation of peristalsis in 
the intestine, tympany results. 

Errotocy.—Dietetic errors are responsible for the majority of cases 
of this affection. Foods of a succulent nature, prone to undergo rapid 
fermentative changes, are liable to induce acute intestinal tympany. 
More especially is this the case when such foods are partaken of in large 
amounts by animals unaccustomed to this form of diet. New oats, 
wheat, boiled foods, clover, vetches, mangolds, turnips, etc., are well- 
recognised causes of intestinal tympany. Raw potatoes are capable in 


180 SYSTEM OF VETERINARY MEDICINE 


some horses of producing the most extreme tympany. Caulton Reeks 
points out that steeped foods which have been allowed to go sour, 
gorging with young herbage, such as may occur when a horse is first 
turned out in the spring after a winter in the stable, also marshy grasses, 
especially when half dried, are, in his experience, common etiological 
factors. Sudden changes of diet are well known to be capable of inducing 
intestinal tympany. Thus, the farm-horse is capable of ingesting green 
food, roots, etc., with impunity ; but if a horse accustomed to ordinary 
diet, and in hard condition, gets a full feed of the above-mentioned 
materials, a serious condition is likely to result. We have met with 
many cases of severe intestinal tympany arising from the ingestion of 
boiled swede turnips in horses unaccustomed to this kind of food. 
Damaged or mouldy foods are also found to be capable of inducing this 
condition. 

But there are accessory circumstances which play an important part in 
the etiology of intestinal tympany, even when the food 1s correct as regards 
quality. When a horse, after a long journey, arrives at his destination, 
and is then allowed a full meal, and soon after this is driven home, it is 
not uncommon for the animal to be attacked with intestinal tympany 
while on the journey homewards ; or if a horse, after completing his 
journey, being tired and hungry, is allowed a full feed on arriving at his 
stable, tympany may result. In posting establishments, where horses 
have long journeys to perform, this variety of colic is by no means un- 
common, unless special precautions are adopted with reference to the 
feeding and general care of the animals. We have experience of one 
establishment in which a series of cases of the most acute form of intestinal 
tympany occurred, either when the animals were on the homeward journey, 
or in a short time after their arrival in the stable. The quality of the 
food was all that could be desired, but on inquiry it was found that the 
horses were not allowed any water in the morning, and on reaching their 
destination were given a full feed of corn, and after a short rest were 
driven home. Attention to the watering, the allowance of thin oatmeal 
gruel prior to giving a reduced feed of corn, and a longer period of rest, 
succeeded in preventing the occurrence of further attacks. 

The allowance of a full drink of very cold water after a feed of corn, 
especially if the animal is in a tired condition after a journey or per- 
spiring freely, is regarded as a fruitful cause of intestinal tympany. 
Some authors state that the effect of the cold water is to induce increased 
peristaltic movements in the stomach and intestines, so that the ingesta 
is rapidly carried to the large bowels, and it is assumed that the 
action of the cold is to induce congestion and partial paresis of the 


DISEASES OF THE INTESTINES: HORSE 181 


\ 


intestinal walls, and thus excessive fermentative changes occur in the 
contents. 

Cadéac* recognises three chief etiological factors in the production 
of acute intestinal tympany, or, as he terms it, “‘ acute gaseous intestinal 
indigestion ”’: | 

1. Insufficiency of the Digestive Secretions.—Arrest or diminution of 
these secretions brings about interference with peristaltic movements, 
and thus induces stasis and fermentation of the ingesta. He points out 
that one of the laws of “ auto-function ” is that substances formed as the 
result of the working of any organ influence the functional activity of 
that organ. Thus, the urine has a diuretic action ; an extract of the 
thyroid gland stimulates the activity of this structure ; the saliva, the 
gastric juice, and the intestinal secretion possess analogous actions on 
the organs concerned. If the succus entericus be injected hypodermically, 
it produces congestion of the digestive mucosa, and increases both secre- 
tion and peristaltic movements. It is said that the phenomena which 
accompany all forms of obstruction or of intestinal occlusion result from 
a form of auto-intoxication. 

2. Diminution or Arrest of Intestinal Movements.—This may depend 
on suppression of the secretions quite independently of actual obstruc- 
tion of the bowel, and gives rise to excessive fermentation of the ingesta. 
Anemia, debility, febrile diseases, chronic intestinal catarrh, etc., inter- 
fere with the normal secretions of the intestines. Severe work immedi- 
ately after a period of repose, also over-exertion, interfere with the 
normal circulation in the intestine, and thus bring about indigestion and 
the formation of gases. The latter in their turn distend the intestinal 
walls, and diminish the blood-supply thereto, and also the secretions, so 
that a vicious circle is thus established. 

3. Foods of a Fermentable Nature, when ingested in large amounts, 
are an important cause of intestinal tympany. It is believed that such 
materials in excess become invaded by micro-organisms, which manu- 
facture an abnormal amount of entero-toxins. The latter inhibit the 
intestinal secretions, diminish the natural defences of the intestinal 
mucosa, and affect the nervous system. Succulent food, such as clover, 
lucerne, etc., when damp or covered with dew or frost, first increase 
intestinal movements, and afterwards paralyse them by a refrigerating 
action ; then gases are formed as the result of fermentation of the carbo- 
hydrates which they contain. .Fermentable food of any kind, when 
remaining stagnant in the intestine, is believed to form toxins, which 


* “ Pathologie Interne.” 


182 SYSTEM OF VETERINARY MEDICINE 


produce auto-intoxication in addition to the mechanical effects prea 
by the tympany. 

Cadéac also points out that drinking large amounts of very cold 
water may induce tympany in the following manner: The peristaltic 
movements in the caecum are first increased, but a paralysing effect 
quickly follows, with stagnation of the contents. 

Wind-sucking may be a cause of intestinal tympany, as the stomach 
and intestines become distended with the air that is swallowed, so that 
secretion and peristalsis are interfered with. 

We think it advisable to give the above extracts from this author in 
detail, as they explain certain points in connection with the etiology and 
nature of flatulent colic. Moreover, as we shall explain later on, they 
demonstrate the indications for the rational treatment of the affection 
and the importance of avoiding intestinal sedatives, such as oprum. 

Morsip Anatomy.—The abdomen is enormously distended, and in 
some instances so great is the pressure of gas in the colon that, on opening 
the abdominal wall, the intestine ruptures. The lesions found will vary 
according to the complications present. When the animal succumbs 
from asphyxia, depending on the pressure exerted on the diaphragm by 
the distended intestine, also from the absorption of carbon dioxide, 
evidences of that condition will be present, and marked venous stasis 
will be observed in the thoracic organs. The double colon contains a 
large amount of undigested material in addition to the gases, but there 
is no actual obstruction present. The gases present are carburetted 
hydrogen, carbon dioxide, sulphuretted hydrogen, nitrogen, and hydrogen. 
The intestinal walls may be attenuated, and show congestion and ecchy- 
moses. Rupture of the diaphragm or rupture of the intestine may occur 
as complications, 

Symproms.—The prominent symptoms in intestinal tympany are pain 
and well-marked tympanites. The pain varies in degree. In some instances | 
the symptoms are similar to those occurring in the so-called spasmodic 
colic, and although intermittent, may be violent prior to the appearance 
of tympany. In others the evidences of pain are not well marked, and 
may be limited to uneasiness, pawing alternately with the fore-feet, 
kicking at the belly with the hind-feet. The animal lies down carefully, 
but only remains a short time in this position. These symptoms are 
usually persistent. The abdomen is enlarged and drum-like, and the 
skin and abdominal muscles very tense. On percussion, resonance is 
easily detected. The tympanites varies in degree. In some instances 
it develops with great rapidity within two or three hours after the last 
feed, or it may arise while the horse is at work. In mild cases the dis- 


DISEASES OF THE INTESTINES: HORSE oo ABS 


tension is more apparent on the right flank, but when the tympany is 
extreme, the entire abdominal region is enlarged and tense. The pres- 
sure of the distended intestines on the diaphragm produces extreme 
respiratory distress. The breathing is short, very quick and thoracic in 
type, and the nostrils are dilated. The pulse is very quick, small, and 
weak, and the action of the heart is tumultuous. The visible mucous 
membranes are highly injected, and in extreme cases may be cyanotic. 
Sweating in patches is observed on the neck, shoulders, and flanks. The 
ears and extremities are very cold, and the temperature may be raised 
2°F. The expression of the countenance is anxious, and the head droops. 
If the animal is forced to move, he staggers and shows some loss of power 
in the hind-limbs. On rectal examination the distended tense condition 
of the colon is readily recognised, and when the condition is extreme the 
pelvic flexure extends beyond its normal limits. In the mare, micturi- 
tion is interfered with, owing to the pressure exerted on the urethra, 
and there is great difficulty experienced when we attempt to pass the 
catheter. 

In many instances we find that, on attending the case, there are no 
evidences of abdominal pain, the symptoms presented being marked 
dyspnoea and an enormously distended tense abdomen. We had ex- 
perience of one case in a posting-horse that was driven a journey of 
eighteen miles at night-time, and during the last few miles of the home- 
ward journey the driver noticed that the horse seemed tired. On arriving 
at the stable the animal was found suffering from such extreme tympany 
that the shafts of the car had marked his sides. Death took place within 
a short time from asphyxia. 

CoursE.—In extreme cases, unless early relief be afforded by thera- 
peutical measures, a fatal termination will result in a short space of time. 
Death may be due to asphyxia depending on pressure on the diaphragm 
and lungs, associated with intoxication resulting from absorption of the 
gases originating in the fermenting ingesta. 

In other cases the fatal termination may be due to rupture of the 
intestine or to rupture of the diaphragm. 

In cases that yield to treatment, the favourable signs are the expul- 
sion of large amounts of flatus per anum, a free action of the bowels, and 
the disappearance of the tympany and of all distressing symptoms. 

Proenosis.—This must always be guarded, as tympany in conjunc- 
tion with abdominal pain may be the precursor of a serious condition. 
Moreover, the relief afforded may not be permanent, and a recurrence is 
not uncommon. In severe cases, where the use of the trocar and cannula 
becomes imperative, as pointed out by Caulton Reeks, the effect of the 


184 SYSTEM OF VETERINARY MEDICINE 


operation should be noted in arriving at a prognosis. If, after the greater 
part of the gas has been removed, the pulse still continues to run down, 
and the symptoms of pain do not abate, a grave prognosis must be given. 

DIFFERENTIAL DracGnosis.—The history of the case should be taken 
into consideration. The occurrence of the symptoms mentioned above 
within a few hours after feeding, especially when the food is of a fer- 
mentable nature, should enable the practitioner to make a diagnosis 
with facility. If the stomach be tympanitic as well as the intestines, 
then gastric symptoms will be in evidence. A rectal examination will 
then enable us to recognise the associated conditions. Severe tympanites 
combined with other grave symptoms is a common phenomenon in the 
later stages of many serious abdominal affections, hence the clinical 
history of the case is essential in order to differentiate such conditions 
from the one under consideration. 

TREATMENT.—The indications for treatment are to bring about ex- 
pulsion of the gases, to prevent them from recurring, to remove the 
undigested material from the intestines, and to restore normal peristalsis 
and secretion. ‘To the above, many authors add measures for the relief | 
of pain—+.e., intestinal sedatives, such as opium or morphine, a thera- 
peutical measure which is not only irrational, but distinctly harmful. 
As is well known, opiates check the peristaltic movements of the intes- 
tine, interfere with the intestinal secretions, and tend to induce tympany, 
all of which actions are inimical to the condition we are discussing, and 
opposed to the indications we have mentioned above. If, then, in an 
ordinary case of the affection, the pain is so distressing that relief of this 
symptom seems to be indicated, we see no objection to the administra- 
tion of a dose of chloral hydrate combined with oil of turpentine, or 
terebene and raw linseed oil. As already remarked, chloral hydrate 
possesses an antiseptic action, and checks fermentation, and, so far as 
our observations go, it does not interfere with intestinal peristalsis or 
secretion. But in the majority of cases of flatulent colic the pain is not 
of a violent character, and when removal of the gas and ingesta is accom- 
plished the pain ceases. Hence we find that a full dose of oil of turpen- 
tine or of terebene, with carbolic acid and raw linseed oil, fulfils the indi- 
cations in ordinary cases.* Some practitioners give, in addition to the 
above, 5 drachms of aloes in solution, and no doubt in the case of heavy 
draught-horses this treatment is a rational one, as there is generally a 
large amount of ingesta requiring to be removed. Moreover, by thus 
clearing out the bowels, a recurrence of the attack is prevented. Hnemas 
of warm water are also useful to assist the expulsion of gases and ingesta. 


* Ol. tereb. vel terebene, Jii.; ac, carbol. pur., Ji. ; ol. lini, O.i. 


DISEASES OF THE INTESTINES: HORSE 185 


Cases are recorded in which very large doses of oil of turpentine 
have succeeded in giving relief, even in severe attacks of intestinal 
tympany. 

But in cases where the tympany and associated symptoms are alarm- 
ing, we consider that the employment of the trocar and cannula is by far 
the most efficacious and the safest measure that can be adopted. The 
relief is immediate, and ‘subsequent treatment is greatly facilitated. The 
technique of the operation is simple, but the occurrence of an abscess at 
the seat of the puncture is not an uncommon sequel. The procedure 
was described from very early times, but was not extensively adopted 
until within comparatively recent years. The site of operation generally 
selected is the right flank at a point equidistant from the last rib, the 
anterior angle of the ilium, and the transverse processes of the lumbar 
vertebra. But it sometimes happens that the largest amount of dis- 
tension occurs in the left flank, in which case this region is selected. So 
extreme is the distension in some instances, that the above landmarks 
cannot be distinguished, so it is advisable to puncture the most prominent 
part of the swelling. It sometimes happens that, after puncturing and 
withdrawing the trocar, no gas escapes, in which case a second puncture 
will be necessary, either 1 or 2 inches removed from the first, or on the 
opposite side of the body. This usually proves successful. The instru- 
ment employed should be from 6 to 8 inches in length, and the calibre 
of the cannula from 1 to 1 inch in diameter. In order to avoid the 
occurrence of an abscess, many suggestions are put forward by various 
writers. It is evident that the abscess is brought about by contamina- 
tion of the wound in the muscles from within—/.e., when the cannula is 
being withdrawn from the intestine, some of the contents of the bowel 
adhere to the instrument, and become deposited between the layers of 
the muscles. Fortunately, the abscess is formed outside the peritoneum, 
and the pus tends to find its way towards the skin. One suggestion is 
to reinsert the trocar before withdrawing the cannula, and to exert a 
firm pressure on the abdominal wall around the instrument during the 
withdrawal. These precautions no doubt will assist in preventing abscess 
formation, but do not always succeed. Although it is said that measures 
for sterilising the instrument are unnecessary, as the infection comes 
from the intestine, still we are of opinion that attention should be directed 
to the surgical cleanliness of the trocar and cannula, so as to avoid any 
risk of introducing infection from without the body. As the operation 
has generally to be carried out with no delay, sterilisation of the instru- 
ment by boiling is not practicable ; but we advise that the trocar and 
cannula be dipped in pure carbolic acid, and then in a 1 in 20 carbolic 


186 SYSTEM OF VETERINARY MEDICINE 


solution. By this means, not only do we prevent infection being carried 
inwards, but we believe that the antiseptic inhibits the micro-organisms 
which are inevitably borne outwards on the cannula while it is being 
withdrawn. In fact, experience in this procedure enables us to recom- 
mend this ready mode of disinfection. As an additional precaution, the 
site of operation should be painted with tincture of iodine both before 
and after the procedure. 

Wilhams advises that, in introducing the instrument, the point of 
the trocar should be directed rather obliquely upwards, in order to allow 
the escape by drainage of any fluid which may be afterwards exuded. 
Friedberger and Fréhner state that the point of the trocar should be 
directed downwards and forwards. Law advises that the cannula be 
left in situ for some time, in order to keep the bowel flaccid and allow 
time for the restoration of its contractile functions. 

Puncture of the intestine per rectum has also been adopted, but we 
fail to see any advantage in this method. 

A very useful form of trocar and cannula was devised by Toope. 
This was fitted with an appliance so that after removal of the gas an 
antiseptic fluid could be introduced into the bowel. <A double object is 
gained by this procedure—viz., further fermentation and gas formation 
is prevented, and there is less tendency to the occurrence of an abscess 
at the seat of puncture. A serviceable solution is composed of 4 drachms 
of pure carbolic acid in 1 pint of warm water. In an emergency an 
ordinary small trocar and cannula can be employed, and the fluid can 
be injected by means of a Higginson’s syringe with a milk siphon attached, 
the latter being introduced into the cannula. 

After relief has been obtained by removal of the gas, it is necessary 
to adopt measures to get rid of the undigested material in the intestine, 
otherwise a recurrence may take place. Some authors advise that, 
provided the patient’s condition will allow of it, from 14 to 2 grains of 
eserine should be injected hypodermically, so as to bring about a quick 
removal of the offending materials. Other practitioners depend on a full 
dose of oil of turpentine and raw linseed oil for this purpose, or a dose of 
aloes either in the form of bolus or in solution. 

It is not uncommon in a severe case occurring in a tired horse after 
a long journey to have a recurrence of the tympany after a short time. 
In such instances recourse must again be had to the trocar and cannula, 
and we often find that a full dose of a diffusible stimulant, such as } pint 
of whisky, is of marked assistance in restoring normal tone to the intes- 
tinal walls. We would point out the advisability of having such cases 
carefully watched, so that immediate attention can be given should the 


DISEASES OF THE INTESTINES: HORSE, 187 


tympany return, otherwise, especially at night-time, a recurrence may 
take place, and a fatal termination may result. | 

Some authors advise the administration of eserine or arecoline as 
routine treatment in cases of flatulent colic. We, however, do not 
agree with this view, as there is a risk of rupture of the intestine occurring, 
as the result of the energetic contractions induced. Caulton Reeks 
favours the administration of eserine, provided the use of the trocar 
and cannula has been followed by a free escape of gas. But he points 
out the necessity for the practitioner to remain in attendance on the 
patient for about an hour, in case, while the eserine is acting, 
tympany may recur, and require the employment of the trocar and 
cannula again. If the practitioner is unable to prolong the visit for 
the time mentioned, then it is advisable to avoid the administration of 
eserine. The same observer advises that the horse should be kept 
walking for about an hour or so after the urgent symptoms have dis- 
appeared. 

With reference to the treatment of the abscess which may result from 
puncturing the intestine, it is important to give a free exit to the pus 
on the first appearance of fluctuation in the part. If operative measures 
be delayed, the pus burrows between the muscles, and causes extensive 
destruction of the surrounding tissues. The development of the abscess 
is often very slow, and beyond a small swelling at the seat of the puncture 
but little may be observed for one or two weeks, or even longer. Then the 
swelling increases in extent, and becomes very painful, and the anima) 
walks in a stiff manner. By the careful use of an exploring-needle of 
small trocar and cannula the pus can be located. It may be situated at 
a depth of even 2 inches in some cases. We met with one instance in 
which the abscess was very large, and extended up to the external angle 
of the ilium and down to the lower region of the flank. There was con- 
siderable difficulty in securing efficient drainage, and recovery was pro- 
longed. In opening these abscesses great care is essential, so as to avoid 
penetrating the peritoneum. After making provision for proper drainage, 
the abscess cavity should be thoroughly irrigated daily with an antiseptic 
solution, and packed with double cyanide gauze. It is of advantage. to 
soak the gauze in a solution of peroxide of hydrogen or a weak solution 
of iodine (Tr. iodine, Jil. ; aqua, O.1.). 


188 SYSTEM OF VETERINARY MEDICINE 


OBSTRUCTIVE COLIC DUE TO IMPACTION. 


Synonyms.—Impaction of the intestines ; Acute intestinal indiges- 
tion, with impaction of the large intestines ; Intestinal indigestion, with 
surcharge ; Obstruction by feeca] matters. | 

GENERAL REMARKS.—It is necessary to distinguish intestinal obstruc- 
tion, depending on the surcharging of the intestines with indigestible 
alimentary material, from acute occlusion of the bowels due to the 
presence of twists, displacements, etc. No doubt both instances have 
certain symptoms in common—viz., cessation of peristalsis and retention 
of feeces—but there are important distinctions with reference to the 
character and nature of the pain and other phenomena presented. More- 
over, impaction of the intestines is a condition which may yield to rational 
treatment, while twists and displacements, etc., invariably prove fatal. 
The majority of authors describe impaction of the intestines under one 
heading, which includes this condition in the large colon, the ceecum, and 
the floating colon ; some even include the rectum. The only British author 
who draws attention to the occurrence of impaction of the small intes- 
tines and describes it clinically is Caulton Reeks. Cadéac states that 
auto-intoxication is far more likely to follow obstruction of the small 
bowels, especially when situated close to the duodenum, than when the 
large intestines are involved, and also mentions that one of the seats 
favourable for impaction to occur is at the opening of the ileum into the 
cecum. He gives no clinical description of the condition. 

On consideration of the subject, we agree with Caulton Reeks that it 
is advisable to attempt a differentiation of the various forms of impac- 
tion of the intestine, and hence we propose to discuss these conditions 
under the following headings: (1) Impaction of the Double Colon ; 
(2) Impaction of the Pelvic Flexure of the Double Colon ; (3) impaction 
of the Ceecum ; (4) Impaction of the Floating Colon ; (5) Impaction of 
the Rectum ; (6) Impaction of the Small Intestine. 

Although the latter of these conditions, if we follow the anatomical 
order, should be discussed first, we consider that it is preferable to com- 
mence with impaction of the double colon, as it is the most common dis- 
order of the intestines met with in practice. 


1. Impaction of the Double Colon. 


SYNONYMS.—Subacute obstruction of the double colon ; Stoppage of 
the bowels. 
Under this heading we propose to describe impaction of the double’ 


DISEASES OF THE INTESTINES: HORSE | 189 


colon occurring in any portion of the viscus: This is the condition which 
accounts for the large majority of cases of colic that do not quickly 
recover, either spontaneously or with simple treatment. Although the 
earlier writers recognised the presence and importance of this intestinal 
disorder, it was not until comparatively recent years that its real nature 
was understood. 

Percivall* did not devote any special section to impaction of the 
colon. He, however, made certain allusions throughout his remarks on 
“colic,” from which we may infer that he recognised the existence of 
fecal obstruction. Thus, he stated that “now and then spasm is 
brought on by costiveness ”’; also, he observed that alimentary matters 
might be confined between two contractions of the intestine, and the 
intermediate portion of the bowel then became greatly distended in con- 
sequence. As already mentioned, Percivall drew attention to the presence 
of “‘ hardened masses of dung” which might collect within the colon and 
‘block up the passage through it as effectually as if there had existed a 
calculus.” It is quite clear, however, that he attached more importance 
to the question of ‘‘spasm”’ of the intestine than to the cause of this 
condition, although in addition to the administration of opium he strongly 
advised a full dose of purgative medicine, “ under whose operation all 
spasm and flatulent and fecal obstruction must succumb.” 

Caulton Reeks,t who has devoted special attention to the subject of 
obstructive colic, suggests that the term “subacute ” should be applied 
to those conditions depending on impaction, so as to exclude acute 
occlusions of the bowels, such as twists, strangulated hernie, etc. 

A consideration of the anatomical and physiological features of the 
double colon suggests certain points of importance in connection with 
impaction of this organ. Its enormous development and its peculiar 
disposition in the abdominal cavity, also the fact that the contents are 
more solid as compared with the small intestines, and remain a consider- 
able time in this viscus, while the only secretion present is the succus 
entericus, are points worthy of notice. The double colon at its origin is 
very narrow, but it quickly enlarges, then descends towards the sternum, 
and, resting on the ensiform cartilage and inferior abdominal wall, it 
turns to the left side, forming the suprasternal flexure, which is of con- 
siderable size. It next ascends towards the pelvis, and forms the pelvic 
flexure, the calibre of the intestine suddenly becoming very narrow. 
The third division runs on the upper surface of the second, and descends 
towards the diaphragm. It gradually increases in calibre, forms the 
diaphragmatic flexure, and ascends towards the loin, the fourth division 


* “ Hippopathology.”’ + “The Common Colics of the Horse.” 


190 SYSTEM OF VETERINARY MEDICINE 


being the most voluminous of any, especially where it terminates in the 
single colon, and at this junction it suddenly contracts. 

As pointed out by F. Smith,* the ingesta in the first and third divisions 
of the double colon descend in the abdominal] cavity, while in the second 
and fourth they ascend. He also draws attention to the fact that under 
normal conditions the characters of the contents are not the same through- 
out the four divisions. Thus, in the first division the ingesta are firm, 
and particles of corn, etc., can be recognised ; in the second division the 
contents become more fluid, while at the pelvic flexure they are altered 
to “‘ a liquid, pea-soup-like condition, and the particles of which they are 
composed are not readily recognised ”’; in the third division the materia] 
becomes slightly firmer ; while in the fourth it resembles thick soup, and 
the ingesta are in a finely comminuted condition. In the single colon, 
for about a foot in length, the same semifluid condition of the contents 1s 
observed, but suddenly they become solid, and are formed into balls. 
The same observer is of opinion that the sudden change mentioned indi- 
cates either most active absorption or that the contents are subjected to 
sreat compression. He also points out that the large intestines of the 
horse are actively employed in dealing with cellulose, ‘‘ not by means of 
any known enzyme peculiar to the body, but rather by the process of 
bacterial disintegration, the result of decomposition.” He regards the 
functions of the large intestines to be as follows: (1) The digestion of 
cellulose. This substance on oxidation yields energy to the body. 
(2) Cellulose encloses a certain amount of proteid, starch, and fat of 
vegetable substances in a framework. These escape digestion in the 
small intestines, but are acted on in the large bowels by long maceration 
and digestion, and are also absorbed therefrom. (3) A special action is 
exerted on the unabsorbed proteid products from the small intestines by 
means of a putrefactive bacterial process, reducing them to simpler end- 
products, which are extracted from the body either through the feeces or 
by the kidneys. These putrefactive processes do not occur in the small 
intestine. 

All the pots mentioned above are of importance in connection with 
obstruction of the colon due to impaction. A consideration of these, 
taken in conjunction with the fact that a large amount of feeces must be 
got rid of during twenty-four hours by the healthy horse, will show what 
serious results are likely to follow any interference with the normal con- 
dition of the large intestines in this animal. 

Cessation of peristalsis leads to interference with the onward passage 
of the ingesta. The latter become hard and dry, owing to absorption of 


* “Veterinary Physiology.” 


DISEASES OF THE INTESTINES: HORSE  . 191 


the fluids, and the solid materials accumulate in the bowel. The exact 
pathological condition of the\intestinal walls in cases of impaction is not 
readily determined. We have already drawn attention (p. 164) to the 
probable causes of the pain in this condition—viz., the pressure on and 
irritation of the nerve-endings in the walls of the bowels, resulting from 
the impacted material plus tonic spasm due to distension by gases evolved 
from the accumulated ingesta. Many authors, however, describe the 
condition of the intestinal walls as being that of paralysis. It seems 
rational to conclude that the tonic spasm may be followed by actual 
paralysis, as on rectal examinations the walls of the intestine show an 
atonic condition associated with the presence of impacted ingesta, and 
give a “doughy ” feel on palpation. 

Et10oLogy.—Errors in diet constitute by far the most important 
etiological factors in connection with impaction of the colon. 

Overfeeding is recognised as a common cause. Thus, after a few days 
of enforced idleness, when the usual amount of fodder is allowed, it is 
not uncommon to find some cases of colic depending on impaction 
occurring in a large stable of horses. 

Errors on Connection with Stable Management.—These include matters 
relating to the hours for feeding, the regulation of work and rest, and 
proper watering. They have already been dealt with in the section on 
Gastric Disorders. With reference to the allowance of water, we find that 
much prejudice exists amongst stablemen on this point, and in our 
experience an insufficient supply of water is often responsible for the 
occurrence of the type of colic we are discussing. Although differences 
of opinion exist as to the time at which water should be allowed, it is 
quite apparent that in consequence of the dry nature of the horse’s food 
a proper amount of fluid is necessary, and if this be restricted, there is a 
tendency to dryness of the intestinal contents. 

As a general rule, it may be stated that the dietetic errors which are 
likely to produce gastric disorders may also bring about impaction of 
the intestine. When food reaches the large intestines in an improperly 
prepared condition—that is, not subjected to sufficient mastication or 
salivation, and gastric digestion, and not properly acted on by the various 
digestive secretions—it tends to accumulate in the colon and give rise to 
impaction. 

The Nature of the Food.—lt is generally recognised that food con- 
taining much indigestible residue, if allowed in large amounts, is likely 
to bring about impaction of the intestines. Mouldy or damaged foods 
may produce similar effects. 

Sand or gravel may be found in variable amount in the colon, and 


192 SYSTEM OF VETERINARY MEDICINE 


may give rise to a very serious form of impaction. These substances are 
taken into the body along with the food. 

Certain Associated A ffections.—Debilitating diseases tend to produce 
weakening and loss of tone in the intestinal walls, and thus predispose 
to impaction. Thus, influenza and contagious pneumonia are often 
accompanied by intestinal catarrh, and during convalescence obstructive 
colic due to impaction is not uncommon, if the diet does not receive careful 
attention. | 

Verminous aneurism of the anterior mesenteric artery interferes with 
the blood-supply of the intestines, and thus brings about diminution or 
entire cessation of peristalsis, and impaction as a result. 

The presence of tumours in connection with the intestines, organic 
alterations in the bowels, and intestinal calculi, etc., also produce im- 
paction. 

PREDISPosING CausES.—Old age is often accompanied by deficient 
peristaltic action, owing to a lack of nervous power in the intestine. 

Defective teeth and dental irregularities render mastication imperfect, 
and thus the ingesta reach the intestine in a state unfit for intestinal 
digestion, and tend to accumulate therein. 

Repeated pregnancies are well known to predispose to constipation 
and fecal obstruction. They tend to distend and weaken the abdominal 
parietes, and during the later stages of gestation the presence of the 
foetus interferes considerably with the actions and movements of the 
intestines. Cases of impaction of the colon are of frequent occurrence 
in aged brood-mares when heavy in foal, and are often a source of much 
anxiety to the practitioner. 

Morsip ANaTomMy.—In consequence of a more rational system of 
treatment being adopted in the present day, we do not obtain so many 
opportunities for autopsies on impaction of the intestines as in former 
times. In common with many other abdominal affections, marked dis- 
tension of the abdomen is present, due to the formation of gases in the 
intestines post mortem. In the condition we are describing the impac- 
tion may occur in any of the divisions of the double colon. The ingesta 
are composed of a partly-digested material, and are very foetid. In 
some instances they do not show excessive hardness ; they simply fill up 
and distend the affected division, as if unable to pass along the bowel. 
In other cases the entire colon may be involved, and the contents are dry 
and hard, and impacted to such an extent that after removal from the 
bowel they retain the form of the intestinal tube ; or a mass of hardened 
material, globular or ovoid in form, may be found occluding any part of 
the double colon, but more especially at one of the flexures. In the case 


DISEASES OF THE INTESTINES: HORSE — 198 


of an impacted firm mass, alterations in the intestinal mucosa are limited 
to the seat of obstruction. ' The mucosa is covered with a thick, viscid, 
whitish layer of mucus, which in some instances is streaked with blood. 
On removal of this layer, the mucosa shows congestion and marked 
friability, and evidences of commencing necrosis may be observed, such 
as the presence of softened greyish or greenish patches, which may extend 
deeply. Perforation or rupture of the intestine may occur in some cases, 
with all the lesions of perforative peritonitis. A diffuse enteritis is 
observed occasionally, and in cases extending over some days gangrene 
of the lung, due to septic absorption from the intestines, may result. 

Friedberger and Froéhner describe the following lesions in connection 
with impaction of the intestines : Catarrhal inflammation of the mucosa, 
with profuse ecchymoses, and later on diphtheritic and necrotic condi- 
tions, leading to the formation of ulcers. 

SyMpToms.—Clinical experience teaches us that the symptoms are by 
no means constant in this affection. Dealing first with cases due to over- 
feeding, we may remark that, until actual impaction occurs, no colicky 
symptoms may be observed, the animal simply showing dulness. The 
symptoms observed are generally those characteristic of dull abdominal 
pain, as described at p. 163. These are often regarded by the owner as 
not serious, and professional assistance may not be requisitioned for 
twelve or twenty-four hours. In the early stages the animal is dull, 
and may show loss of appetite, but occasionally may take small amounts 
of food in a listless manner. The pulse, temperature, and respirations 
are not altered to any extent. As the case progresses, evidences of dull 
abdominal pain appear, and at times the animal presses the hind-quarters 
against the nearest post or wall. While lying down he turns his head 
towards the flank, and exhibits an anxious expression of countenance. 
Constipation is present, and on examination per rectum this portion of 
intestine may either be empty or it may contain a small amount of hard 
feeces covered with mucus. In some instances the rectum may be dis- 
tended with either semifluid or solid material. The impacted intestine 
can be felt on palpation per rectum. It may be solid in consistence or 
may be easily indented by pressure of the fingers. In some instances 
a moderate degree of tympany may be present. The rectum is 
“ballooned,” and the animal may strain violently on rectal examination 
or may make frequent straining efforts at defecation. On auscultation 
of the abdominal walls there is an entire absence of peristalsis, and if 
slight tympany be present, a metallic tinkle may be heard, which is 
ascribed by Caulton Reeks to some feeble attempt of the bowel at peris- 


talsis. Amongst other symptoms that may be observed are coldness of 
VOL IL. ; 13 


194 SYSTEM OF VETERINARY MEDICINE 


the extremities, a fcetid condition of the mouth, and an icteric tint of 

the visible mucous membranes. Evidences of acute pain may present 
themselves either early in the attack or later on in its course. So violent 

may the symptoms become in some cases that an erroneous diagnosis of 

enteritis, or even of twist, etc., may be given. The animal walks round 

his box, throws himself down in a violent manner, sweats in patches, 
shows an anxious expression of countenance, the ears and extremities 
are cold, the pulse becomes frequent, and may reach 70, 80, or even 100, 

per minute. The respirations may be greatly accelerated, and of a 

“sobbing” character. The temperature may be raised to 101° F., or 

103° F., or even 104° F. But there are many instances in which serious 

alterations in connection with the pulse, respirations, and temperature do 

not occur, while in others the indications afforded by an examination 

of the patient show that grave changes are present in one of the 

three. Injection of the visible mucous membranes is well marked, 

and tympany to a varying extent is generally present as the case 

advances. 

CourSsE.—This varies according to the degree of impaction present, 
and to the treatment adopted. In the majority of cases, especially under 
a stimulant treatment, the duration is from twelve to twenty-four hours. 
Caulton Reeks records one case that lasted for eight days, and recovered. 
But there are instances showing acute symptoms in which recovery may 
occur rather rapidly, provided rational treatment is carried out. In fatal 
cases the duration may vary from thirty-six to forty-eight hours, or the 
animals may linger on for three or four to eight or ten days. 

The same observer informs us that he has met with two cases in which, 
owing to the administered purgatives, the ingesta in the large colon were 
in a fluid state, with the exception of one portion. This one portion of 
bowel, with no evidence of twist and no excessive hardness of the con- 
tents, remained simply inert in its state of distension, and was powerless 
to pass its contents along. In such a case it is clear that the torpidity 
or inaction of the muscular coat of the bowel has been the exciting cause 
of the disease. 

The immediate cause of death in cases of impaction of the colon is 
not always easy to determine. In those instances which linger on from 
three to eight or ten days, each day sees increasing weakness, decreasing 
sensibility to pain, a pulse of a “‘ running-down ” character, and a gradual 
loss of the vital energies—all of which are indications of approaching 
death from exhaustion. Death may also result from the absorption of 
toxins from the paralysed intestine. The occurrence of tympany no doubt 
contributes to the fatal termination, the accumulated gases not only 


DISEASES OF THE INTESTINES: HORSE BOB 


becoming partly absorbed and exerting a lethal action on the heart, but 
also causing pressure on the lungs through the diaphragm. 

Some authors regard enteritis as being responsible for death in some 
cases, but 1t 1s seldom so well marked as to merit its inclusion amongst 
the immediate causes of a fatal termination. 

As already remarked, death from ordinary impaction of the colon is 
not of common occurrence in the present day, provided rational treat- 
ment be adopted. 

DIFFERENTIAL Dracnosts.—Careful attention to the history of the 
case and to the character of the pulse, considered in conjunction with the 
temperature and respirations, gives valuable aids to diagnosis. The 
evidences afforded by rectal examination are also very valuable, and this 
procedure should never be neglected. .A guarded opinion should always 
be given, as a case may commence with mild symptoms and may 
ultimately prove a serious one ; or, per contra, the presence of violent 
symptoms is likely to lead the practitioner to give a diagnosis of 
enteritis or twist, and thus to adopt a line of treatment distinctly 
inimical to favourable results. T’oo often a diagnosis of ‘‘ spasmodic 
colic’ is given without due consideration of the cause of the spasms. 

The diagnostic symptoms of such conditions as obstruction of the 
pelvic flexure, obstruction of the cecum, and of the single colon, will be 
considered under the headings of these affections. 

Proenosis.—In the presence of the symptoms we have mentioned it 
is an extremely difficult matter to venture an opinion with reference to 
the ultimate termination of the case. Due regard must be paid to the 
character of the pulse, temperature, and respirations, taken collectively, 
if errors are to be avoided. An alteration in the character of the pulse is 
an important danger-signal which should never be overlooked. If the 
pulse remains fairly normal, and the vital powers are maintained, the 
presence of pain per se of a dull character, continuing for three or four 
days, need not be regarded as a fatal omen. Of course, a free action of 
the bowels is the chief evidence of a favourable termination. 

TREATMENT.—From early times much difference of opinion has 
existed with reference to the treatment of this affection. On the one 
hand, the leading symptom—.e., the pain—received attention, and 
measures were adopted for its relief irrespective of its cause. Hence the 
employment of the time-honoured opium and its derivatives, and even 
at the present day this practice is largely in vogue. On the other hand, 
there were authors and practitioners who recognised the cause of the 
pain, and with a view to removal of this advised the administration of a 
cathartic, such as aloes, but added an opiate, so as to relieve the dis- 


196 SYSTEM OF VETERINARY MEDICINE 


tressing symptoms. The aperient treatment met with much opposition, 
the grounds advanced for which were that aloes was likely to induce 
enteritis, should there be a tendency to the occurrence of such a con- 
dition ; while in the case of impaction of the intestine, it was contended 
that the drug could induce rupture of the colon by forcing the contents 
of the small intestines into the over-distended colon. 

All the erroneous therapeutical views in connection with obstructive 
colic due to impaction arose from a misconception of the real nature of 
the affection. In our earlier days of practice we held these erroneous 
views, and directed all our attention to the relief of the pain that was 
present, with the result that even mild cases of the affection were con- 
verted into cases of obstinate impaction, while severe cases frequently 
succumbed, owing to the effects of the sedatives employed. A perusal 
of Caulton Reeks’s work, ‘‘ The Common Colics of the Horse,” first led 
us to consider the question seriously, while attention to post-mortem 
examinations and a trial of the treatment advised by the above author 
proved to us that his views on the subject were not only logical, but also 
that his therapeutical measures were successful in practice. We have 
already drawn attention to the irrational administration of opiates in 
the treatment of the so-called spasmodic colic—an affection which in 
most instances depends on the presence of irritating ingesta in the intes- 
tines—and we have pointed out that such agents, although relieving the 
pain temporarily, brought about a cessation of peristalsis, which resulted 
in retention of the intestinal contents. The two chief errors responsible 
for the irrational treatment of such conditions are—(1) that spasm of 
the intestines evidenced by the exhibition of pain is the important 
matter to which therapeutical measures must be adopted ; (2) that pain, 
if unrelieved, will prove fatal, either by mducing exhaustion or by the 
case terminating in enteritis. 

But from the description we have already given of the nature of such 
cases it is clear that it is the cause of the pain which merits the attention 
of the therapeutist, and that rational treatment consists in the removal 
of this cause—viz., the irritating ingesta—while measures should be 
employed to overcome the resulting spasm of the muscular coat of the 
intestines or the paralysed condition of this structure. 

Again, the large majority of observant clinicians agree that enteritis 
arises as a disease per se, and does not usually follow obstructive colic 
due to impaction, or unrelieved spasmodic colic. Now, opium and its 
derivatives possess certain well-marked actions on the intestines, more 
especially when the latter contain a large amount of undigested material, 
and suffer from impaired peristalsis. These agents not only paralyse the 


DISEASES OF THE INTESTINES: HORSE ~*~ 197 


movements of the intestines, but also tend to induce tympany. We are 
quite prepared to admit that in many instances they succeed in relieving 
pain, and in the cases that recover there is a tendency to attribute the 
happy result to the time-honoured dose of laudanum or the hypodermic 
injection of morphine. But we must again emphasise the point that 
simple cases very often recover without any treatment ; it is the cases 
depending on the retention of undigested material that furnish the large _ 
majority of instances designated as obstinate or severe colic. Now, there 
is no possible doubt that opiates dull or relieve the pain temporarily, but 
the cause remains unaffected, the character of the case is masked, the 
pains return later on, an erroneous diagnosis is likely to be given at the 
start, the sedatives paralyse the walls of the intestines and bring about 
complete stasis of the contents, which further treatment may be powerless 
to overcome. Moreover, opiates cause extreme nausea, and in many 
horses the full doses given, with a view to relieve continuous pain, induce 
a semi-delirious condition, instead of a sedative action on the nervous 
system. The above was our experience during the period in which we 
adopted the opiate treatment, and the number of cases in which obstinate 
constipation or impaction followed the relief of the acute pain, and the 
large mortality that resulted, was simply appalling when viewed in the 
light of our present-day knowledge and results. The practical deduction 
arrived at is that opiates of any kind are contra-indicated in either simple 
colic, flatulent colic, or obstructive colic depending on impaction. The 
treatment for simple colic and flatulent colic has already been described 
(see pp. 177, 184). To Caulton Reeks must be accorded the credit of first 
pointing out the evil effects of opiates, and the rational lines of treatment 
to be adopted in impaction of the intestine. This treatment is based on 
the view that, having a paralysed and impacted intestine to deal with, 
the condition is best overcome by the administration of full doses of 
nervous stimulants. In other words, treatment is directed primarily 
towards restoring the altered nerve power in the intestinal walls by the 
administration of full doses of nervous stimulants. Cathartics alone will 
fail to cause expulsion of the impacted material in consequence of the 
paralysed condition of the intestinal walls, but in conjunction with 
the stimulant treatment, and judiciously employed, they prove of 
value. 

The following is an outline of the treatment advised by the above 
author: When the case is a severe one and the symptoms well marked, 
2 ounces of carbonate of ammonia and 1 ounce of powdered nux vomica, 
with sufficient soft soap, are made into four balls, and these are adminis- 
tered at once. Immediately afterwards a drench composed of 2 ounces 


198 SYSTEM OF VETERINARY MEDICINE 


each of oil of turpentine and aromatic spirits of ammonia in | pint of raw 
linseed oil is given. If the animal still shows pain at the expiration of 
three to four, five, or six hours, a similar dose of carbonate of ammonia, 
but without the nux vomica, is given, powdered ginger being substituted 
for the latter ; and should the case tend to become protracted, and show 
a strong but not too frequent pulse, a hypodermic injection of eserine 
sulphate (1 grain) with pilocarpine (2 grains) is administered. If, on the 
next visit to the case, there has been no action of the bowels, and peris- 
talsis is still in abeyance, the eserine is repeated in a larger dose—viz., 
2 grains. Frequent enemata of hot water are also administered. The 
carbonate of ammonia is continued at intervals of three hours in 1 to 
2 ounce doses until relief is obtained. In the case of a very young cart- 
horse or a nag the dose of nux vomica is reduced to 4 ounce. ~ The doses 
of carbonate of ammonia and nux vomica, especially the latter, may be 
considered by many practitioners as massive, but Caulton Reeks assures 
us that smaller amounts will not produce the desired effects—z.e., the 
restoration of nervous power and peristalsis to the intestines, and the 
expulsion of the impacted ingesta. He has found that, although the 
above treatment proved successful without the employment of aperients, 
yet the judicious employment of aloes proves of value in conjunction 
with the stimulant treatment, and may be substituted for the linseed oui. 
For a gross, heavy cart-horse 6 drachms of aloes may be safely given, and 
for a nag in the same condition 5 drachms is a suitable dose. 

Other practitioners who have adopted the above treatment confirm 
its value, but there are certain circumstances connected with the efficient 
carrying out of the therapeutical measures which merit attention. In 
our experience the treatment can be carried out with facility in the case 
of patients in the infirmary ; but when we come to deal with cases in a 
country district, where the owner and the attendants are unable to ad- 
minister drugs prescribed in the form of bolus, considerable difficulty is 
experienced. The practitioner cannot attend personally to administer 
the medicaments at repeated intervals, in consequence of the distance, 
and the ordinary attendants in country districts—at any rate, in Ireland 
—are unable to give medicines in the solid form. Obviously, it is not 
possible to administer the required doses of carbonate of ammonia in the 
form of a drench, and we may remark also that the procedure would not, 
be a safe one in the hands of country attendants. Under such conditions, 
it is our practice to administer the dose of ammonium carbonate and nux 
vomica, and to follow it up with a hypodermic injection of eserine and 
pilocarpine, should there be no contra-indications to the employment of 
the latter agents—a subject to which we shall refer farther on. Should 


DISEASES OF THE INTESTINES: HORSE + |. 199 


these contra-indications exist, then we have no hesitation in prescribing 
a dose of aloes. 

With reference to the employment of aloes, it will be necessary to 
make a few remarks. We have already mentioned that from early times 
this drug was employed in the treatment of colic, whether simple, ob- 
structive, or flatulent, but in most instances it was combined with opiates 
with a view to relieving the pain. So far as impaction of the intestine 
is concerned, if the case is a severe one, it is generally found that the 
drug very frequently fails to exert a purgative effect. This is not sur- 
prising when we consider how often the ordinary dose of aloes, given in 
the form of bolus to a horse unprepared for physic, fails to act. Now, 
in impaction of the intestine, as pointed out by Caulton Reeks, atony 
of the small intestines exists, and the drug may fail to reach the large 
bowels. Moreover, the functions of the liver are frequently in abeyance, 
as evidenced by the icteric tint of the visible mucous membranes ; hence, 
the drug is not subjected to emulsification by the bile, and its action is 
thus interfered with or delayed. But if the stimulant treatment be 
adopted in conjunction with the aloes, then the latter exerts its purga- 
tive effect. We observe a similar state of affairs in cattle practice, when 
large amounts of magnesium sulphate fail to induce purgation, the 
administration of full doses of ammonium carbonate and nux vomica 
restores nerve power to the stomach and intestines, and the bowels act 
freely. 

Whether the aloes should be given in the form of bolus or in solution 
is a matter of opinion. Some practitioners prefer the drug in the form 
of a watery solution, and find that it is more likely to act than when given 
in the solid form. Of course, the dangers of drenching must be con- 
sidered, and also the fact that a portion of the medicament is likely to 
be wasted during the process. 

In the less severe forms of intestinal impaction we believe that it is 


drug being liable to induce enteritis being now. eeeitedh "Even in the 
event of an erroneous “diagnosis, aloes does not cause distressing symp- 
toms like eserine or arecoline, when administered in cases of enteritis or 
twist. 

Raw linseed oil is largely employed as an aperient in cases of intes- 
tinal impaction. It is said to be far safer than aloes, but in our experi- 
ence it should, like aloes, be used with discretion. That very large doses 
can be given in some cases without producing any effects we are per- 
fectly aware, but its action is very uncertain, and we have seen many 
cases of superpurgation and laminitis follow full and repeated doses 


900 SYSTEM OF VETERINARY MEDICINE 


of this agent in cases of colic with impaction. Moreover, it produces 
severe nausea for a long period—far more so than is the case with aloes. 

Eserine with Pilocarpine proves very useful in the treatment of intes- 
tinal impaction, but, when marked tympany is present, many prac- 
titioners consider that eserine should not be employed, as owing to 
the energetic muscular contractions induced, rupture of the intestines 
may result. With this view we are in agreement, and when well-marked 
distension of the abdomen is present, we consider it is safer treatment to. 
employ the trocar and cannula to relieve the tympany, then to give a full 
dose of oil of turpentine or terebene in raw linseed oil, and te continue 
the stimulant treatment. Later on the eserine may be given, if necessary. 

As regards the dose of this agent hypodermically, it is often found 
that 1 grain combined with 2 grains of pilocarpine will succeed in inducing 
muscular contractions of the intestines and the passage of feeces. The 
pilocarpine is added in consequence of its power of increasing glandular 
secretions, both salivary and intestinal, and thus aiding the action of the 
eserine. Some practitioners administer the eserine intravenously, and 
claim that its action is quicker and more certain by this route. If the 
drug fails to act within a reasonable time, it may be repeated in a 
dose of 2 grains. We have adopted the plan in some cases of giving 
small doses—e.g., 4 grain—and repeating them at intervals until the 
bowels respond. We consider this method is safer when there is moderate 
tympany and hardening of the abdominal walls present. Of course, it 
can only be carried out in infirmary cases, as 1t would not be practicable 
in country practice. 

Here we may remark that when a case has been irrationally treated 
by the administration of opiates, so great a degree of intestinal paralysis 
may be induced that the ordinary doses of eserine may fail to act. 

Arecoline Hydrobromide has of late years been preferred by many 
practitioners to eserine. It combines the action of eserine and _pilo- 
carpine, and causes profuse salivation. The dose by hypodermic injec- 
tion is 1 grain. It may also be given intravenously, in which instance 
its action proves very energetic. 

We consider that, like eserine, it is contra-indicated when tympany 
is a marked feature in the case. 

Barium Chloride is sometimes employed to overcome intestinal im- 
paction. It produces violent muscular contractions of the intestines, 
and cannot be considered a safe agent in consequence of the danger of 
bringing about intestinal rupture. 

Hughes* advises that in cases of impaction, associated with tym- 


* Veterinary Record, November 2, 1912. 


DISEASES OF THE INTESTINES: HORSE » . 201 


panites, a special trocar and cannula be employed.. After removal of 
the gas, a rubber tube is attached to the neck of the cannula, and a quart 
of warm chinosol solution is injected into the colon. This softens the 
impacted mass and prevents the further formation of gases. 

Intestinal Irrigation —In all cases of obstructions of the large intes- 
tines due to impaction the employment of intestinal irrigation is indi- 
cated. Now, the ordinary enema, composed of about half a bucketful of 
water and administered by the usual syringe and tube, is of little value 
in such cases, as it does not extend beyond the rectum. A gum- 
elastic tube 6 feet in length attached to the ordinary enema pump must 
be employed, and large amounts of water should be pumped in. F. Smith 
was the first clinician to adopt this form of treatment, and he preferred 
cold to warm water for the purpose. The procedure requires care and 
patience in order to. pass the tube the sufficient length; but after the 
practitioner has become expert in its use, the fluid can be made to enter 
the single colon and probably the double colon. The tube should be well 
anointed with lard in preference to oil, as the former is less easily rubbed 
off during the passage of the instrument. It finds its way along the 
course of the rectum with little difficulty, and requires only gentle pres- 
sure in order to facilitate its passage beyond this. A large amount of 
water should be slowly pumped in. By this means the anterior portion 
of bowel becomes dilated, and after carefully manipulating the tube, no 
force being required, its full length is gradually inserted. The greatest 
drawback encountered in the passage of this tube is when the animal 
strains vigorously or when the instrument bends on itself. Under such 
conditions great care is essential, and these difficulties can generally be 
overcome by passing the tube very slowly and pumping in water at the 
same time. We quite admit that there are cases in which it may be 
impossible to pass the tube its full length, and also that when marked pain 
is present the procedure cannot even be attempted unless we place the 
animal under light chloroform anesthesia (see p. 117). Having passed 
the tube as far as possible, large quantities of fluid should then be pumped 
in, and not infrequently we find that the fluid passing out is of a yellowish 
colour, and later on contains quantities of undigested material. In 
many instances a large amount of the fluid is retained, and not only 
softens the impacted material, but also reduces the abnormal tempera- 
ture, and supplies water to the animal’s system. 

We can speak with confidence of the value of intestinal irrigation as 
above described in the treatment of impaction of the colon. We have 
not observed beneficial effects to follow the administration of a solution 
of aloes by this method, as advised by Williams, but on several 


209 SYSTEM OF VETERINARY MEDICINE 


occasions we haverinjected large amounts of raw linseed oil with good 
results. 

The Treatment of Pain in Connection with Intestinal Impaction.—We 
have already pointed out that opium and its derivatives should not be 
employed in this condition ; but there are cases in which the pain be- 
comes violent, and the question then arises as to how such pain can be 
relieved without interfering with the stimulant treatment or with the 
action of agents for producing evacuation of the intestinal contents. 
Not that the pain per se will contribute to a fatal result, but there is a 
possibility that displacement of the double colon may occur from the 
animal throwing himself about. 

Again, the owner of the animal is not satisfied unless relief is given, 
in spite of the assurance that the pain will cease when the action of the 
bowels becomes restored. 

At one time it was held that cannabis indica was an ideal anodyne, 
relieving pain without interfering with intestinal peristalsis. An exten- 
sive experience with this drug enables us to state that it interferes 
materially with the action of the bowels, although it does not produce 
the exciting effects of opiates in full doses; hence we consider that its 
employment is contra-indicated in intestinal impaction. 

In our experience chloral hydrate is the most advisable analgesic 
agent to administer in cases characterised by violent pain. We have 
never observed that it interfered with intestinal peristalsis, even after 
full and repeated doses were administered. 

In similar cases we have induced light chloroform anesthesia with 
good results. By this procedure, in cases accompanied by marked 
straining, rectal examination and also the passage of the long rectum 
tube are greatly facilitated. Caulton Reeks finds that by using cold 
water for irrigation, the straining is greatly allayed. 

Of course, these remarks apply to instances where the pain is acute 
or violent. In ordinary cases, where the pain is of the dull type, analgesic 
agents are not called for. As regards the application of hot fomentations, 
blankets wrung out of hot water, etc., to the abdominal walls, we must 
admit that the benefits said to be derived are imaginary. 

The after-treatment consists in careful attention to dieting. It 1s 
not wise to permit a return to solid food for some days. In cases where 
aloes has been administered, precautions similar to those carried out after 
an ordinary physic-ball has been given must be adopted, so as to avoid 
any danger of superpurgation. A course of nerve tonics and vegetable 
bitters, such as nux vomica and gentian, is generally indicated. ’ 

Preventive measures consist in inquiring into the history of the case, 


DISEASES OF THE INTESTINES: HORSE ° | 203 


and ascertaining the probable causal factors, and adopting steps to over- 
come these. When.a number of cases of the affection occur in a stable, 
it will generally be found that the system of feeding is at fault, or that 
sufficient water is not allowed. 

The teeth of the animals should also be examined for dental irregu- 
larities, and suitable attention must be given to these, if present. 


2. Obstruction of the Pelvic Flexure of the Double Colon due to 
Impaction. 


SYNONYM.—Subacute obstruction of the pelvic flexure of the double 
colon. 

This condition was included in the general description of impaction 
of the double colon given in the preceding section, but there are certain 
clinical features in connection with impaction, when mainly, if not 
entirely, confined to the pelvic flexure, which justify a separate con- 
sideration. The first author who described this condition as a clinical 
entity was Caulton Reeks,* and to his work we are indebted for the fol- 
lowing information on the subject. At the same time, we may remark 
that the clinical phenomena he brings forward are reliable, and stand the 
test of experience, when once attention is directed to the existence of 
this special form of impaction. 

There are certain reasons why the pelvic flexure should be a common 
seat of impaction. Thus, from an anatomical point of view, this portion 
of the colon is much diminished in size and lumen as compared with the 
second division of the viscus, and this diminution in lumen is very abrupt. 
Again, this portion of intestine has a very free distribution in the abdo- 
minal cavity, which without doubt favours the occurrence of twist or 
displacement, but very probably also tends to an accumulation of ingesta 
at this point, independent of the first-named lesion. On physiological 
grounds, it may be assumed that the circulation at the pelvic flexure is, 
especially in the case of an old animal, likely to be diminished in force, as 
compared with the other divisions of the colon, because at this point 
the bowel is supplied by the distal portions of the direct and retrograde 
colic arteries. This peculiarity in the circulation probably tends to bring 
about interference with peristalsis. Moreover, as pointed out by Caulton 
Reeks, the commonest sufferers from this form of impaction are aged 
animals, in which, however, there are other predisposing factors, such 
as dental irregularities interfering with mastication, defective secretion 
of gastric and intestinal fluids, and a gradual diminution of nerve force. 

The same author points out that impaction of the pelvic flexure occurs 


* “The Common Colics of the Horse.”’ 


204 SYSTEM OF VETERINARY MEDICINE 


mainly in animals of a heavy and lymphatic type, owing to the large 
amount of bulky food they consume, and probably also to the extensive 
size of the double colon. 

As regards the exciting causes of this condition, they are similar to 
those described for ordinary impaction of the colon (see p. 191). 

Symptoms.—The general symptoms may be said to resemble those 
observed in ordinary impaction, with a few modifications which are of 
clinical importance. The pain, although dull in character, shows long 
periods of intermittence, during which the animal lies stretched out in 
apparent ease; but he occasionally lifts his head and looks towards his 
flank. Ifthe case be seen during one of these periods of ease, an erroneous 
opinion may easily be arrived at, as there is little, if any, alteration in the 
character of the pulse, and nothing is found to indicate the existence of 
a serious affection, unless a rectal examination be carried out. In a 
variable period, however, evidences of pain are manifested, the animal 
is restless, walks round his box, may paw with alternate fore-feet, and 
look anxiously towards the flank. The respirations are increased in 
number, the pulse is accelerated and irregular, and patchy sweating 1s 
observed on the body. The state of the bowels may deceive the prac- 
titioner, as from the start of the case small quantities of feces are passed 
several times ; but although in the aggregate a considerable amount has 
been expelled, it is in reality derived from the third and fourth divisions 
of the colon and the floating colon, none being able to proceed from the 
bowel anterior to the obstruction at the pelvic flexure. A rectal examina- 
tion reveals an open, empty, and ballooned condition of the rectum, and 
within easy reach is found the impacted pelvic flexure, rounded and 
engorged. In some cases the distension is so marked that the pelvic 
flexure extends into a more central position than is normal. The 
contents are hard, and can only with difficulty be indented by the fingers 
pressing thereon. 

CoursE.—Even under suitable treatment the course of this affection 
is slow, and cessation of the pains may not occur until after eighteen to 
twenty-four hours, or even longer in the case of aged animals. 

DIFFERENTIAL D1aGnosis.—This is chiefly based on a careful rectal 
examination, and here we may again emphasise the importance of this 
valuable aid to diagnosis, which should never be neglected by the 
practitioner when attending a case of intestinal disorder. 

It is necessary to differentiate the following conditions from impac- 
tion of the pelvic flexure : 

Obstruction of the Floating Colon.—In this affection the symptoms 
presented are more serious and acute. The pain is continuous ; the pulse 


DISEASES OF THE INTESTINES: HORSE \ .205 


shows serious disturbance} the animal stands for short intervals in a 
stretched-out position, with penis hanging, as if endeavouring to mic- 
turate ; the tail is quivering; the pains gradually increase in severity ; 
there are constant straining attempts at defecation, but no feces are 
expelled. On rectal examination there is a well-marked clinging action 
of the rectum on the arm of the operator, and violent straining, the latter 
being also called into action when attempts are made to administer 
enemata. One or two of these symptoms may be observed occasionally 
in cases of impaction of the pelvic flexure, but, when present, they are 
by no means well marked. 

Displacement or Twist of the Pelvic Flexure.—Caulton Reeks states 
that he is unable to distinguish any peculiarity either in the shape or 
in the distribution of the bowel that can be put down as diagnostic of 
twist ; but he has found from experience that in nearly every instance 
where the impacted pelvic flexure is present in the pelvis it may be taken 
as certain that twist has not occurred, as in the great majority of cases 
of volvulus of the double colon the pelvic flexure has been displaced to 
the extent of removing it from reach, so that it cannot be palpated by 
rectal examination. 

Proenosis.—This should be guarded, as there is always the possi- 
bility of a twist being present. Favourable signs during the course of 
the attack are the occurrence of long periods of freedom from acute pain 
and the absence of marked alterations in the character of the pulse. 
Although paroxysms of acute pain occur at intervals, they are not to be 
regarded as fatal omens, as they may be due to the action of the drugs 
administered to overcome the obstruction. 

TREATMENT.—Obviously, opiates of all kinds are contra-indicated. 
A dose of aloes either in the form of bolus or in solution should be ad- 
ministered early, and followed up with the stimulant treatment—viz., 
nux vomica and ammonium carbonate—as already described (see p. 197). 
Intestinal irrigation with the long rectum-tube should be diligently and 
frequently carried out, and the water employed should be hot, care being 
taken to insure that its temperature is not too high. The value of the 
long rectum-tube in this affection has been amply proved by experience, 
not that the fluid is likely to reach the pelvic flexure, but at any rate it 
reaches the floating colon, and causes removal of ingesta from this portion 
of bowel, and possibly in a reflex manner acts on the double colon. 
Caulton Reeks is of opinion that the hot water exerts an action on the 
walls of the double colon through the walls of the rectum, and that the 
warmth produced excites increased secretion in the former viscus, and 
slowly softens the impacted material, 


206 SYSTEM OF VETERINARY MEDICINE 


As regards the employment of eserine, the same author advises that 
it is not wise to administer this drug in the early stages of the case. 
The proper course to adopt is to defer giving eserine or agents having a 

‘similar action until the impacted material has undergone some degree of 
softening, as the result of the other medicaments administered. The 
consistency of the obstruction can be easily ascertained by rectal examina- 
tion, and when it shows some tendency to softening the eserine can then 
be given with good results. With this view we are perfectly in agree- 
ment, as we have frequently seen the administration of eserine fail when 
the obstruction was hard in consistency. No doubt the drug caused 

severe pain and straining, but no effect was produced on the impacted 
material. 

In cases where relief is not obtained within twenty-four hours, and 
the pulse becomes irregular, the hypodermic injection of ether is advised 
by the above author. This agent equalises the circulation, renders the 
pulse somewhat slower, but stronger and fuller, and promotes the action 
of the bowels. Caulton Reeks informs us that he often injects 2 ounces 
of methylated ether in lingering cases, and obtains excellent results. In 
some instances a large abscess forms at the site of Injection, accom- 
panied by extensive sloughing of the surrounding skin and subcutaneous 
tissue. But the results obtained justify the employment of this agent, 
even at the risk of the above-mentioned undesirable sequele. 


3. Impaction of the Ceecum. 


Although this condition is mentioned in some textbooks under the 
general heading of “ Impaction of the Intestines,” it does not receive 
special attention either from the pathological or the clinical point of 
view. Percivall, indeed, mentions a case in which all the large intes- 
tines exhibited evidences of spasm, and “ the cecum was exceedingly 
distorted by contraction, and instead of being full of water, contained 
dung-balls.”” In the Veterinarian from 1828 to 1901 no case of the 
affection is recorded. 

Cadéac refers briefly to the condition, and states that it is recognised 
by rectal exploration, by means of the shape of the bowel, and the 
presence of its two longitudinal bands ; also its consistence is not generally 
as hard as that of an impacted colon. This author quotes statistics from 
the observations of Ernst, in which, out of thirty cases of obstruction 
due to impaction, ten occurred in the cecum. Judging by the small 
number of cases recorded, this affection must be regarded as compara- 
tively rare. Still, it is possible that, as post-mortem examinations are 
only conducted by a limited number of practitioners, this condition may 


DISEASES OF THE INTESTINES: HORSE , 207 


be overlooked. Gofton* was the first to recognise and describe this 
condition in Great Britain. Hemet with four cases, all occurring amongst 
the horses of one firm. Three of these were observed within a few 
months of one another, and the fourth after an interval of two years. 
At the discussion on this paper which followed, several of the members 
present stated that they had met with cases of impaction of the cecum, 
but in most of the instances brought forward, the double colon was 
involved as well. 

Etrotocy.—Nothing definite is known with reference to the causa- 
tion of the affection. There is at least some doubt as to whether im- 
paction of the cecum occurs as a disease per se, because in the cases 
recorded purgatives had been administered, and had acted, so that at 
the autopsy the colon was, comparatively speaking, empty, while the 
cxcum was firmly impacted. There are certain points in connection 
with the anatomy and physiology of the cecum which merit attention, 
and may offer a possible theory to account for the occurrence of impac- 
tion in this organ. 

According to F. Smith,t the contents of this bowel are “ always fluid, 
sometimes quite watery, occasionally of the colour and consistence of 
pea-soup, in which condition they are full of gas-bubbles. When watery, 
the fluid is generally brownish in colour, with particles of ingesta floating 
about in it.”” It has been demonstrated by experiment that water will 
pass from the stomach to the cecum in from five to fifteen minutes. 
The openings into and out of the caecum are both found at the upper part 
of this viscus, situated close together, being less than 4 inches distant, 
even when stretched apart. The inlet—viz., the opening of the ileum— 
is furnished with a sphincter, which is formed by the thickened condition 
of the wall of the ileum. The exit—viz., the opening of the first division 
of the double colon—has a slightly funnel-shaped arrangement, as seen 
from the interior of the cecum. But the exit is situated above the inlet ; 
hence the ingesta, in passing from the cecum into the colon, have to 
work against gravity. This is accomplished by means of the four mus- 
cular bands with which the bowel is provided. These contract and 
shorten the viscus, thus forcing the contents upwards towards the 
“crook,” and the ileum being closed by its sphincter, the ingesta enter 
the colon. One of these muscular bands merits special attention, as it 
runs from the cecum to the pelvic flexure of the colon, and it may be 


b) 


* Paper on ‘‘ Impaction of the Caecum in the Horse,”’ submitted at the meeting 
of the Scottish Metropolitan Veterinary Association, vide Veterinary Record, 
May 11, 1912. 

t ‘‘ Veterinary Physiology.” 


208 SYSTEM OF VETERINARY MEDICINE 


intimately connected with the mechanism which brings about the passage 
of material from the cecum to the colon. 

Some difference of opinion exists as to the length of time the material 
remains in the cecum. F. Smith is of opinion that it 1s not absolutely 
necessary for ingesta to remain in the cecum, and he suggests that the 
opening of the ileum and that of the colon may be so brought together 
that ingesta may pass direct from the former into the latter. This may 
be accomplished by the rigid end of the ileum approximating itself to the 
slightly funnel-shaped arrangement of the opening into the colon. 

Such a view has much to recommend it, as, if the ingesta remained 
any time in the cecum, one would expect to find it there at post-mortem 
examinations on cases in which death resulted from intestinal impaction. 
Moreover, when an animal succumbs from other causes, the cecum does 
not contain solid ingesta. In the cases recorded by Gofton, two etio- 
logical factors were mentioned. One was a deficient supply of water, 
the other was the use of a moist artificial food mixed with the corn and 
hay, and the mixture was left lying for some days before being given to 
the horses. 

With reference to the influence of a deficient supply of water, it must 
be remembered that one of the functions of the cecum is to act as a 
receptacle for fluids. If the fluid is not supplied, then it is rational to 
theorise that morbid nervous alterations may occur in the cecum, so 
that the ingesta, instead of passing from the ileum to the colon, may be 
directed into the cecum, and become lodged therein. Or, from the lack 
of fluid, the ingesta may become so dry that their normal passage through 
the ceecum is interfered with, and impaction of the organ results. 

If we assume that impaction of the colon is a concomitant condition 
in every instance, then there is not much difficulty in suggesting the 
etiological factor for the involvement of the cecum. Accepting the view 
that the food is passed direct from the ileum into the colon, it is rational 
to suggest that, if the latter bowel is impacted, a condition of stasis will 
occur in the ileum. If the impaction in the colon be relieved by thera- 
peutical measures, the ileum again resumes its functions. 

But in a case of serious impaction of the colon a paralysing influence 
may be exerted on the intestinal tract generally, and involve the nervous 
mechanism in connection with the approximation of the terminal end of 
the ileum and the opening into the colon, so that the ingesta may pass 
into the cecum and distend this organ. 

As against this theory, we may point out that a large number of post- 
mortem examinations have been made on cases of impaction of the 
colon, but the cecum was not found involved. Moreover, Gofton points 


DISEASES OF THE INTESTINES: HORSE 209 


out that in the cases he observed the colon did not seem to be impacted. 
Probably, further investigations may succeed in ascertaining the true 
cause of the condition, and also in explaining why it is that medicinal 
agents succeed in acting on the colon, but fail to have any effect in 
relieving the impacted cecum. To our mind, the impacted cecum 
presents many points of similarity to engorgement of the stomach. 
There is the difficulty for egress of the ingesta in both, and the same 
tendency to rupture. In fact, from an anatomical point of view, one 
could not conceive a structure in which more difficulty in overcoming 
impaction is presented than the cecum, and this is demonstrated by the 
‘fatal nature of the affection. 

Many other theories might be suggested to account for impaction of 
the cecum, but in our present state of knowledge no useful purpose 
would be accomplished by bringing them forward. 

Morsip AnAToMy.—lIn the cases recorded by Gofton, the caecum 
presented a very prominent appearance when the abdominal cavity was 
opened, and this viscus was impacted with ingesta containing very little 
moisture. In each of the cases the organ was ruptured, and some of the 
contents were diffused over the peritoneum. The double colon was 
found remarkably empty, an effect ascribed by Gofton to the action of 
the purgative that was administered, and to the small amount of food 
consumed. 

In a case observed by Caulton Reeks, the autopsy revealed, in addi- 
tion to an enormously impacted cecum with hard and dry contents, a 
rupture in the first division of.the colon. 

Symproms.—The clinical picture, as depicted by Gofton, was as 
follows : The animal first showed symptoms of a mild attack of diarrhoea 
while at work, and recovered spontaneously, the bowels afterwards acting 
in anormal manner. Within twenty-four hours symptoms of abdominal 
pain of a mild subacute type were manifested, resembling those met with 
in ordinary cases of impaction of the colon. There was a marked ten- 
dency to assume the recumbent posture, and the animal remained thus 
for an hour or longer in apparent ease. On rising, there was little dis- 
position to wander round the box ; the animal generally stood still, and 
only occasionally moved about uneasily or pawed with a fore-foot. 
These symptoms of dull pain with depression continued from day to 
day, but during the later stages the horse lay down almost continuously, 
and could scarcely be forced to get on his feet. The general disturbance, 
until a short time prior to death, was small in amount, and the pulse 
showed little alteration in comparison to the duration of the case. The ~ 


duration of the cases varied ; the shortest lasted for eight days, and the 
VOL. II. 14 


210 SYSTEM OF VETERINARY MEDICINE 


longest for fourteen days, before death occurred. In the latter instance 
the animal, twelve hours prior to death, showed a fairly strong pulse, 
numbering 48 to the minute; the temperature and respirations were 
normal, and no appreciable change was observed in the visible mucous 
membranes. There was almost total loss of appetite, and no action of 
the bowels for the first two or three days. On the administration of raw 
linseed oil, followed by aloes, the bowels acted tardily, but to all appear- 
ances satisfactorily, and after purgation had ceased they continued to 
act, though infrequently, and the feeces were passed in small amounts. 
But in spite of the passage of feces, the dull pains continued, and the 
animal was constantly lying down. Rectal examination at first revealed 
nothing abnormal, but a further and more thorough examination showed 
an unusual, prominent, unyielding condition of the cecum, indicating 
that the contents were of firm consistence. The organ was located in 
the lumbar region, near the centre of the abdomen, lying mainly on the 
right side, but projecting a little over the middle line. The administra- 
tion of.eserine or arecoline produced no effect so far as the impaction in 
the czecum was concerned. 

Coursr.—As already mentioned, the affection may last from eight to 
fourteen days. Little change in the symptoms is observed from day to 
day, then evidences of rupture of the intestine suddenly develop—viz., 
a running-down pulse, anxious expression of countenance, short gasping 
respirations, sweating, tympanites, and muscular tremors, death occurring 
within afew hours. In all the cases recorded, a fatal termination resulted 
from rupture of the intestine, and every form of treatment failed 
to overcome the extreme impaction which brings about the above 
lesion. 

DiFFERENTIAL Diacnosis.—This is based on the evidence obtained 
from a rectal examination. Gofton found that an impacted cecum 
could not be mistaken for anything else; but in the case met with by 
Caulton Reeks well-marked straining was present, and it was impossible 
to detect the impacted cecum. As additional aids to diagnosis, it is 
well to remember that the dull pains and loss of appetite continue after 
the administered purgatives have acted ; also to observe the small dis- 
turbance of pulse as compared with the duration of the case, the absence 
of serious symptoms until a short time previous to death, and then their 
sudden appearance. Probably the adoption of light chloroform anes- 
thesia to overcome the straining would enable a rectal examination to 
be carried out with more facility. 

ProgNnosis.—Obviously, in our present state of knowledge, the prog- 
nosis of this affection is distinctly unfavourable. 


DISEASES OF THE INTESTINES: HORSE ° - 211 


TREATMENT.—So far as we are aware at present, there is no line of 
treatment which can be relied on to overcome the impacted condition of 
the cecum. As already remarked, the affection appears to be similar in 
this respect to severe impaction of the stomach. In both instances the 
walls of the organs are in a state of paralysis and distended, and the 
means of exit for the contents do not favour therapeutical measures for 
relief. Purgatives no doubt succeed in removing the contents of the 
colon, but seem powerless to act on the distended cecum. 

Theoretically, large amounts of water administered by means of the 
stomach-tube might be expected to reach the caecum, and possibly to 
-so{ten and wash out the contents, and we should feel inclined to try this 
treatment. 

The stimulant treatment advised for impaction of the colon is also 
indicated in this condition. 


4. Impaction of the Single Colon. 


SynonyM.—Subacute obstruction of the single colon. 

Most textbooks include this condition under the general heading of 
Impaction of the Intestines; some do not refer to its existence. To 
Caulton Reeks * we are indebted for the first graphic description of this 
form of impaction, and for a clear conception of its clinical phenomena, 
differential diagnosis, and treatment. As regards the frequency with 
which this condition occurs, it is difficult to offer an opinion, as it 1s very 
likely that many cases are overlooked or ascribed to ordinary impaction 
of the colon, and the diagnoses are not verified by post-mortem examina- 
tions. As the result of clinical experience, we are enabled to state that 
the description of the affection, as given by Caulton Reeks, coincides in 
every respect with our observations in similar cases, and we are clearly 
of opinion that impaction of the single colon should be regarded as a 
special condition, and described accordingly. Moreover, it often proves 
to be a very serious affection—far more so than ordinary impaction ‘of 
the colon—as all therapeutical measures may fail to overcome the obstruc- 
tion. 

Eriotocy.—The ordinary causes are similar to those already described 
for impaction of the colon, but there are special predisposing causes 
which merit attention. Anatomically, the single or floating colon has a 
sacculated form, and in it the fecal matter is compressed into rounded 
or oval-shaped masses. Physiologically, the chief function of this por- 
tion of intestine is to complete the absorption of the fluid matters of the 
ingesta. Now, when causes favouring impaction occur, it can readily be 


* «<The Common Colics of the Horse.”’ 


212 SYSTEM OF VETERINARY MEDICINE 


understood how easily a solid obstruction may form in the single colon. 
When the ingesta are in an abnormally dry condition, due either to a 
deficiency of water or to prolonged febrile disturbance, in which absorp- 
tion occurs to an abnormal extent, the fecal material tends to accumu- 
late in this region, forming excessively hard masses, which the intestinal 
movements are unable to pass onwards to the rectum. 

Caulton Reeks is of opinion that nervous influences may play an 
important part in the etiology of this affection. Thus, prolonged and 
excessive work, especially of a heavy hauling nature, acts principally on 
the muscles of the lumbar region, and has a depressing action on the last 
portions of the bowels, leading to a torpid or stationary condition of 
their contents. The nerves become paralysed, or suffer from temporary 
inhibition of function, by being in contact with overworked or tired 
muscles. The latter are impregnated with effete materials, which cannot 
be got rid of, and there is likely to be absorption of waste products. The 
nerves and nerve centres in close apposition with such muscles fail tem- 
porarily, to perform their function. The nerve centre likely to be im- 
plicated by the above cause is the posterior mesenteric plexus, which is 
formed in great part by the lumbar portion of the great sympathetic, 
and furnishes branches for the supply of the single colon and the rectum. 
The lumbar portion of the sympathetic lies in close contact with the 
psoz muscles, and is largely covered by the posterior vena cava, and 
would be the first nerve structure to feel the ill-effects of waste materials 
coming from the muscles of the hind-limbs and loins. 

An occasional cause of impaction of the single colon is the occurrence 
of paralysis of the rectal walls, with accumulation of feeces therein. Under 
such a condition the contents of the single colon cannot be passed onwards, 
and thus accumulate, forming an obstruction. 

Morzsip Anatomy.—lIn a well-marked case, although the double colon 
contains a large amount of ingesta, the latter is not hard ordry. But the 
single colon is completely obstructed by fecal material, which is exces- 
sively hard, and in some cases may be of an almost stony consistence. The 
bowel may present the appearance of a large, very irregular sausage, but 
in some instances the obstruction may be localised as a hard, irregular 
mass. Cadéac describes cases in which the hardened mass produced 
ulcerations of the mucosa of the bowel. Cases are recorded in which 
the obstruction was nearly round, resembling a large cocoa-nut in some 
instances ; while in others the single colon was impacted for a length 
of 6 to 12 inches. 

Symproms.—In the early stages the symptoms resemble to a great 
extent those described as occurring in impaction of the double colon. 


DISEASES OF THE INTESTINES: HORSE . 213 


But to the careful observer there are certain peculiarities which are of 
importance. 

The pain is generally continuous, and the periods of ease so often ob- 
served in ordinary impaction of the double colon are absent. At times, 
however, the animal may stand quietly for a few minutes, and if a rapid 
examination of the case be made during this period of apparent ease, an 
erroneous opinion is likely to be formed. An examination of the pulse 
will demonstrate the existence of a serious condition. 

The pulse in the affection we are discussing shows almost from the 
commencement of the case grave alterations in character. It varies very 
quickly, and may suddenly alter, so that at one moment the artery 
may feel moderately firm, while at another it runs up to 70 or 80, and 
becomes indistinct and fluttering. The conjunctive are injected, and the 
skin shows sweating in patches. Unless relief be obtained within twelve 
hours or so from the commencement of the attack, an important symptom 
is observed—vyiz., the animal assumes a stretched-out position, as if 
attempting to micturate, and the penis is protruded, but flaccid. This 
posture, however, may be observed in other intestinal affections as well, 
but in our experience it is more marked and more continuous in impaction 
of the single colon than in any other condition. As the case proceeds, 
the pain becomes more marked, and there are no intervals of apparent 
ease. Violent straining 1s also observed, accompanied by painful groans, 
which are accentuated by attempts at rectal exploration, or by the 
administration of snemas, and in some instances the rectal mucosa may 
be everted for several inches. 

Rectal exploration is violently resisted by the animal, and the arm 
of the operator is firmly clasped by the rectal walls, so that it is extremely 
difficult to carry out the procedure. The pelvis may be found to contain 
portions of the small intestine in an empty condition, or the impacted 
portion of the single colon may be located. Cadéac points out that it 1s 
often impossible to discover the obstruction, even with the most careful 
and complete exploration. In cases where the impacted portion can be 
located, slight pressure with the fingers causes pain, and the animal will 
crouch to the ground, or even lie down, if the exploration be continued. 
Tympanites is rarely present until towards the termination of a fatal 
case. In the cases that we observed this symptom was absent during 
their entire course. 

Coursz.—This is usually slow. Some cases terminate fatally in two 
days ; others may last for three or four days. Death may result from 
exhaustion, or in cases where large doses of eserine have been given 
rupture of the intestine may be the cause of the fatal termination. 


214 SYSTEM OF VETERINARY MEDICINE 


DIFFERENTIAL DraGNnosts.—When the impacted portion of intestine 
is discovered by rectal examination, a definite diagnosis can be arrived 
at. In cases where this is not possible, we may, by paying attention to 
the symptoms mentioned above, suspect the presence of this condition, 
but the difficulties in diagnosis must be admitted. 

In order to overcome the violent straining and resistance to rectal 
exploration, we advise that the animal be placed under light chloroform 
anesthesia, so that this means of diagnosis may be facilitated. 

Procnosis.—In our experience, impaction of the single colon is a 
very serious and often fatal condition ; hence prognosis should always be 
euarded. 

TREATMENT.—As in all other forms of intestinal impaction, opiates of 
all kinds should be avoided. When the pain is acute, a dose of chloral 
hydrate should be given. The stimulant treatment advised in cases of 
impaction of the double colon should be carried out and repeated. As 
regards the administration of aloes, we have never observed any bene- 
ficial result from this drug in the condition we are discussing. Indeed, 
post-mortem experience supplies sufficient evidence to indicate why 
purgatives of the kind should fail to overcome a firm obstruction in this 
portion of the intestine. Similar remarks apply to eserine and arecoline. 
If the obstruction is very hard and firmly lodged, these agents, although 
producing marked straining, have no effect on the impaction, but are 
very likely to cause rupture of the intestine. Caulton Reeks, however, 
advises that when other remedies have been given a trial of from ten to 
twelve hours, a small dose of eserme—viz., 1 grain—should be given, as 
it occasionally succeeds in overcoming the obstruction. 

The same author advises that when the obstruction is within reach, 
the practitioner should carefully knead it with the knuckles of his closed 
fist through the rectum, endeavouring to crush it between his hand and 
the floor of the pelvis. A similar measure is advised by Cadéac, who 
points out that great care is necessary so as not to cause injury to the 
intestinal wall. 

Intestinal irrigation is especially indicated, but the great difficulty is 
to overcome the violent straining which the procedure induces. Generally 
the fluid is ejected with considerable force, and it is impossible to propel 
it any distance into the bowel. We advise that the animal be placed 
under light chloroform anesthesia, and that the long rectum-tube be 
then employed. By this means the copious enemas necessary in a case 
of this kind can be forced into the single colon. Caulton Reeks informs 
us that intestinal irrigation with cold water has in his hands produced 
excellent results in cases of obstruction of the single colon when all 


DISEASES OF THE INTESTINES: HORSE | 215 


other measures have failed. He has met with instances in the country 
where the pain continued for two, three, or four days, although the 
usual treatment was adopted. He then had the animals brought to his 
infirmary, and after carrying out diligent intestinal irrigation, recovery 
resulted. Similar remarks apply to the treatment of impaction of the 
pelvic flexure of the double colon. 

Should these measures fail, and the obstruction be located, in the 
case of a valuable horse, operative measures are the only resource left. 
Needless to remark, if surgical treatment is to prove of any value, it 
must be attempted before the animal’s strength commences to fail. In 
our present state of knowledge, operative measures can only be under- 
taken by one who has devoted special attention to this branch of surgery, 
and the procedure is not likely to be attempted by the ordinary practi- 
tioner. It is admitted that the single colon is, of all the intestines, the 
most suitable for surgical interference, in consequence of its compara- 
tively thick longitudinal band, which offers a suitable position for in- 
cision and subsequent suturing. 

It has been experimentally demonstrated by Macqueen that the 
operation of opening the single colon and suturing the wound in the intes- 
tinal wall can be carried out in healthy horses without danger, provided 
aseptic precautions are strictly observed ; but up to the present time 
only one successful case in practice has been recorded—viz., that by 
Felizet in 1849, in which a calculus was removed from the commencement 
of the. single colon by laparotomy. 

For full details of the operative technique necessary in euch cases, 
the reader is referred to Caulton Reeks’s work, ‘‘ The Common Colics of 
the Horse.” 

5. Impaction of the Rectum. 

This condition is generally associated with paralysis of the rectal walls. 
It may depend on a spinal lesion, or an injury to the sacro-lumbar nerves, 
or to the loins, croup, or pelvic bones. Williams records cases depend- 
ing on degenerative changes in the rectal walls, producing a decreasing 
contractile power in the bowel, so that the feces accumulate to an in- 
ordinate extent, and are only expelled by violent straining and contrac- 
tion of the abdominal muscles. 

Amongst other causes may be mentioned old age and debility, the 
presence of neoplasms, interference with the blood-supply of the rectum 
due to a thrombus in the internal iliac artery, paralysis of the hind- 
quarters arising in connection with various conditions. 

Symproms.—Defecation is accompanied by severe straining, and the 
feeces may be discharged in the form of a large sausage-shaped mass. 


216 SYSTEM OF VETERINARY MEDICINE 


In severe cases there is complete inability to expel the contents of the 
rectum, and they accumulate and distend the bowel. In some of these 
instances paralysis of the tail accompanies the condition. 
TREATMENT.—In cases where defecation is impossible, the rectum 
must be emptied by means of the hand four or five times daily. Enemas 
should also be administered. Nervine tonics, such as strychnine, are 
indicated, and should be continued for a long period, combined with 
potassium iodide. The application of a counter-irritant to the lumbar 
region may assist in the restoration of nerve power in the affected part. 


IMPACTION OF THE SMALL INTESTINES. 


SynonyM.—Subacute obstruction of the small intestines. 

GENERAL REMARKS.—Judging by the facts that, with one exception, 
the above affection is not mentioned in British veterinary textbooks, and 
that very few cases of it are recorded in British veterinary literature, we 
are led to conclude that it is not of common occurrence. No doubt cases of 
organic changes in the walls of the small intestines, leading to a narrowing 
of the lumen of the bowel, have been recorded on several occasions, but 
the condition we now propose to discuss is obstruction of the intestine 
depending on impaction by ingesta. Caulton Reeks* is the only British 
author who gives a detailed description of this affection, and in the cases 
he records the impaction was believed to occur in the duodenum. The 
diagnosis in each case was based on clinical evidence only, as no oppor- 
tunities were presented for observing the condition post mortem. On 
consulting the volumes of the Veterinarian from the first number (1828) to 
1901, we have only found two cases of the affection recorded—viz., one of 
impaction of the duodenum reported by Leech in 1856, and one of impac- 
tion of the ileum by Sparrow in the same year. The Veterinary Journal 
from vol. i. to vol. xviii. does not contain any recorded cases of the affec- 
tion, nor could we discover any in the volumes of the Veterinary Record. 
In the Hdinburgh Veterinary Review, 1861, Poyser reported a case of 
impaction of the ileum. Simonds} recorded a case of impaction of the 
ileum, and at the same meeting Tege and Woodger related two instances 
of a similar affection accompanied by slight laceration of the intestinal 
wall, 

Continental authors appear to be more familiar with the condition. 
Cadéac{ states that one of the common seats of intestinal obstruction 


* «<The Common Colics of the Horse.” 
+ Transactions of the Veterinary Medical Association, April 2, 1844. 
t ‘‘ Pathologie Interne.” 


DISEASES OF THE INTESTINES: HORSE = ,_-217 


occurs at the entrance of the ileum into the cecum, and he quotes the 
statistics of Ernst, who found that in thirty cases of intestinal impaction 
nine were found in the above-mentioned region. 

Hutyra and Marek* describe impaction of the ileum and impaction 
of the duodenum, and state that in the ileum the obstruction occurs 
rather frequently in front of the ileo-ceecal valve, and in the duodenum 
it is observed in the vicinity of the second curvature of this bowel. Only 
quite exceptionally is impaction found in the jejunum. A special feature 
in connection with impaction of the small intestine is that the condition 
may occur in the space of half a day, or sometimes earlier. This is in 
marked contrast to the slow development of impaction of the large 
bowels. 

Friedberger and Fréhnert state that “ food accumulations occur most 
frequently in the ileum just before its point of discharge into the cecum.” 

On anatomical and physiological grounds, we should expect that when 
impaction occurs in the small intestine, the above locations would be the 
most likely seats of obstruction. Thus, the peculiar shape of the duo- 
denum and its situation between the stomach and colon, would, in the 
event of the latter being distended, or the food not being properly sub- 
jected to gastric digestion, predispose to stagnation of ingesta in the 
duodenum. Again, the structure of the ileum and the nature of its 
contents would seem to render it still more liable to impaction. Thus, 
atits entry into the cecum, its walls are thickened so as to form a sphincter 
(the so-called ileo-cecal valve), and its contents are dry as compared 
with the material found in the anterior portion of the small intestines. 
No doubt the short space of time that the ingesta remains in the small 
intestines will account for the smaller number of cases of impaction met 
with as compared with the large intestines. 

Et1oLocy.—Little definite seems to be known with reference to the 
etiological factors, as distinguished from those already mentioned in con- 
nection with impaction of the colon. According to Hutyra and Marek, 
coarse dry food-stufis, especially chop, chopped straw or chaff, may cause 
impaction of the ileum at the ileo-cecal valve. As the gastric contents 
pass into the intestines partly unchanged, it may happen that, owing to 
incomplete trituration or to a deficiency of moisture, the undigested food 
tends to accumulate at the point named, or at times in front of the second 
curvature of the duodenum. This impaction occurs in a short space of 
time in the small intestines, as compared with a similar condition in the 
large bowels, 


* “Special Pathology and Therapeutics of Domestic Animals.” 
t “Veterinary Pathology.” 


218 SYSTEM OF VETERINARY MEDICINE 


In Poyser’s case the obstruction of the ileum was due to the presence 
of a large quantity of sand, confined at both extremities with half-digested 
food material. The obstruction was 20 inches in length, and very solid. 

In Simonds’s case the horse was kept for a long period without food, 
and was then supplied with a liberal feed of oats and beans. The ileum 
at its termination in the caecum was literally blocked up for 6 or 8 inches 
with half-masticated corn. 

In the case recorded by Sparrow the animal, an aged cart-horse, had 
suffered from several attacks of colic with impaction within the previous 
six months. The ileum at its termination in the cecum was filled to dis- 
tension with a mass of closely-packed chaff and oats in a dry unmasticated 
condition, the stomach was filled to repletion, and the contents of the 
large bowels were semi-fluid. 

In Leech’s case of impaction of the duodenum, occurring in a two- 
year-old colt, the intestine, 6 inches from the stomach, showed two large 
pouches firmly packed with the leaves and twigs of whitethorn, and 
completely blocking the lumen of the bowel. 

Symproms.—These are variable, judging by the recorded cases. 
According to Hutyra and Marek, the symptoms develop rather suddenly, 
thus differing from those occurring in impaction of the large intestines. 
They may be observed in a horse apparently healthy within a few hours 
after feeding, and exceptionally in the case of duodenal impaction they 
may occur while the animalis feeding. The evidences of pain are usually 
much more pronounced than in the case of impaction of the large intes- 
tines, and violent symptoms are often observed. Occasionally, the 
animal, if a male, stretches out as if attempting to micturate, but after 
the passage of feeces this symptom disappears within a few hours. There 
is a gradual increase in the pulse and respirations, depending on a secon- 
dary dilatation of the stomach, or on the occurrence of inflammatory 
changes in the intestinal mucosa. The appetite is in total abeyance 
from the commencement of the attack. The stomach is frequently 
involved in a secondary manner, and evidences of acute dilatation of 
this organ will then present themselves, while the general symptoms of 
enteritis or other complications may also be observed. 

In Poyser’s case of impaction of the ileum, which occurred in a cart- 
mare rising four years old, the animal, on coming in from work, showed 
dulness, uneasiness, and loss of appetite. Professional assistance was 
not requisitioned until one o’clock the following morning. The mare 
was found standing with a dull, dejected countenance, and hanging head, 
and showed symptoms of abdominal pain. The pulse was of a quick, 
soft, fluttering, and debilitated character ; the visible mucous membranes 


DISEASES OF THE INTESTINES: HORSE  < 219 


were of a pallid hue ; the mouth was hot and dry ; and there was frequent 
evacuation of small quantities of soft, dark-coloured, very foetid faeces 
for a period of about two hours. After this there was complete suspen- 
sion of the action of the bowels. In four hours the pulse became quicker 
and more full in character, and the pain more violent. The animal 
rolled on her back and kicked at her belly. In the evening the pulse 
rose to 80 per minute, and became small and indistinct. The acute 
symptoms abated, the animal pawed the ground and occasionally walked 
round the box. Tympanites appeared, and heaving of the flanks, and 
the pulse became imperceptible. Death occurred on the afternoon of the 
following day, and was preceded by complete exhaustion. 

In the case recorded by Sparrow acute pain was manifested, the 
abdomen was enlarged, the visible mucosa slightly injected, the pulse 
and respirations were only slightly affected, and sweating was present. 
After a time the acute symptoms subsided, and the animal lay quiet for 
some hours, then got up and stood still. Death took place quietly during 
the night. 

In Leech’s case (impaction of the duodenum) intermittent attacks of 
abdominal pain were observed, the respirations were accelerated, and 
the extremities cold. The animal rolled at times, there were frequent 
efforts at vomition, followed by a discharge of fluid containing masticated 
ingesta from both nostrils, more marked when the head was depressed. 
No tympany was observed, and the pain was not violent at any time. 
Death ‘occurred in six hours from the commencement of the attack. 
This case, in addition to impaction of the duodenum, showed on post 
mortem a sacculated condition of the rectum. 

Caulton Reeks describes the symptoms observed in the cases met 
with by him as follows : The attack is preceded by a period of dulness, 
lack of energy, and uneasiness. The animal may lie at intervals, and 
occasionally turn his head towards his flank. The pulse is slightly in- 
creased in frequency, but feels firm and full. A slight degree of fever is 
present, the conjunctiva is stained a muddy yellow, the mouth is dry, 
and exhales a fcetid odour. The tongue and the buccal mucosa have an 
icteric tint. The rectum contains a small amount of hard faces, abnor- 
mally dark in colour, and no impaction of the colon is present and no 
tympany. The practitioner seldom sees the case at this stage. When 
his attendance is requested, the pain, although still of a dull character, 1s 
more marked, the animal lies down at intervals, but there are fairly long 
periods of ease. Purging occurs at intervals, the feces being watery and 
very offensive, and followed by more or Jess intense pain. Rectal 
examination shows the contents of the rectum, and probably of the single 


220 SYSTEM OF VETERINARY MEDICINE 


colon, to be in a fluid condition, but the other portions of the intestines 
within reach are found to contain solid ingesta. Under suitable treat- 
ment improvement may take place in a few hours, or in a day or two. 
This is manifested by the cessation of the purging and of the pain. In 
some instances the dull pains may continue for seven or eight days. The 
critical symptom is the passage of a large mass of faces, clay-like in 
colour and consistence, and extremely foetid. This is followed by cessa- 
tion of the pains, and in the space of a few days, with careful dieting, the 
animal is convalescent. During the period that purgation continues the 
case might be mistaken for one of superpurgation, and treated errone- 
ously in consequence; but in superpurgation, accompanied by colicky 
pains, the animal is very thirsty, the flanks are “ tucked up,”’ the respira- 
tions accelerated, the pulse weak, and on auscultation of the abdomen 
the peristaltic movements are much in evidence. But in the condition 
under discussion the above symptoms are not present, and it may here 
be stated as a clinical fact that the patient cannot be persuaded to drink 
in cases of obstructive colic. 

We have already remarked that in the above cases described by 
Caulton Reeks the diagnosis was not confirmed by post-mortem evidence. 
The symptoms certainly point to some derangement of the small intes- 
tine, but of the real nature of the cases it is difficult to speak definitely, 
as the symptoms differ widely from those observed by practitioners who 
have recorded instances of impaction of the small intestine which have 
been verified by post-mortem examination. It may possibly be that a 
condition of partial impaction of some portion of the small intestine 
would account for the symptoms mentioned by the above author. 

DIFFERENTIAL DraGnosis.—Judging by the variety of the symptoms 
described above, it is apparent that a differential diagnosis will be at- 
tended by considerable difficulty. Examination per rectum may enable 
us to decide that obstruction is not present in the large intestines ; also 
the history of the case is of value, as the development of impaction in the 
large bowel is comparatively slow, whereas a similar condition in the 
small intestine is more rapid. When gastric symptoms are present, the 
condition may be mistaken for an affection of the stomach. According 
to Hutyra and Marek, ‘‘ rectal examination reveals the distended ileum 
as a regular, cylindrical smooth structure as thick as one’s arm, that 
stretches from the hinder pole of the left kidney to the right of the spinal 
column from above obliquely downwards and backwards to the right, or 
from below to the left upwards and to the right, to join the base of the 
cecum and connect with it. The impacted duodenum may also be felt 
as a cylindrical smooth body, which forms a bend from right to leit 


DISEASES OF THE INTESTINES: HORSE . 221 


immediately behind the anterior origin of the mesentery, and connected 
by quite a short piece of mesentery.” 

TREATMENT.—The stimulant treatment advised for impaction of the 
colon is that best calculated to be of service in the condition we are dis- 
cussing. It is obvious that opiates should be avoided. serine or areco- 
line is contra-indicated, as the violent. contractions induced may bring 
about rupture of the intestine. A dose of aloes with calomel may be 
given in conjunction with the stimulant treatment. 


OBSTRUCTIVE COLIC IN FOALS DUE TO IMPACTION OF THE 
COLON OR RECTUM. 


This is a subject of considerable importance, as, owing to an erroneous 
diagnosis and irrational treatment, many valuable foals are lost yearly. 
One of the commonest causes of obstructive colic in the newly-born foal 
is retention of the meconium, and the symptoms may develop very 
shortly after the birth of the animal. The careful and experienced stud- 
groom pays special attention to this matter, and when he finds that the 
bowels do not act normally, he very properly administers a dose of castor 
oil to the animal. But there are many instances in which the animal is 
neglected, and attention is not directed to him until colicky pains and 
straining are in evidence. Again, there are cases which, in spite of every 
care, suffer from retention of the meconium. The evidences of pain are 
well marked, with short intervals of ease. The animal rolls frequently, 
and at times may try to lie on his back. He may throw himself down 
with violence, struggle a few times, then rise, and make a listless attempt 
to suck the dam, then walk around her in an uneasy manner. During 
the paroxysms of pain the pulse is increased in frequency, and the respira- 
tions are accelerated. In some cases straining as if to defecate is observed, 
in others this is absent, and beyond the presence of the pain, there is 
nothing to indicate the real nature of the case. A common but irrational 
treatment is to administer opium or chlorodyne, in order to relieve the 
pain. Now, the cause of the pain is the presence of hardened masses of 
meconium in either the doublecolon, the singlecolon, orthe rectum, and the 
only chance of success is to adopt measures for the removal of this ob- 
struction. Hence, a full dose of castor oil should be given, and enemas 
of warm water should be administered. A special rectum-tube fixed to 
the ordinary enema-pump is required for this procedure. The contents 
of the rectum should first be got away, then the tube, well anointed with 
lard, is to be very carefully passed inwards, the water being pumped in 
at the same time so as to distend the bowel in front, and thus facilitate 


999 SYSTEM OF VETERINARY MEDICINE 


the passage of the tube. Considerable difficulty will be experienced in 
some cases, owing to the presence of a large hard mass of meconium 
which completely blocks the lumen of the bowel. When this is within 
reach it should be carefully broken down by means of a special spoon- 
shaped instrument. This operation requires skill, so as not to cause 
injury to the mucous membrane. In some instances it will be found 
that warm olive oil instead of water will act better for the purpose of 
softening and dislodging the obstructing body. If the pain be very 
acute, a small dose of chloral hydrate may be given in milk, but we 
generally find that, when the obstruction is overcome and the bowels 
act, the pain disappears. The administration of intestinal sedatives in 
this condition simply spoils all chance of recovery by inducing paralysis 
of the intestines. We may remark, too, that early treatment is of the 
greatest importance in these cases, as foals rapidly succumb to intestinal 
obstruction unless relief be speedily given.. 

At a later period of the foal’s life—z.e., when, about four months old, 
he commences to take solid food—impaction of the colon may be met with. 
As pointed out by Caulton Reeks, this condition not infrequently occurs 
from the habit these animals have, when they first begin to pick for them- 
selves, of nibbling at mounds of decaying litter or dried vegetation, etc. 
In the treatment of such cases oleaginous purgatives should be adminis- 
tered, also nux vomica and carbonate of ammonia in doses Sibi gan to 
the size of the patients. 

Di FFERENTIAL Diacnosis.—In all cases of abdominal pain in foals an 
enema should be administered, so as to ascertain the state of the rectal 
contents, and thus lead to a correct diagnosis. As rectal examination 
cannot be carried out by the hand in these animals, we have not the same 
facilities for detecting the presence of an impacted colon as in adults. 
Still, an impacted rectum revealed by the administration of an enema 
usually points to the presence of hard fecal matter in the colon as well. 

There are other important conditions in foals in which abdominal 
pain is a prominent feature, and a differential diagnosis must be made. ~ 

One is an wnjury to the intestines, due to the mare treading on the 
abdomen of the young animal when the latter is stretched asleep. We 
have met with cases of this kind in which the presence of the lesion was 
not disclosed until after death. The symptoms are usually obscure. The 
pains are constant, but not acute, and the animal assumes the recumbent 
position. In some cases we have observed tympanites and a hard, tense 
condition of the abdominal walls, followed by symptoms of collapse, 
indicating the presence of rupture of the intestine. Another diagnostic 
symptom of intestinal injury is the passage of blood-stained faces. 


DISEASES OF THE INTESTINES: HORSE . 993 


Strangulated Scrotal Hernia is a condition which in colt foals gives 
rise to symptoms of abdominal pain. A diagnosis is made by placing 
the animal on his back, and carefully manipulating the scrotum, when 
the hernia, if present, will be discovered. We may remark that in all 
cases of abdominal pain in colt foals this examination should never be 
neglected. 

Diarrhea or scouring is another condition which may be accompanied 
by colicky pains (see p. 300). 

In concluding this section, we consider that it is of importance to 
draw attention to some peculiarities of colic, either simple or obstructive, 
in young unbroken animals. Caulton Reeks* graphically describes such 
cases, and points out the difficulties attached to their diagnosis. The 
patient, being unhandled, resents the restraint put upon him during the 
procedure of haltering, etc., and probably the owner attempts to ad- 
minister a drench, so that excitement, sweating, hurried respiration, and 
a very quick pulse, are observed, which might in error be ascribed to the 
presence of pain. If the animal is at pasture when attacked, it is ad- 
visable to carefully study the symptoms prior to any attempt being made 
at haltering and handling. Again, it is sometimes found that a highly- 
bred, nervous animal, although suffering severe pain, may show little 
evidence of such a condition to a cursory examiner. On the other hand, 
the patient may present violent symptoms, but after being caught and 
handled, it is found that the case is one of simple colic. Hence, when 
dealing with this class of animal, great care is essential as regards diag- 
nosis and prognosis. Moreover, in the treatment, if the patient vigor- 
ously resents the process of drenching, it should not be persisted in, as 
some of the fluid may be drawn into the trachea, and set up broncho- 
pneumonia. Medicinal agents should be given in the form of bolus. 


INTESTINAL OBSTRUCTION DUE TO CALCULI, ETC. 


GENERAL RemMARKS.—Some authors describe under separate headings 
intestinal obstruction depending on the presence of calculi, and a similar 
condition due to what are termed “ Hair Balls” and Mixed or False Cal- 
culi. The difference consists in the composition of the obstructing body, 
but in cases where the false calculi become of large size similar symptoms 
may be produced. 

Mixed or false calculi are also known as “gagropiles.” They are 
composed of the fine vegetable hairs surrounding the grain of the oat or 
calyx of clover, also of hairs derived from the animals themselves or 


* <«The Common Colics of the Horse.”’ 


294 SYSTEM OF VETERINARY MEDICINE 


from their fellows, especially in horses showing a depraved appetite, with 
a tendency to lick each other. In combination with the above, indiges- 
tible material such as vegetable fibres are found, associated with mucus, 
and by the vermicular movements of the stomach and intestines a solid 
mass is formed. A central nucleus, such as a piece of leather or stone, 
etc., may or may not be present. The external aspect becomes covered 
by a layer of lime or magnesium salts, while in some instances these 
salts may form a large proportion of the mass. 

Oat-hair calculi may consist almost entirely of the hairs of ate barley, 
or other grain ; they are light in weight as compared with the other forms, 
and are occasionally mixed with phosphatic salts. These false calculi 
develop very slowly, and may attain a large size; they may be spherical 
or polyhedral in shape, with an uneven surface. When containing a large 
proportion of mineral material, they resemble true calculi in appearance. 
Their chief seats are in the caecum and colon, but they may also be 
found in the small colon. No evidences of their presence may be mani- 
fested until they become of such a size as to interfere with the lumen 
of the bowel, or until they pass into a portion of intestine which is narrow, 
such as the pelvic flexure of the large colon or the commencement of the 
floating colon. Being lighter in weight than the true calculi, they do ~ 
not exert traction on the intestine or mesentery. When interfering with 
the lumen of the bowel, the symptoms produced vary according to the 
degree of obstruction. Colicky pains of varying intensity are observed, 
which may be transient and recurrent ; and when complete obstruction 1s 
produced the symptoms and lesions are similar to those occurring in cases 
of true calculi (see p. 226). 

Cadéac has observed instances in which the calculi were so voluminous 
that pressure was exerted on the diaphragm, and the character of the 
respirations resembled that met with in pulmonary emphysema. Tym- 
pany and marked straining were also observed. 

True caleula—also termed enteroliths or benzoars—are hard in con- 
sistence, and composed chiefly of ammonio-magnesium phosphate and 
lime salts arranged in concentric layers around a central nucleus. This 
nucleus may be a foreign body such as a nail, a particle of sand, a pebble, 
a portion of inspissated mucus, etc. As regards composition, the con- 
stituents vary. In some instances a large proportion of ammonio- 
magnesium phosphate is present. The other ingredients are phosphate 
of lime and magnesia, a small amount of silica, mucus, epithelium, and 
organic matters derived from the ingesta. Calculi which contain a large 
proportion of ammonio-magnesium phosphate tend to assume a crystal- 
line form ; they are generally of a yellowish-brown or of a grey colour, 


DISEASES OF THE INTESTINES: HORSE S225 


and on section show a radiated structure from the centre to the circum- 
ference, in addition to the concentric layers. | 

In those containing a large proportion « of phosphate of lime the surface 
is generally smooth, and on section the concentric rings are more dis- 
tinctly marked, while the radiating lines are not so well defined. 

Calculi vary in shape : they may be round, spherical, ovoid, cylindrical, 
prismatic, etc. Large calculi generally occur singly, but the smaller 
forms may exist in very large numbers. In some instances they are 
joined two by two ; in others a large number of smaller calculi are agglom- 
erated in the form of a mulberry. When numerous, they show facets on 
their surface, owing to the constant friction of one on the other. Their 
weight, size, and density vary; in some instances they may attain a 
diameter of 6 inches. They nearly always originate in the large colon, 
very rarely in the cecum, but they may emigrate to the small colon and 
rectum, and occasionally are expelled per anum. 

As regards the period of time which a calculus takes to form, some 
observers state that a layer is formed after each meal, and they calculate 
that 360 days would be occupied in its formation. Pastore discovered 
a calculus the size of a fist in a two-year-old colt. The observation was 
made in 1848, and the nucleus of this calculus was found to be a coin 
bearing the date 1847 ; so it was computed that the period of development 
was less than a year. 

ErioLocy.—The foreign body forming the nucleus enters the ali- 
mentary canal with the food, and from the same source the constituents 
of the calculus are derived. The conditions which determine the precipi- 
tation of the latter have been studied by Fiirstenberg, and he arrived at 
the following conclusions : Phosphoric acid occurs in wheat bran in the 
proportion of 2°5 per cent. This acid is liberated in the stomach under 
the influence of the hydrochloric acid of the gastric juice. Magnesia 
occurs in high proportion in wheat bran; hence this form of food is 
regarded as predisposing to the formation of calculi. Certain waters are 
also found to contain a large amount of magnesia, and hence, when used 
for drinking, the amount of this agent in the system is increased. 

Ammonia occurs in the intestine as the result of the decomposition 
of nitrogenous material. Some writers state that when ammonia is thus 
evolved, and comes into contact with magnesium phosphate, the insoluble 
salt, ammonio-magnesium phosphate is precipitated. But, according to 
Cadéac, the conditions which determine the precipitation of the above 
salts are not yet understood, and the etiology of intestinal calculi is still 
involved in uncertainty. 


Horses owned by millers are well known to furnish more cases of 
VOL, II. 15 


226 SYSTEM OF VETERINARY MEDICINE 


intestinal calculi than those engaged in other work. This is sometimes 
ascribed to the dust and sweepings of the mill, which become mixed with 
the food—a circumstance which was more likely to occur in former days, 
when millstones were employed, instead of modern methods. 

The presence of foreign bodies in forage no doubt predisposes to 
calculi by supplying the nuclei necessary for their formation. 

The late A. Rogerson, Veterinary Surgeon to the Midland ies 
Company, first clearly demonstrated that all intestinal calculi are formed 
round a central foreign body. His loss of horses from calculi was so 
large that he advised passing all the oats over magnets, to remove 
fragments of nails which became mixed with the grain on board ship. 
After this machine was adopted, deaths from calculi ceased.* 

Morzsip ANAToMy.—Occasionally one may find post mortem a cal- 
culus of fairly large size in the large colon, although no indications of its 
presence were apparent during life. In such instances the only lesion 
observed is a sac-like distension where the calculus was lodged. But 
when it alters its position and becomes arrested at a narrow part of the 
intestine such as the pelvic flexure, or in the small colon, lesions occur in 
the bowel wall, such as local congestion or inflammation. A calculus 
with a rough crystalline surface is more likely to cause such lesions. 
Ulceration followed by perforation and rupture of the intestinal wall 
may be observed ; the calculus is then found in the abdominal cavity, 
and evidences of perforative peritonitis are present. 

Symptroms.—There is a marked similarity between the symptoms 
presented in a case of intestinal calculus and those occurring in intestinal 
impaction. Generally speaking, the pain is more severe in the former 
condition. In many instances the clinical history shows repeated attacks 
of colicky pains of variable duration. As already mentioned, a calculus 
may be present and cause no symptoms so long as it remains in a portion 
of the intestine of sufficient calibre, so that occlusion is not brought about. 
It is believed that in cases characterised by repeated attacks of abdominal 
pain the calculus regains its former position. Some observers state that 
one cause of the alteration of position is an attack of ordinary colic, 
the struggling movements of which cause the calculus to pass backwards 
and become lodged in a narrow portion of the bowel. H. Begg informs 
us that he has frequently observed in connection with cases of calculus 
not detectable by rectal examination, that there is an occasional absence 
of faces for a day or two, followed by the passage of an inordinate amount 
or of only fluid material (capable of getting past the calculus), and when 
the calculus alters its position full amounts of more solid faeces are passed. 
A common seat of obstruction is the small colon, especially at its com- 

* Veterinary Record, February 22, 1913. 


DISEASES OF THE INTESTINES: HORSE = * .227 


mencement. The attack may be prolonged for several days, but some 
authors state that the course is generally shorter than that of impaction 
of the large bowels. A variety of attitudes and postures may be assumed 
by the patient, but none of these are characteristic of the presence of a 
calculus. When rupture of the intestine occurs, all the symptoms of 
perforative peritonitis will be in evidence. Amongst other complications 
that have been observed, we may mention vomition and gastric rupture 
due to stasis in the colon and consequent pressure on the stomach. 

DirFERENTIAL Dracnosis.—All authors agree that the diagnosis of 
calculus must be based on the evidences afforded by rectal exploration. 
If the calculus be situated in the pelvic flexure of the double colon, it 
can be located as a hard, stony mass, the bowel anterior to it being dis- 
tended, tense, and elastic. If in the floating colon, it can be detected 
under the left kidney. When situated in the diaphragmatic flexure, a 
definite diagnosis is impossible. 

The history of the case may prove of assistance. If the animal has 
suffered from a series of attacks of abdominal pain, and is the property 
of a miller, these points may lead us to suspect the presence of a calculus. 

Prognosis.—Except in those rare cases where the calculus is lodged 
in the rectum within reach of the hand, prognosis must always be grave, 
as, unless removal can be effected, death will result. No doubt cases 
occur in which, although serious symptoms are present, an apparent 
recovery results when the calculus regains its original position in the 
dilated. portion of the bowel. 

TREATMENT.—Cases are recorded in which, by rectal exploration, 
removal of the calculus has been effected. Obviously this can only occur 
when it is within reach of the hand. Small calculi in the small colon or 
rectum may be expelled after the administration of copious enemata. 
Cadéac suggests that by manipulation per rectum it may be possible to 
force a calculus in an anterior direction, so that it will enter a dilated 
portion of the bowel, and thus occlusion may be temporarily overcome. 
Agents such as eserine and arecoline are contra-indicated, as they are 
likely to induce rupture of the bowel. 

When the calculus can be located, but is beyond the reach of manual 
extraction, operative measures for its removal should be considered. 
Up to the present the results are not encouraging, as only one successful 
case is on record—viz., that by Félicet, who removed a calculus the size 
of an infant’s head from the small colon by means of a flank incision. 
For full details of the technique for this operation the reader is referred 
to Caulton Reeks’s work, ‘“‘ The Common Colics of the Horse,” in which 
Macqueen’s experimental researches in this direction are lucidly described. 


228 SYSTEM OF VETERINARY MEDICINE 


INTESTINAL OBSTRUCTION DUE TO FOREIGN SUBSTANCES, 
SAND, ETC.—* SAND COLIC.”’ 


Various substances such as buttons, screws, portions of wire, needles, 
etc., have been found in the intestinal canal of the horse ; these were taken 
in with the food, but are by no means so frequently ingested by horses 
as by cattle. 

H. Begg informs us that he has met with cases of obstruction in the 
double colon due to the ingestion of large amounts of the seeds of charlock 
(wild mustard), which were mixed with oats. The bowel was found 
distended with these black seeds agglutinated into an unyielding 
mass. 

An important source of obstruction is sand or very small gravel 
stones in the large colon, which reach this intestine by the medium of 
the drinking-water, or by feeding on short pasture in a gravelly soil. 
Horses which drink from shallow streams or pools are more likely to suffer 
from this variety of obstruction than those watered in the ordinary 
manner, especially during very dry seasons. Feeding on roots from 
which clay and sand have not been removed is another cause of the con- 
dition. A depraved appetite due to gastric derangement, in which the 
horse eats large amounts of clay whenever opportunity offers, will account 
for some of the cases met with. 

The symptoms of “sand-colic”’ are not characteristic ; the clinical 
picture is that of impaction of some portion of the double colon. In some 
of the cases we have met with the pain has been rather violent, but 
their true nature was not ascertained until autopsies were held. F. Smith 
states that horses may carry pounds of sand and gravel in their intestines 
for months, and perhaps years, without producing any apparent ill effect. 
We have frequently found large quantities of sand in the colon when 
conducting autopsies on horses that have succumbed to various diseases. 
There seems little doubt, however, that the presence of sand in the 
bowel to any great extent tends to favour the occurrence of im- 
paction. 

As regards treatment, the measures are similar to those advised for 
ordinary impaction of the colon. Small repeated doses of eserine are — 
advised by Friedberger and Frohner. Intestinal irrigation by means of 
the long rectum tube should be diligently carried out, and often proves 
successful. Large quantities of water should be injected at frequent. 
intervals with a view to washing out the colon (see p. 20). 


bd 


DISEASES OF THE INTESTINES: HORSE ° -229 


INTESTINAL OBSTRUCTION DUE TO DISPLACEMENTS, 
STRANGULATION, VOLVULUS, ETC. 


GENERAL REMARKS.—We have already drawn attention to the fact 
that the large majority of fatal intestinal affections depend on the above 
conditions. In some of the preceding sections we have dealt with 
various forms of intestinal obstruction in which the obstruction was 
caused by impaction of the contents of the bowel, associated with 
secondary alterations in the walls of the viscus. These alterations 
comprised either a paralysed condition of the intestinal wall, a limited 
enteritis, or, in extreme cases, rupture of the affected organ. Under 
early and rational treatment the majority of such cases were curable, 
provided rupture did not take place. But in some of the affections we 
now propose to discuss the lesion occurs primarily in the walls of the 
intestine, the circulation is directly interfered with in a variety of ways, 
and an acute enteritis results, in which all the coats of the affected 
portion of the bowel are involved. The lesion invariably proves fatal 
in a period of time that varies according to the bowel that is affected, 
and the rapidity with which the circulation is occluded. 

In surgical practice we have examples of a similar condition in the 
various forms of strangulated hernia—e.g., inguinal and scrota! hernie— 
in which the blood-supply to the incarcerated portion of bowel is cut 
off, acute enteritis, followed by grangrene, being the result. Some 
writers have termed strangulation occurring in the abdominal cavity 
“internal strangulation,” in which a portion of intestine finds its way 
either into a natural opening or into a rupture in the mesentery, and 
becomes strangulated. From a general standpoint we may make an 
arbitrary distinction between cases in which a loop of bowel becomes 
imprisoned in the above manner or constricted by adventitious bands, 
adhesions, etc., and those cases where the intestine becomes twisted or 
knotted on itself, the latter being termed “ volvulus ” or “ twist.” The 
pathological result in both instances is similar—viz., arrest of the circu- 
lation in the portion involved, followed by gangrene and death. Never- 
theless, it is desirable to describe these conditions separately, from the 
point of view of morbid anatomy rather than that of diagnosis and 
treatment, as our knowledge on these latter points is extremely limited. 
On referring to veterinary literature, even at an early period we find 
that strangulation and volvulus of the intestine were recognised, and a 
large number of cases were recorded. The clinical histories and post- 
mortem appearances of these affections were carefully described by the 
pioneers of veterinary medicine, and down to the present day such cases 


230 SYSTEM OF VETERINARY MEDICINE 


are of frequent occurrence and are of much interest to practitioners. 
But in spite of familiarity with the lesions of these affections at autopsies, 
it cannot be said that our knowledge of their etiology, diagnosis, and 
treatment, has advanced to any extent, if we except those cases in which 
a diagnosis can be arrived at by rectal exploration. It is true that many 
theories have been advanced to account for the etiological factors, 
and that numerous attempts have been made to recognise diagnostic 
symptoms, while experimental surgery has been carried out with a view 
to overcome the morbid conditions present ; but the clinician who keeps 
a faithful record of his cases and carries out systematic post-mortem 
examinations is bound to confess that the observations he has accumu- 
lated as the result of his investigations only serve to demonstrate his 
lack of knowledge of the subject and accentuate the fallacy of the 
diagnostic symptoms laid down by some authors and practitioners. 
Even in human medicine the diagnosis of similar conditions is attended 
with marked difficulty, and Osler remarks that “ volvulus can rarely 
be diagnosed.” As already remarked, there are two directions in which 
advancement can be claimed—viz., (1) more careful attention in the 
performance of autopsies has enabled us to recognise the presence of 
certain forms of strangulation and volvulus which hitherto were over- 
looked and the lesions attributed to acute enteritis ; (2) by, careful rectal 
examination it is now possible to locate the presence of certain displace- 
ments of the large colon, and thus to account for at least some of the 
fatal forms of enteritis affecting this bowel; in other words, there are 
certain lesions of the large colon recognised in the present day which in 
former times were overlooked. 

Before ‘proceeding to consider the various points in connection with 
strangulation and volvulus, it is advisable to discuss the manner in which 
these lesions produce fatal results. Formerly, it was thought that the 
acute pain and shock, etc., were the phenomena responsible for the fatal 
termination ; but, in addition to these, it has been demonstrated by 
experiments on dogs that a general infection of the system and an auto- 
intoxication play a very important part in this direction. Ifwe observe 
the phenomena presented during the later stages of strangulation or vol-. 
vulus we shall be convinced that some other factors are at work besides 
shock and exhaustion, as in many instances all evidences of pain have 
disappeared. In the experiments referred to, in which a double ligature 
was applied to a loop of bowel, it was found that the micro-organisms 
normally present in the intestine became virulent, migrated through the 
intestinal walls, entered the system, and set up a septic peritonitis. A 
single ligature caused death in seven, ten, or seventeen days, but a 


DISEASES OF THE INTESTINES: HORSE ~— + 231 


) 
double ligature proved fatal in two days and sometimes in twenty-four 
hours. It was also found that the more anteriorly the ligatures were 
placed on the bowel, the more rapidly fatal were the results. The in. 
volved portion of bowel was distended with liquid and gases and 
showed intense peritonitis, while the micro-organisms present were very 
active and virulent (Clado, Klecki and De Rouville). In addition to the 
general infection of the system by micro-organisms, an auto-intox!- 
cation results from the putrid products contained in the strangulated 
loop of intestine. It has been shown by experiments that the contents | 
of the small bowel are far more toxic than those of the large intestine, 
and that the intestinal walls themselves contain toxic substances. The 
clinical aspect of cases of strangulation and volvulus and the post- 
mortem appearances are quite in keeping with the theory of infection 
and intoxication, and we are aware that these lesions, when occurring 
in the small intestines, prove more rapidly fatal than when present in 
the large bowels. 
Strangulation of the Intestine. 

Although the term “strangulation” is sometimes applied to the 
effects of volvulus or twist of the intestine, it is advisable to restrict its 
employment to those cases in which a loop of bowel enters a natural or 
artificial opening in connection with the structures of the abdominal 
cavity and becomes incarcerated therein, or when a portion of intestine 
becomes constricted by adventitious bands or adhesions, or by ligaments 
in connection with certain organs, or by new growths. The results, as 
already remarked, are similar to those observed in ordinary cases of 
strangulated hernia. 

There are various conditions under which strangulation may occur, 
and in the great majority of instances the lesion is only discovered post 
mortem. 

These lesions are most conveniently discussed as follows : 

1. Hernra.—These include hernia through a rupture of the mesen- 
tery, hernia through the foramen of Winslow, and hernia through 
Meckel’s diverticulum. 

Hernia due to Rupture of the Mesentery—This may occur as the result 
of violent struggling, severe falls, contusions, etc., or the opening may be 
a congenital one in the form of a narrow slit. A loop of bowel may 
gain access to the opening, become incarcerated, and then strangulated. 
The borders of the slit in the mesentery may present no morbid altera- 
tions or, on the contrary, they may be congested, hemorrhagic, or even 
show necrotic changes ; in some instances a large hematoma is found 
in the vicinity of the opening. Again, a cord-like structure may result 


232 SYSTEM OF VETERINARY MEDICINE 


from the rupture of the mesentery, forming a ring, which causes strangu- 
lation of the imprisoned loop of bowel. The small intestine, in conse- 
quence of its narrow calibre, mobility, and great length, is most likely to 
enter an opening in the mesentery. The common seats of such openings 
are the gastro-splenic omentum, the falciform ligament of the liver, the 
great mesentery, the great omentum, and the gastro-hepatic omentum. 
The strangulated loop of bowel may also suffer from volvulus (twist). 
Cases are recorded in which the caecum was strangulated by a duplicature 
of the mesentery. Leblanc observed an instance where the suprasternal 
flexure of the large colon, with the jejunum, entered a rupture of the 
gastro-hepatic omentum and became strangulated ; also a case in which 
a hard band, formed by the remains of a ruptured spleno-colic omentum, 
encircled two divisions of the large colon, converting them into two 
dilatations, separated by a constricted portion. 

Hernia through the Foramen of Winslow.—The foramen of Winslow 
is a small opening situated between the lesser curvature of the stomach 
and the liver, and is the entrance to the cavity of Winslow. Its 
boundaries, according to McFadyean’s “‘ Anatomy,” are—In front it is 
bounded by the base of the lobulus caudatus ; behind by the fourth division 
of the double colon, below by the free edge of the gastro-hepatic omentum, 
and above by the posterior vena cava and the right pillar of the dia- 
phragm. At its base a thin layer of peritoneum is found at the level of 
the spigelian lobe of the liver, and when the loop of intestine enters the 
foramen it ruptures this peritoneal layer and strangulation occurs, or 
the portion of bowel extends deeply and becomes incarcerated. Several 
cases of this form of hernia are recorded. The jejunum is the viscus 
which is usually involved, the explanation suggested being that in 
consequence of the extreme mobility of this bowel, due to a long mesen- 
tery, itis more liable than any of the other divisions to enter the foramen. 
It is said that a spare diet or one which is in small bulk predisposes to 
the accident, as such treatment renders this bowel comparatively empty, 
and thus permits a loop to enter the foramen with more facility. But 
physiology teaches us that the jejunum usually contains only a small 
amount of fluid material, so the above cause cannot be accepted. Other 
etiological factors suggested are falls, struggling while in the recumbent — 
position, severe efforts in draught, and abnormal postures assumed by 
animals suffermg from acute abdominal pain. The length of in- 
testine involved may be about 3 feet. Sven Wall (Stockholm) records 
cases in which the lesion was complicated with volvulus and hernia of 
the mesentery. Cadéac met with one instance in which a portion of the 

colon entered the foramen of Winslow. 


DISEASES OF THE INTESTINES: HORSE = » 233 


Hernia through Meckel’s Diverticulum.—This diverticulum is a rem- 
nant of the omphalo-mesenteric duct, through which, in the early embryo, 
the intestine communicated with the yolk sac. It occasionally persists 
as a sacculation or cecal appendage from the ileum, towards the posterior 
portion of this bowel. According to some authors, it may bring about 
strangulation of the intestine in two ways: (1) Its end, although usually 
free, may become attached to the abdominal wall near the umbilicus, 
or to the mesentery ; a ring is thus formed, through which a loop of 
bowel may pass and become strangulated. (2) The diverticulum may be 
free, and may wind itself around a loop of bowel and cause constriction 
of the latter by forming a knot around it, secured by an enlargement of 
the terminal end of the diverticulum ; or the termination may become 
adherent to surrounding structures, and thus exert pressure on the im- 
prisoned bowel. Some authorities believe that the diverticulum plays a 
more frequent part in strangulation of the bowel than is imagined, and 
this form of hernia is often overlooked, the lesion being mistaken for one 
due to the presence of a cyst or a lipoma. 

Herma through the Diaphragm.—tin some cases of diaphragmatic 
hernia, strangulation of the portion of intestine passing through the 
opening of the diaphragm may result (see Affections of the Diaphragm). 

2. STRANGULATIONS DUE EITHER TO ADVENTITIOUS Fisrous Banps 
(FatsE LigAMENTS), OR TO LIGAMENTS IN CONNECTION WITH CERTAIN 
ORGANS, oR TO NEoPLASMS.—These include— 

False Ligaments.—These result from a_ pre-existing circumscribed 
peritonitis, and occur in various forms, as follows: Thus in injuries of 
the abdominal walls, when the muscular layers are ruptured, but the 
subperitoneal connective tissue remains intact, the latter is subsequently 
converted into a band of organised tissue stretching across the internal 
edges of the rupture, and a loop of intestine may pass inside this band and 
become strangulated. Or pseudo-ligaments, resulting from peritonitis or 
from wounds of the flank, may form on or between the intestines or other 
abdominal viscera, and as the result of contraction while being organised 
they exert pressure on a portion of the bowel and may produce strangula- 
tion. Post-operative adhesions are met with after ovariotomy, the 
castration of cryptorchids, and operations for umbilical or ventral 
herni#, and cases are recorded where the intestine was attached to the 
umbilical ring or to the base of a sutured hernial sac, and was constricted 
almost to strangulation. Occasionally after castration an irreducible 
hernia of the mesentery, accompanied by a bend or kink of portion of 
the small intestine, is met with, and strangulation results. Neoplasms 
and mesenteric abscesses may contract adhesions with the intestines, 


234 SYSTEM OF VETERINARY MEDICINE 


produce a narrowing of the canal, and interfere with peristaltic move- 
ments and with the circulation in the walls of the affected portion of 
bowel. 

Pseudo-ligaments may cause strangulation of any portion of the 
intestine. In rare instances a cicatricial band may cause constriction of 
the duodenum. The small intestine becomes involved in connection 
with various lesions of the abdominal organs. Cases are recorded in 
which the cecum was attached to the wall of the right flank by a fibrous 
band ; also where a false ligament passed round the middle of this bowel 
and caused strangulation. The large colon has been found adherent 
to the abdominal walls, to the diaphragm, or to the cacum, and its pelvic 
flexure may be fixed to the floor of the abdomen. In other cases the 
large colon has been constricted by bands, so that dilated portions of 
the bowel are formed, separated by narrow divisions, and compartments 
are thus produced on the external aspect, in which one or more loops of 
small intestine may become incarcerated. 

Instances are recorded in which the small colon has been fixed by 
adhesions to the anterior border of the pelvis, to the abdominal wall, or 
to other loops of the bowel itself. 

Ovarian Ingaments.—In cases where the ovary is hypertrophied or 
invaded by neoplasms, cysts, etc., its ligament becomes lengthened, due 
to the constant traction exerted by the largely increased weight of the 
organ. The ligament may then encircle the small colon, and produce 
strangulation. A cystic ovary may compress the small colon against 
the cecum, and bring about occlusion of the bowel. 

The Spleno-Renal Ligament.—A structure which extends from the 
spleen to the left kidney and to the vertebral column contributes to the 
formation of an incomplete ring, which. may cause occlusion of the 
intestine by suspending a loop of bowel. The parts involved are the 
small intestine or the floating colon, and the accident is said to occur 
during an attack of colic or as the result of falls, etc. According to 
Sven Wall, if the loop of bowel be empty it may be released by the peri- 
staltic movements, but if full of ingesta or fluid it becomes compressed 
between the spleen and the ligament, and suffers from strangulation. 
The true nature of the lesion can easily be overlooked at the autopsy. 

Pedicle of a Lipoma of the Mesentery.—This is a comparatively fre- 
quent cause of strangulation of the intestine. The pedicle is in the form 
of a narrow band, which, if of sufficient length, winds round a loop of 
bowel, but in rare instances the intestine winds round the pedicle. The 
small intestine is the viscus that is usually involved, but occasionally 
the small colon may be implicated. 


DISEASES OF THE INTESTINES: HORSE — > 235 


Amongst other causes of strangulation observed we may mention 
cyst of the mesentery, hematoma of traumatic origin, and a diverticulum 
of the intestine, filled with sand. 

Morsip Anatomy.—The alterations in the portion of intestine in- 
volved vary according to the degree of strangulation present. When 
extreme constriction occurs, acute congestion, hemorrhage, and even 
gangrene of the imprisoned loop of bowel, is observed. This latter is of 
a dark purple colour, full of uncoagulated blood mixed with ingesta -; 
the mucosa is very friable, and peritonitis is frequently present. The 
intestine anterior to the lesion is found dilated and distended with ali- 
ment or fluids and gas, while posteriorly it may be empty and in a 
state of paresis. If the strangulation has not been complete and the 
circulation not entirely cut off, necrotic changes are not in evidence, 
but acute congestion and sanguinolent intestinal contents are present. 

Symproms.—There are no characteristic symptoms of strangulation 
of the intestine. The evidences of acute abdominal pain are similar to 
those met with in other acute and fatal conditions of the intestines, 
while various attitudes and postures may be assumed which are also 
common to other abdominal affections. It is said by some authors that 
at the commencement of the attack the pain is of a dull and intermittent 
type, and gradually becomes of a violent character; also that tym- 
panites 1s absent. Occasionally the lesion can be detected by rectal 
examination, such as in the case of a diseased ovary whose ligaments 
encircle the small colon. The duration of the affection depends on the 
degree of strangulation present. As in other fatal bowel lesions, all 
evidences of pain disappear in a variable period prior to death. When 
the degree of strangulation is less marked the course is less rapid. 

A chronic form of strangulation is described in which the symptoms 
are suggestive of a stenosis of the lumen of the intestine. At the com- 
mencement colicky pains of a dull character are observed, which gradu- 
ally become acute, and are accompanied by obstinate constipation and 
tympanites. In some instances diarrhoea alternated by constipation 
occurs, due to a chronic purulent catarrh of the bowel anterior to the 
narrowed portion. These cases succumb in a variable period, with 
symptoms of general intoxication. 

According to Cadéac, recovery is possible in some cases, when the 
energetic peristaltic movements of the intestine overcome the lesion by 
setting free the incarcerated loop of bowel. This is evidenced by the 
rapid evacuation of accumulated fecal matter in the form of a foetid 
diarrhoea, alternated for a few days with a more or less well marked 
constipation. | ) 


236 SYSTEM OF VETERINARY MEDICINE 


We are inclined to think, however, that these so-called ‘‘ recoveries ”’ 
are to be explained by an erroneous diagnosis, as in cases of the kind 
that terminate favourably it is very difficult to ascertain the exact 
pathological condition that was present. 

TREATMENT.—In our present state of knowledge concerning the 
diagnosis of this condition, treatment must be regarded as hopeless. 
Therapeutical measures are confined to the relief of pain, and are similar 
to those advised in the case of acute enteritis (see p. 277). In the case 
of strangulation due to an ovarian ligament it is suggested to perform 
ovariotomy, and thus to remove the cause of the lesion. Forsell * operated 
on three cases of strangulation due to hernia in the foramen of Winslow, 
and in one of these succeeded in reducing the hernia by performing 
laparotomy in the left flank and, by enlarging the foramen, was able to 
release the strangulated loop of bowel. 


Displacement of the Intestines due to Flexions, Bends, or Kinking. 


This is a form of displacement recognised by Continental authors, 
but ‘so far as we are aware it is not described by British authorities. 
The term “coudure ” is applied to it by Cadéac, who states that the 
lesion occurs with comparative frequency, and almost always terminates 
in obstruction of the intestine, as at the level of the bend a prominent 
projection is formed, which tends to produce occlusion of the lumen of 
the bowel. In the large colon not only may kinks or bends occur, but 
also deflections—z.e., the suprasternal and diaphragmatic flexures may 
be straightened out or obliterated. 

The lesion may occur in the small intestine, the caecum, the large colon, 
and the small colon. The circulation in the intestinal walls is not in- 
terfered with, but at a late stage torsion of the affected part may result. 

Small Intestine—Permanent displacements due to kinks or bends 
only occur in this region when a loop of bowel becomes fixed by adhesions 
to organs in the vicinity or to the abdominal wall. The peristaltic 
movements and the passage of ingesta are interfered with, but strangula- 
tion is not present. Hnergetic contractions may be produced, succeeded 
by a kinking of the affected portion, and torsion may result. 

Caectm.—This is said to be the most common seat of displacements 
due to kinks or bends. According to Friedberger and Frohner, the so- 
called volvulus of the caecum is “ rather a kinking, with displacement of 
the point downwards and backwards and a shifting of the base upwards 
and forwards.” Cadéac states that the cecum may be freed from its 
mesentery cwing to external injuries, impaction with hardened ingesta, 


* Zeitschrift fiir Tiermedizin, 1907. 


DISEASES OF THE INTESTINES: HORSE —_—237 


acquired relaxation, or congenital elongations, and remain attached only 
by its base to the sublumbar region, its point wandering in a free manner 
in the abdominal cavity. It may be directed towards the left side, or 
posteriorly towards the small colon, or its position may be completely 
reversed, and in these numerous displacements the organ becomes kinked 
or bent, and may undergo torsion of its walls. 

According to Hutyra and Marek these bends or flexions, both in the 
cecum, and colon, are followed by blood-stasis, which is rapidly produced, 
and depends on the bloodvessels in the walls of the portion of bowel in- 
volved becoming folded in the flexion and obstructed. These authors 
also state that kinkings of the point of the caecum have several times 
been observed, and the folded part has simply become anemic and 
necrotic. 

Large Colon.—Flexions or kinkings of this viscus are stated by Cadéac 
to be a frequent cause of incomplete occlusion of the bowel, a very slight 
displacement of this organ being sufficient to produce stenosis of the 
intestine and alimentary stasis. According to this author, the pelvic 
flexure of this organ may be displaced into the pelvic cavity, a condition 
which may prove serious in some instances by causing occlusion, but 
may be curable in others. He quotes various observers who have met 
with cases where the pelvic flexure occupied the usual position of the 
bladder in the pelvic cavity. Another important displacement occurs 
when the diaphragmatic and supra-sternal flexures of the colon are 
straightened out against the diaphragm or are engaged between the 
anterior aspect of the stomach and the posterior surface of the liver and 
diaphragm. These curvatures may be compressed and flattened by a 
hard, distended stomach, around which they form a sort of cravat, as in 
a case recorded by Chauvrat. 

Caulton Reeks informs us that he has observed on different occasions 
both of these flexures in a semi-obliterated condition, due to pressure 
exerted on them by an engorged stomach, the latter being secondary 
to an accumulation of ingesta in the colon, and a partial stasis of the 
contents. He is also of opinion that a bend or deflection of the pelvic 
flexure may develop into torsion of the bowel by the pressure of surround- 
ing intestines and the gradually increasing tympany in the second division 
of the bowel, both of which impinge on the bent portion of intestine. 
He met with a case of torsion of the pelvic flexure in which, when the 
twisted portion was released, it assumed a bent position, and even when 
forcibly straightened out it immediately resumed its bent position when 
let go. The bend could not be straightened. This would indicate that 
the lesion started as a bend or kink. 


238 SYSTEM OF VETERINARY MEDICINE 


Small Colon.—Cases are recorded in which kinks or bends have been 
found in this viscus, followed by fusion of the two peritoneal coats in 
apposition, and the disappearance (probably by sloughing) of the walls 
in contact. The edges of these walls, however, remained adherent by 
means of the plastic exudate which was thrown out. 

Errotocy.—Various causes are suggested to account for the occur- 
rence of these displacements, such as falls, sudden muscular movements, 
struggling associated with colicky pains, etc. 

Symproms.—These differ from the phenomena observed in cases of 
strangulation or volvulus by being less acute and not violent in character. 
The leading symptoms present are those common to cases of intestinal 
obstruction, but some observers describe, in connection with this lesion 
in the pelvic flexure of the large colon, the appearance of certain attitudes 
and postures, such as resting on the knees with the inferior extremity of 
the head on the ground and the hind-quarters raised, or the animal walks 
with the head held low and the nose touching the ground, or he raises 
the right hind-limb and seems to make an attempt to bite the inguinal 
region. Small amounts of feeces may be passed at the commencement, 
and there are frequent attempts at micturition, but only a few drops of 
urine are emitted. 

But the diagnosis is chiefly based on a rectal examination. The 
pelvic cavity is found to be filled with a soft depressible mass, part of 
which can be forced forward into the abdominal cavity by the hand, but on 
withdrawing the pressure the pelvic flexure is forced back into the pelvis 
by constant contraction.* In the mare the vagina is flattened from 
below to above against the rectum, the bladder is forced backwards 
towards the vulva, and the cavity of the organ is lessened in extent. 

In displacements of the suprasternal and diaphragmatic flexures, 
stasis occurs in the colon and in the stomach, but as the parts affected 
are beyond the reach of manual exploration, diagnosis is impossible. 
For a similar reason, we are unable to diagnose displacements of the 
small intestine. 

TREATMENT.—In the case of displacement of the pelvic flexure into 
the pelvis, Cadéac advises to raise the animals’ hind-parts, and to make 
attempts to push back the portion of intestine by means of the hand 
introduced into the rectum. 

In the mare, he suggests that an incision be made in the vaginal wall, 


* Under normal conditions the pelvic flexure of the double colon does not occupy 
the pelvic cavity, but is situated just anterior to the inlet of the pelvis. It can 
sometimes, but not always, be detected by rectalexploration. But when impaction 
of the pelvic flexure occurs, this portion of bowel then extends backwards into the 
pelvic cavity, and can readily be palpated. 


DISEASES OF THE INTESTINES: HORSE 939 


as in the performance of ovariotomy. The hand and arm should then 
be introduced into the abdominal cavity, and the intestine drawn back 
into its normal position. For other therapeutical measures, see Treat- 
ment of Torsion of Colon (p. 254). 


Displacements with Torsion, Volvulus, etc. 


These form a very important group, and, as already remarked, they 
are accountable for the majority of fatal intestinal affections in the horse. 
The term “ displacement ”’ is more properly applied to the large bowels, 
although in the case of volvulus of any portion of the intestines the normal 
position of the affected viscus becomes altered. Owing to the observa- 
tions of Walley, F. Smith, and Caulton Reeks, it is now possible with 
some degree of accuracy to recognise certain morbid conditions of the 
large colon, not only post mortem, but also during life, and in this direc- 
tion many valuable and useful additions have been made. Hence it is 
desirable to describe these conditions according to their location and 
characteristic lesions. 

As we shall point out later on, when dealing with the commonest and 
most important of intestinal displacements—viz., torsion of the pelvic 
flexure of the double colon—the prevailing form of lesion in this location 
is incomplete torsion—1.e., a bending or doubling over of the bowel with- 
out actual strangulation. But as the case progresses, morbid processes 
occur as the result of pressure on the portion of bowel involved in the 
bends, the blood-current is interfered with, and stasis with tympany 
supervenes. 

Volvulus of the intestine is also known as “ torsion,” or “ twist,” and 
signifies the twisting of a loop of bowel upon its mesenteric axis. This 
has been termed “ rotatory strangulation.” A second form of the lesion 
results from bends or displacements of the intestine such as occur in the 
cecum or large colon, and a third form occurs when one loop of bowel 
encircles another portion, forming a knot. The results are occlusion of 
the intestine and strangulation, the intensity of the latter depending on 
the degree of constriction that is present, and, as already remarked, in 
certain cases the occlusion and torsion may not be complete. 

Volvulus is generally met with in those portions of the intestine 
which possess the greatest degree of mobility in the abdominal cavity ; 
hence the common seats of the lesion are the small intestine, the 
large colon, and the small colon. The large colon furnishes by far the 
largest number of cases, and the lesions and symptoms have been more 
thoroughly studied than those of any other of the divisions of the 
intestines, 


240 SYSTEM OF VETERINARY MEDICINE 


We shall first discuss volvulus of the small intestines, and then devote 
special attention to the various forms of the lesion that occur in the large 
colon. 

Volvulus of the Small Intestine. 

Statistics by various authorities show that volvulus of the small intes- 
tine is of far less common occurrence than in the large colon. According 
to Palat, the proportion of the former to the latter is 1 to 4. Schultze 
met with sixty-nine cases of torsion of the bowels, and of these only 
thirteen occurred in the small intestine; but, according to Willett,* 
twist of the small intestine is 60 per cent. more frequently met with in 
London than a similar condition of the large bowel. 

ErroLoGy.—Various causes have been suggested to account for the 
occurrence of volvulus of the small intestine. The long mesentery is 
believed to favour the occurrence of the lesion, but F. Smith is of opinion 
that tympany of the bowel is the factor at work in the causation of vol- 
vulus of the small intestine, as, “if the bowels be artificially distended 
with air, loops of them behave in such a way as would lead to twist in 
the living animal.’ Willett is of opinion that the causes of twists of the 
small intestines are mainly dietary, and he observed that a series of cases 
occurred in a particular stud of horses due to errors in feeding. He 
found another cause to be prolonged exertion without food, and the 
increased spasmodic contraction of the bowels during that state. Cadéac 
states that stenosis, dilatation, or the presence of tumours of the intes- 
tine, favour the production of twists, as they interfere with the passage of 
ingesta, and a distended loop tends to encircle one that is comparatively 
empty, and so induces volvulus. The jejunum is said by some authors 
to be the intestine most commonly involved, in consequence of the length 
of its mesentery. A loop of bowel may turn round a fixed point formed 
by the attachment of the mesentery. The twist may be simple, double, 
triple, or even quintuple, according to the number of turns the involved 
portion takes round the mesenteric axis. A favourite seat for twist to 
occur is close to the termination of the ileum in the cecum. | 

Cases are recorded in which torsion of the duodenum was met with. 
This lesion can only occur when the gastro-hepatic ligament becomes 
ruptured. 

Other causes suggested for volvulus are violent exertions, falls, 
struggling and rolling on the back such as occurs in cases of violent ab- 
dominal pain, but there is no direct evidence to support this view. More- 
over, cases occur in the absence of such conditions. 

The lesions found in cases of volvulus resemble those described as 
occurring in strangulation of the intestine. 


* Veterinary Record, May 4, 1912. 


DISEASES OF THE INTESTINES: HORSE | 241 


Symptoms.—There are no characteristic symptoms of volvulus of the 
small intestine. They may be described as those of acute abdominal 
pain, with the presence of various attitudes and postures, which are, 
however, common to other affections. 

The pain is rapid in its onset, persistent, and so agonising that violent 
symptoms may be produced. Tympany occurs early, and is well marked. 
Sweating is profuse, and the pulse, respirations, and temperature, show 
a serious condition of affairs. Lying on the back for comparatively long 
periods is a symptom frequently met with, but too much dependence 
cannot be placed on this, as we have occasionally observed it in cases of 
abdominal pain that recovered. Vomiting is observed in some cases, and 
F. Smith records a case of volvulus of the small intestine in which the 
horse lay on his chest with the nose extended, the ingesta gushed in a 
stream from both nostrils, and a sound accompanied the effort. The 
termination of cases of volvulus resembles that occurring in acute enteritis 
and strangulation. 

Willett,* who has had considerable clinical experience in these cases, 
states that in the early stages the symptoms may apply to several of the 
other bowel troubles, and in many cases are misleading, as they vary 
according to the temperament of the animal. In one instance the 
degree of the pain may be moderate throughout the course, and the 
gravity of the case is recognised by the persistence of the symptoms— 
viz., pain unrelieved by sedatives, patchy perspiration, and later on the 
haggard expression of countenance, the deep injection of the conjunctiva, 
the running-down pulse, and the sobbing character of the breathing ; 
in another instance, the patient may show violent symptoms from the 
first, with profuse perspiration, followed by delirium with a quieter 
interval before the end. The course in such cases is rapid. Amongst 
other symptoms observed was a peculiar crouching action, as though 
the animal was going to lie down, yet there is prolonged reluctance before 
he eventually does go down. On auscultation of the abdominal region, 
a tinkling bell-like sound is detected, and Willett regards this as diag- 
nostic, as in every case in which it was heard the post-mortem revealed 
a twist of the small bowel. Rectal examination he found in the early 
stages was often misleading. The rectum was generally found empty, 
neither unduly constricted nor dilated, but later on tenesemus was 
induced by manipulation, and the dilated coils of small bowel could be 
felt close to the rectum. The degree of tympany varies in different 
cases. The duration from the first symptom to death is, on an average, 
about twelve hours. 

* “Notes on Twists of the Intestines” (Veterinary Record, May 4, 1912, read 


before the Central Veterinary Medical Association). 
VOL. Il. 16 


242 SYSTEM OF VETERINARY MEDICINE 


Coleman* related two cases of twist in which no violent symptoms 
of pain were shown. Malet recorded three cases of twist in which the 
visible mucous membranes were pallid, the pulse soft and full, and the 
animals showed no violent symptoms. He attributed the pallidity of 
the visible mucosa to the occurrence of extravasation of blood into the 
lumen of the bowel. These are important points, as in instances of the 
kind an erroneous opinion is likely to be given as regards diagnosis and 
prognosis. 

TREATMENT.—It is quite obvious that in our present state of know- 
ledge as regards the diagnosis of volvulus of the small intestine treatment 
of any kind is hopeless. All that can be done is to relieve pain as far as 
possible by the administration of sedatives, as described for Enteritis 
(see p. 277). If surgical interference with the abdomen ever becomes an 
established practice in equines, then early laparotomy may be produc- 
tive of successful results in some cases. But, unfortunately, the symp- 
toms presented are not diagnostic, and do not justify the performance 
of an early operation. If delayed until serious organic alterations have 
occurred in the intestines, and the patient’s strength becomes exhausted, 
and his system depressed by absorption of toxins from the bowels, then 
failure must result. 


Volvulus and Displacements with Torsion of the Large Colon. 


These affections in the large colon, in consequence of their frequency, 
and the fact that they offer more facilities for diagnosis than similar 
conditions in the small intestines, deserve attention in a special section. 
Moreover, it is held by some practitioners that in certain cases of dis- 
placement with incomplete torsion of the pelvic flexure recovery may 
take place. To Walley, F. Smith, and Caulton Reeks, must be accorded 
the credit of drawing the attention of the profession in Great Britam to 
the subject of displacements with torsion of the large colon, and pointing 
out the varieties of these lesions and the means for a differential diag- 
nosis. Walley was the pioneer in this direction, and his observations 
were published in the Veterinary Journal, vol. ix., 1879. It is stated by 
Mollert that Jelkmann in 1890 was the first to draw the attention of 
practitioners to the diagnosis of twists of the double colon, and to their 
surgical treatment. The most recent article on the subject was pub- 
lished by Caulton Reeks in the Journal of Comparative Pathology and 

* Discussion on “Twists of the Intestines’? (Veterinary Record, December 21, 
1912, Central Veterinary Medical Association). 


+ Lbid. 
{ “ Veterinary Surgery,” Moller and Dollar. 


DISEASES OF THE INTESTINES: HORSE 243 


Therapeutics, December, 1911, and to both these articles we are indebted 
for the information contained in the present section. 

We have already referred tq the fact that the majority of observers 
agree with reference to the far greater frequency of these lesions in the 
large colon than in the small intestines. In addition to the statistics 
already given, it is interesting to note that in 618 cases of fatal abdominal 
affections observed at the Vienna Veterinary School, torsion of the large 
colon occurred in 166. Jelkmann observed that out of 192 fatal cases, 
70 were due to displacements of the large colon, and in another observa- 
tion 10 out of 23 fatal cases were due to a similar condition. 

On the other hand, Reinhardt, of Berne,* found that out of 125 
autopsies conducted on fatal cases of abdominal affections, 22 were due 
to volvulus of the small intestine and 24 to volvulus of the large colon. 

In our experience, the lighter breeds of horses are more subject to 
these lesions in the small intestines, while in cart-horses similar lesions 
occur more frequently in the large colon. 

It is desirable to discuss displacements and torsion of the large colon 
according to the seat of the lesion, especially as we are now in possession 
of data which enable us, in many instances at least, to differentiate 
certain forms of the affection. 

Broadly speaking, we recognise that in some cases complete torsion, 
or twist, with displacement and strangulation, occur in certain locations 
especially ; while, on the contrary, when the pelvic flexure is the part 
involved, there is a bending or doubling over of the bowel without actual 
strangulation, complete torsion and early occlusion of this portion of 
the intestine being comparatively rare, and, according to some observers, 
such cannot occur. 

Walley recognised three forms of twist and displacement—viz., 
torsion or displacement of the double colon, with venous strangulation ; 
torsion with arterio-venous (complete vascular) strangulation ; and dis- 
placement of the pelvic flexure in an obliquely forward direction from 
left to right and across the small intestine. 


Torsion or Displacement of the Pelvic Flexure of the Double Colon. 


Errotocy.—The lesion is generally found in the heavy dray or lorry 
horse, and this remark applies to torsion of the other divisions as well. 
‘The explanation is that in the larger breeds the build of the colon is com- 
paratively more voluminous, it is often filled with abnormal quantities 

* Deutsche Tier. Wochen., December 7, 1912. 

{ For the above description we are indebted to the valuable article on the 


subject by H. Caulton Reeks (Journal of Comparative Pathology and Therapeutics, 
December, 1911). 


44 SYSTEM OF VETERINARY MEDICINE 


of indigestible food, and these factors tend first to tympanitic conditions, 
and later on to displacement. The free position of the pelvic flexure 
in the abdominal cavity also renders i# liable to displacement, more 
especially as it is usually the receptacle of a large amount of semifluid 
material. 

According to F. Smith,* the actual mechanism which brings about 
twists is disordered muscular action, and this is the result of disordered 
nervous action. “In the case of the large intestines, the muscular 
action must be capable of causing the bowel to perform a revolution 
more or Jess complete, and in this way reversing its position. ... The 
colon and cecum are most liberally supplied with bands, and it does not 
appear to us to be beyond the bounds of reasonable probability that 
these play a most important part in the production of displacements of 
the large intestines... . Apart from such obvious explanations as 
errors in feeding, the most common cause of derangement of the muscular 
action of the digestive canal is work.” 

Walley f recognised three etiological factors—viz. : 

1. Rolling about in the agonies of colic, or when turned out to grass ; 
falling violently forwards in attempting to start a load ; slipping in frosty 
weather ; falling over an embankment. 

2. Powerful contractions of the muscular walls of the intestines 
occurring in spasm, of the bowels. 

3. The effect of tympany on the interior of a portion of intestine 
which is comparatively empty of ingesta. 

The power of imprisoned gas to cause displacement of a knuckle of 
intestine is often observed at autopsies, when portions of the bowel 
become inflated by gases formed by the decomposition of ingesta. This 
observer was of opinion that attendant symptoms may not be shown for 
many hours after the occurrence of the accident which has produced the 
lesion ; also that the displacement may occur while the horse is at work, 
and no symptoms may be displayed until the small intestines and stomach 
become tympanitic from the pressure exerted on them by the distended 
colon. 

Caulton Reeks states that the usual history of such cases showed that 
the horse was hard worked on the previous day, and that symptoms were 
not manifested until the early morning of the following day. His ex- 
perience goes to show that, although torsion or displacement may occa- 
sionally occur during work, in the great majority of instances the colicky 
pains come on so many hours after the cessation of work that the nature 


* “ Veterinary Physiology.” 
{t Veterinary Journal, 1879. 


DISEASES OF THE INTESTINES: HORSE 245 


of the latter (heavy hauling, etc.) cannot of itself be put down as the direct 
cause. The sequence of events he believes to be as follows: (1) Heavy, 
exhausting work, plus long hours, inducing abnormal hunger; (2) ravenous 
feeding on bulky food; (3) consequent tympany and disordered muscular 
action of the intestinal walls; (4) displacement or torsion of the colon as 
a result. 

On occasions it may happen that during the effort to start a heavy 
load on a sharp or greasy incline the animal may slip forwards, and 
in endeavouring to maintain his foothold the weighted and free end of 
the colon may be thrown into abnormal positions, and displacement 
may be brought about. 

We have no direct evidence that displacement of the colon can result 
from the abnormal positions and the rolling that occur in cases of acute 
abdominal pain, but we do know that the lesion occurs in the absence 
of such alleged causes. 

Symproms.—On comparing the clinical histories described by those 
observers who have devoted special attention to this form of displace- 
ment, we find that, although they agree in some respects, they differ in 
others. Walley found that the symptoms were manifested gradually 
and usually secondarily—+z.e., after an animal had suffered from enter- 
algia from any cause for a number of hours. The pain is dull—in fact, 
the horse may stand quiet for a long time, or may evince occasionally 
accessions of pain. The pulse is quick and weak, the visible mucous 
membranes injected, the respirations laboured and occasionally spas- 
modic, the temperature about 103° F., a moderate amount of sweating, 
and an anxious expression of countenance. Gastric symptoms are present 
—viz., continual regurgitation of fluid and gases, and distension of the 
cesophagus with each regurgitation. On auscultation over the region of 
the gullet, the thoracic region, and stomach, a metallic gurgling is de- 
tected, attempts at vomition are generally present, and a large amount 
of fluid may be vomited prior to death. The circulation in the 
portion of bowel involved is not seriously interfered with, such as occurs 
in other forms of displacement; hence there is no acute pain. The 
gastric symptoms are due to the pressure exerted on the small intestines 
and stomach by the displaced colon. The passage of ingesta is inter- 
fered with, gas is evolved, which passes into the cesophagus, and causes 
the regurgitation mentioned above. Symptoms common to other intes- 
tinal affections may or may not be present. Death results from exhaus- 
tion and interference with the normal function of other organs. 

According to Caulton Reeks,* the symptoms presented, in addition 


* Op. cit, 


246 SYSTEM OF VETERINARY MEDICINE 


to the more or less general signs of colic, are usually constant pain, with 
serious constitutional disturbance. Occasionally periods of ease from 
pain may be observed, during which the animal maintains the standing 
position; but there is an absence of the stretched-out appearance of 
comparative comfort that is present in cases of impaction of the pelvic 
flexure. The pulse is quick and weak, the respirations laboured and 
spasmodic, the temperature 103° or 104° F., the visible mucous mem- 
branes highly injected, patchy sweating is observed on the body, and small 
amounts of feeces of a sloppy or oily consistency are occasionally passed. 
A peculiar crouching position is assumed when the animal attempts to 
lie down. While he is walking about the box he suddenly leans to one 
side, bends to the ground as though to drop down, suddenly recovers 
himself, and continues to move about. This performance is frequently 
repeated, and ultimately the horse goes down; but the stretched-out 
position is not maintained, and he frequently sits on his haunches, makes 
a sudden attempt to rise, and, when half-way up, subsides back to the 
original posture. A peculiar haggard expression of countenance is 
present. 

Course.—Unless in those cases in which spontaneous reduction of 
the torsion and displacement is brought about, further serious symptoms 
develop. Tympany of the colon, and later on of the stomach, occurs, 
and the gastric phenomena described by Walley (see p. 245) are observed. 
The sweating becomes more profuse, and is cold in character. The pulse 
becomes weaker, the respirations more laboured, sobbing, and spasmodic. 
The animal staggers in his gait, falls forward, and succumbs, the pain 
being persistent to the end. The duration varies from twelve to twenty- 
four hours, and depends on the degree of torsion of the bowel that is 
present. 

RectaL ExpLoraAtion.—This affords the most valuable evidence of 
the existence of the condition, and on it the diagnosis is based. The 
walls of the rectum are in a spasmodic condition, so that exploration is 
attended with marked difficulty. The animal groans and strains vio- 
lently, and the rectal walls exert a clinging clasp around the inserted arm. 
No portion of the colon can be felt, but in many cases a distended coil 
of small intestine of considerable size is found in the pelvis, and this may 
easily be mistaken for the displaced pelvic flexure. 

Morsip AnAtomy.—In the cases recorded by Caulton Reeks the fol- 
lowing conditions were observed : 

In Case No. 1 the cacum failed to protrude when the abdominal 
cavity was opened, and even when the flaps of the abdominal wall were 
deflected the viscus was not to be seen. The first division and about 


DISEASES OF 'THE INTESTINES: HORSE 247 


two-thirds of the second division of the double colon were lying in their 
normal positions next the floor of the abdomen. The whole of the pelvic 
flexure—+?.e., the end of the second division and the commencement of 
the third—was turned over from right to left, and downward and for- 
ward (with the carcass in the dorsal position). The point of the pelvic 
flexure was hidden from sight, and a distended part of the middle third 
of this flexure ran in a transverse manner across the abdomen. 

In Case No. 2 the pelvic flexure was doubled downwards and forwards, 
the end of the flexure being out of sight beneath the second and third 
divisions of the bowel and a quantity of small intestines. A greatly 
distended coil of small intestine was present in the pelvis. 

In Case No. 1 marked discoloration of the displaced bowel was ob- 
served, but was not sharply defined, while in Case No. 2 this lesion was 
absent. This was accounted for by the fact that in the latter case the 
twist was not so well marked. Moreover, the symptoms noted during 
life seemed more favourable, such as the passage of flatus, the compara- 
tive absence of abdominal distension, and the absence of spasmodic 
contraction of the rectal walls. In Case No. 1 the duration was twelve 
hours, in Case No. 2 twenty-four hours. The torsion is rarely complete, 
so that actual strangulation and occlusion of the bowel does not occur. 
This will account for the passage of flatus and small amounts of faces 
at the early periods of the attack, and the more or less gradual manner 
in which serious symptoms commence. It is not until the wall of the 
bowel, owing to the pressure exerted on it, commences to undergo morbid 
processes due to stagnation of the blood-current that actual stasis and 
consequent marked tympany occur. 

Walley recorded the following post-mortem appearances: “ An 
entire absence of congestion or inflammation of the colon. There is not 
any or but slight strangulation of the large vessels of the displaced 
colon, consequently circulation is not obstructed as in the other forms. 
The small intestine usually presents punctiform hemorrhages, and the 
gastric mucosa is more or less inflamed, this being the result of irritation 
by the retained ingesta and the medicines. The stomach, intestines, and 
cardiac end of the cesophagus are distended with gas and fluid. The 
stomach, owing to its state of distension and the weight of fluid, may 
become ruptured if the animal falls.” 

DiFFERENTIAL Dracnosis.—Although it is claimed by Walley that 
diagnosis of this form of displacement, as well as other forms affecting 
the colon, can be carried out with “ almost unerring accuracy,” other 
observers remark that its recognition in every case cannot be regarded 
as easy. Judging from our own experience, and comparing it with that 


248 SYSTEM OF VETERINARY MEDICINE 


of others, and after a perusal of the available literature at our command, 
we cannot regard the diagnosis of displacement with torsion of the pelvic 
flexure, or of other portions of the double colon, as being by any means 
a simple matter. The history of the case is of importance, especially the 
gradual development of the symptoms, while rectal exploration is the 
only key to the situation. The following conditions must be differ- 
entiated : 

Twist of the Small Intestine.—In this the symptoms of pain are rapidly 
developed, the alterations in pulse, temperature, and respirations are 
early in evidence, the sweating profuse, and there is a tendency for 
the patient to assume the dorsal position when down. But the chief 
reliance must be placed on a rectal examination. 

Displacement with Torsion of Some Other Point than the Pelvic Flexure. 
—The differentiation is carried out by rectal examination. The absence 
of the pelvic flexure and the presence of the loop of small intestine in the 
pelvis is said to be significant of displacement of the pelvic flexure. But 
if torsion of other portions of the large colon is present, the pelvic flexure 
may be withdrawn out of reach, and yet be free from torsion. This con- 
dition can only occur to any great extent when the torsion is complete, 
and the blood-supply to half or to the whole of the viscus is then cut 
off. When such occurs, strangulation and subsequent gangrene of the 
distal portion of bowel results, and the symptoms resemble those met 
with in twist of the small bowels; they are developed rapidly and are 
accompanied by muscular tremors. 

Caulton Reeks points out also that the employment of the trocar and 
cannula proves of assistance in diagnosis. In cases of complete torsion 
the evacuation of the gas gives no relief from pain and distress, and as 
the last of the gas is being given off a foetid, thick, blood-tinged, light 
cofftee-coloured discharge bubbles from the mouth of the cannula, this 
being an indication of acute enteritis, with commencing gangrene of the 
bowel wall. 

Impaction of the Pelvic Flexure.-—In differentiating torsion of the 
pelvic flexure from impaction of the same structure the clinical history 
of the case must receive careful consideration. In impaction the animal 
has periods of ease from pain; the pulse is full and normal in beats except 
during the paroxysms of pain; the respirations are deep and regular, only 
becoming quickened and catchy during the periods of pam; the tempera- 
ture is normal; thereis no straining on rectal examination ; the rectum is 
ballooned, and there is no marked spasmodic condition of its walls ; while 
rectal exploration reveals the presence in the pelvis of the impacted 
pelvic flexure. On comparing these symptoms with the phenomena 


DISEASES OF THE INTESTINES: HORSE 249 


described as occurring in cases of torsion of the pelvic flexure, important 
points of differentiation will readily be recognised. 

ArypicAt Casrs.—In Case No. 2, recorded by Caulton Reeks, although 
grave constitutional symptoms were present, the abdomen was only 
slightly tympanitic, and the rectum, instead of clinging tightly to the 
inserted arm, was rather inclined to be open or ballooned. When lying 
down the animal at times appeared fairly quiet, and a good passage of 
feeces followed the administration of eserine and pilocarpine. Death 
occurred, with marked symptoms of pain, after a course of nearly twenty- 
four hours. The torsion was incomplete, no strangulation occurred, and 
it was not until the later stages that the lumen of the bowel became 
obstructed. The presence in the pelvis of a coil of small intestine dis- 
tended by gas can easily be mistaken for the pelvic flexure, and thus 
give rise to an erroneous diagnosis. It is possible for semi-torsion of the 
pelvic flexure to be associated with impaction of this region, in which 
case this flexure would be displaced into the pelvic cavity, and its presence 
detected by rectal exploration. F. Smith recorded a case of torsion of 
the pelvic flexure in which profuse diarrhoea was present for nearly the 
whole period of the attack. 

It will thus be seen that although in some instances a correct diagnosis 
can be arrived at, there are others in which an erroneous opinion may be 
given by even the most experienced clinician. No doubt the grave 
constitutional symptoms, the history of the case, the presence of special 
phenomena, and the evidences obtained from rectal exploration, point 
to the colon as the seat of the lesion, but to decide the exact portion of 
this viscus that is involved is a matter that often presents considerable 
difficulty. Here we may remark that the presence of gastric symptoms 
is likely to lead to an erroneous diagnosis, unless a careful rectal 
examination is carried out. 

Proenosis.—The possibility of the reduction of a displacement 
associated with partial torsion, either spontaneously or as the result of 
therapeutical measures, should render us very careful in arriving at a 
prognosis. The evidence adduced in favour of the possibility of such a 
happy result is that in a case presenting all the symptoms we have 
mentioned, the practitioner may occasionally find on his next visit a 
disappearance of the apparently fatal phenomena, and that ultimately 
recovery ensues. Similar results have also followed the administration 
of eserine in such cases. The conclusion arrived at is that as rolling in 
colic may be a cause of displacement with partial torsion, while powerful 
contractions of the muscular walls of the intestine contribute to the same 
result, it is rational to assume that the rolling and powerful muscular 


250 SYSTEM OF VETERINARY MEDICINE 


contractions of the bowel induced by the administration of eserine may 
effect a reduction of the displacement. Walley,* in advocating the use 
of the trocar and cannula in cases of twist or displacement where the 
tympanitic intestine can only be felt through the wall of the rectum, 
stated : “‘ I am satisfied that some cases of partial twist and displacement 
are cured by the spontaneous reduction of the involved knuckle of 
intestine, and that not infrequently the gradual removal of the imprisoned 
gas by absorption or otherwise is an important factor in this reduction.”’ 
Cadéac states that in some instances the rolling and various changes of 
attitude may succeed in causing the disappearance of the lesion. 
TREATMENT.—Caulton Reeks advises a stimulant treatment early in 
the case, and also the administration of eserine, with a view to bringing 
about a reduction of the displacement in the manner mentioned above. 
Cadéac states that agents such as eserine, pilocarpine, etc., fail to reduce 
torsion of the intestine, and only hasten the fatal termination. For 
particu'ars with reference to manual reduction of the lesion, see p. 254. 


Other Forms of Displacement with Torsion of the Double Colon. 


According to Cadéac, the first and fourth divisions of this bowel do 
not suffer from displacement or torsion in consequence of their attach- 
ments to the pancreas, the caecum, and the large mesenteric artery. He 
regards the suprasternal and diaphragmatic flexures and the pelvic flexure 
as the common seats of the above lesion. Other observers, however, 
including Caulton Reeks, recognise that the lesion may affect the bowel 
at a point between its head—+.e., the combined first and fourth divisions 
—and the suprasternal and diaphragmatic flexures. The degree of torsion 
varies : it may be complete or incomplete, and between these extremes 
there are variat:ons—thus, a quarter-turn, a half-turn, or a three-quarter 
turn may be observed. Complete torsion is said by Cadéac to be rare. 
Caulton Reeks records a case in which a double twist occurred at the 
suprasternal and diaphragmatic flexures. The effects produced on the 
bowel vary according to the completeness of the twist. Most authors 
state that the left divisions of the colon—+z.e., the second and third—are 
more liable to torsion in consequence of the lack of attachments to sur- 
rounding parts. 

The most frequent form of torsion affecting the second and third 
divisions, according to Jelkmann, Moller, and Cadéac, is in a direction 
from left to right. In the case of a half-twist, it is found that when a 
post-mortem examination is carried out, the subject being fixed in the 
dorsal position, the third division crosses the median line, and is directed 


* Op, cit. 


‘DISEASES OF THE INTESTINES: HORSE 251 


from behind forwards and from left to right. This is a twist of the third 
division on the second. In complete twist the constriction occurs at the 
point where the third division commences to dilate. The explanation 
offered by Cadéac as to the frequency of torsion from left to right is as 
follows : The second division being more voluminous, and containing more 
ingesta than the third division, tends to hang or drag on the latter when 
the horse assumes certain positions. Thus, if the animal lies on the left 
side, the second division of the colon, being replete with ingesta, glides 
between the abdominal wall and the third division, and this alteration in 
the position of the bowel is more likely to be maintained if the animal 
suddenly assumes the standing posture. 

On the other hand, if the animal lies on the right side, the third minien 
of the colon may insinuate itself between the abdominal wall and the 
second division. The second and third divisions may leave their normal 
position and approach the middle line, the third being slightly superior 
to the second. If the third division becomes full of ingesta, it tends to 
hang on the second, turns from left to right, and occupies an inferior 
position. The third division is then placed to the right of the second, 
and effects a rotation from left to right. If now the animal rises quickly 
to his feet, the second division, instead of returning to its primary position, 
continues, owing to its weight, to undergo torsion from left to right, and 
thus occlusion of the bowel results. Cadéac also points out that the 
torsion may be only temporary, but it becomes permanent when the coils 
of the floating colon occupy the position vacated by the left division of 
the double colon, thus preventing the return of the second division to 
its normal position at the moment when the animal rises to his feet. 

When incomplete torsion from right to left occurs, the autopsy shows 
that the third division is situated beneath the second, and crosses it. It 
is a twist of the second division on the third from right to left. When the 
torsion is complete, the lesion is localised at the point where the third 
division commences to become dilated. 

It is important to remember that in the case of a half-twist the 
vascular surfaces of the second and third divisions do not correspond with 
those of the first and fourth, as their position becomes altered. But in a 
complete twist the rotation is in the form of a complete circle, and the 
vascular surfaces then return to their ordinary position. 

Symproms.—The symptoms vary in intensity according to the degree 
of torsion present, but they are more severe than in cases of bends and 
deflections, or of displacement with torsion of the pelvic flexure. 

The following symptoms were observed by Walley :* In cases of 


* Op, cit, 


252 SYSTEM OF VETERINARY MEDICINE 


venous straneulation, “the symptoms may appear suddenly, but in 
many instances they are preceded by prolonged enteralgia and evidences 
of enteritis. In due course the previously full, strong, and irritable 
pulse becomes softer, the injected mucous membranes gradually paler 
in colour, the body bedewed with moisture, the countenance anxious, and 
the breathing somewhat hurried and laboured. The head is turned wist- 
fully to the flank or side, the enteric pains are more subdued, but still 
persist, . . . attempts to distend the jugular vein for the purpose of 
phlebotomy are not successful, and when opened only a comparatively 
small quantity of blood, usually of a dark colour, can be abstracted ; this 
phenomenon becomes more pronounced as dissolution approaches. The 
posterior bowels are usually emptied rapidly, the feeces being pultaceous 
and passed in small quantities at the outset. The temperature does not. 
as a rule, exceed 104° F. Death may not take place for sixteen or even 
eighteen hours.” 

The train of symptoms 1s explained by this writer as follows: “ The 
blood is constantly being pressed into the veins through the arteries, and 
as it cannot escape by its natural channels, the veins become distended 
with blood to their utmost limits, and the pressure continuing, the fluid 
parts of the blood are finally forced through the walls of the capillaries 
into the intestinal cavity, the peritoneum, and the submucous and sub- 
serous tissues, the denser portions of the blood and the red corpuscles 
accumulating in the obstructed veins. In many instances the walls of 
the capillaries give way, and extravasations result. The culmination of 
all this is death by internal hamorrhage.... Hence the diminution in 
the colour of the injected visible mucous membranes, the failure of the 
pulse, and the progressive emptying of the jugular veins.” 

In complete vascular strangulation the symptoms are developed very 
suddenly and with great violence. “The pulse is bounding, almost 
incompressible, the jugular veins . . . are full of blood, can be readily dis- 
tended, and when opened the blood flows with great force, and is bright 
in colour. Venesection only reduces the pulse to a slight degree, and 
gives but little relief from pain. The visible mucous membranes are 
intensely injected, perspiration profuse, tremors marked, eyes prominent, 
countenance desperate, and the pain is persistent and agonising, mani- 
fested in a great variety of ways, and cannot be relieved. Death usually 
takes place in from four to six or eight hours. Mortification takes place 
rapidly, and death is produced by nervous exhaustion. The amount of 
blood lost to the circulation is so slight as not to interfere with the pulse 
or jugular veins.” 

_ The above symptoms are not characteristic, but the evidences obtained 


DISEASES OF THE INTESTINES: HORSE 253 


from a careful rectal examination are sometimes useful from a diagnostic 
point of view. According to Jelkmann and Moller, not only can the dis- 
tended colon be recognised by palpation per rectum by means of its 
longitudinal bands, but also by ascertaining the direction taken by these 
bands one can determine the direction in which the torsion has occurred. 
Under normal conditions these bands run nearly parallel with the long 
axis of the body. In torsion from left to right they run backwards 
and inwards, while in torsion from right to left they are directed back- 
wards and outwards. According to Cadéac, the superior surface of the 
second and third division, is more readily recognised by palpation of the 
vessels and lymphatic glands than by the muscular bands. This author 
states that in torsion from left to right of the third division on the second 
we find the muscular band of the third division directed from below 
upwards, from before backwards, and from without inwards. ‘The 
mesentery is found tense, cord-like, and painful to palpation ; it is inclined 
in an upward direction from right to left, instead of occupying a vertical 
position ; the loops of the floating colon have taken the place of the third 
division of the large colon, and the latter exerts compression on the small 
intestines. 

In the case of semi-torsion from right to left rectal examination reveals, 
as in the preceding case, that the vessels and the lymphatic glands of 
the pelvic flexure occupy an inferior position, instead of being superiorly 
situated as in the normal position of the bowel. This author also remarks 
that when torsion is complete 1t cannot be detected, no matter what 
direction it takes, as the pelvic curvature then occupies its normal 
position, and a diagnosis is impossible. | 

Klett* states that in cases of torsion of the large colon the convexity 
of the pelvic flexure is directed towards the left, while in impaction of 
this structure it is turned towards the right. 

According to Moller, the careful examination of the muscular bands 
is of chief importance in diagnosis. These must be distinguished from 
the posterior bands which can be detected on the caecum when this bowel 
is distended with ingesta, by remembering that the caecum runs from the 
outer angle of the right ilium, is directed forwards, and terminates near 
the region of the stifle-joint of the left side. Walley stated that rectal 
examination reveals the presence of a resilient tumour (the distended 
loop of small intestine) in the pelvic cavity, also the tense and twisted 
longitudinal bands of the bowel. 

We have given the views of the above authors on twists of the double 
colon at considerable length, but must admit that, with the exception 


* Deutsche Tierarz. Wochen., 1907. 


254 SYSTEM OF VETERINARY MEDICINE 


of torsion and displacement of the pelvic flexure, the differential diagnosis 
is attended with enormous difficulties. The evidences afforded by rectal 
examination, taken into consideration with the acute symptoms present, 
may enable us to suspect the presence of torsion of the colon, but as to 
its exact seat we confess our inability to locate it. 

Morsrp ANAToMy.—The intensity of the lesions varies according to 
the degree of torsion present. In semi-torsion the arterial circulation is 
not seriously interfered with, but the venous outflow is completely 
obstructed. This was termed by Walley* “ torsion with venous strangu- 
lation.”” He observed the following lesions: ‘‘ The presence of a sero- 
sanguineous effusion into the peritoneal cavity. The occluded intestine 
is increased in bulk, in weight, and in thickness. The peritoneum is 
sometimes intensely congested and ecchymosed, in which instance peri- 
toneal effusion is always present ; at other times this structure is nearly 
normal in appearance. On section of the bowel a quantity of foetid gas 
escapes. The ingesta are usually mixed with large quantities of blood- 
serum, and not infrequently coloured with hematin ; at other times they 
are mixed with blood-clots, or large quantities of fluid blood. The 
intestinal mucosa is thickened, softened, dry, corrugated, and roughened 
on its free surface, of a dirty brown or green colour, and frequently fissured. 
The submucous and subserous tissues are infiltrated with serum to the 
extent of from ? to 14 inches, while their small vessels are intensely 
engorged, The arteries are empty, the veins fully distended with semi- 
coagulated blood, which often-times resembles damson pulp, and is 
composed mainly of coloured corpuscles, many of which are ruptured 
and their walls shrivelled. The line of demarcation between the involved 
and free portions of bowel is very pronounced, as it is also in the form 
termed ‘ arterio-venous strangulation.’ ” 

In arterio-venous (complete vascular) strangulation “the intestine 
is found to be black, mortified, and friable, and the veins and arteries 
plugged. <A very foetid odour is evolved from the strangulated intestine 
and its contents.’ This form depends on complete torsion. 

TREATMENT.—According to Moller, in very exceptional cases torsion 
of the large colon may be reduced by the animal rolling, but as a rule the 
only chance of a successful termination lies in early manual treatment. 
Statistics of the success of this treatment are not available, but Moller 
and Jelkmann claim to have brought about recovery in several cases by 
this procedure. Cadéac states that the methods advised are as yet more 
theoretical than practical, and it is only on rare occasions that torsions 
of the bowel can be reduced by taxis; moreover, when the lesion is 


* Veterinary Journal, December, 1879. 


~ 


DISEASES OF THE INTESTINES: HORSE 255 


situated beyond the level of the floating colon, the above means must 
fail. 

However this may be, we consider it advisable to give a brief descrip- 
tion of the method of taxis adopted by Moller and Jelkmann. The 
rectum is first cleared out by means of an enema. In the case of torsion 
from left to right the left hand and arm are inserted into the rectum, 
and the operator presses forward towards the left abdominal wall, and 
endeavours to thrust the left portion of the large colon, with the convo- 
lutions of the floating colon, forwards from this point towards the middle 
line of the abdomen. When this is accomplished, the hand is passed 
slowly upwards, then the colon falls back over it into the normal position. 
These authorities consider that the convolutions of the floating colon 
being directed towards the left abdominal wall by being thrust upwards, 
leave room for the large colon to return to its normal position. Moller 
carried out experiments in the dead subject which tended to demonstrate 
the practical utility of the above procedure. 

In torsion from right to left the right hand and arm are inserted into 
the rectum, and the muscular bands of the large colon are sought for ; 
they run from in front backwards and outwards, or towards the left. 
These muscular bands lying abodve offer a means of purchase by which 
reposition of the displaced portion of bowel is brought about. The hand 
is strongly adducted, and its volar surface or the fingers are laid against 
the bands, and after repeated careful attempts one may succeed in 
drawing these bands so far towards the right that the colon returns to its 
normal position parallel to the middle line of the body. When this is 
accomplished, the pelvic flexure of the bowel, which up to this was dis- 
tended with gas, suddenly collapses, the peristaltic movements are 
restored, and all symptoms of pain and constitutional disturbance dis- 
appear in from half an hour to an hour. 

When tympany of the bowel is a marked feature, the trocar and 
cannula should be employed. As already mentioned, Walley advised 
this latter procedure in all cases of displacement and torsion, and stated 
that some cases of partial twist recover by the spontaneous reduction of 
the involved portion of intestine, and that not infrequently the gradual 
removal of the imprisoned gas is an important factor in this reduction. 

Moller records a case which showed symptoms of partial torsion of 
the double colon for a period of twenty hours. Examination per rectum 
_ revealed the pelvic flexure greatly distended by gas, and forced backwards 
against the pelvic inlet. On the outer surface of the colon a tense cord 
could be felt which passed from above downwards and inwards, and from 
behind upwards. A similar cord passing in the same direction could be 


256 SYSTEM OF VETERINARY MEDICINE 


detected on the inner surface of the colon. By the method described 
above several attempts were made to move the bands of the bowel 
towards the middle line of the abdomen ; these finally succeeded, active 
peristalsis occurred, succeeded by the passage of gas and feeces, and in an 
hour all pain had ceased, and recovery resulted. 

It is admitted that the mode of treatment by taxis requires con- 
siderable endurance on the part of the operator. 

The employment of eserine and allied agents with a view to the 
reduction of twists and displacements is condemned by Cadéac, and with 
this view we are in agreement. We suggest that the employment of 
light chloroform anesthesia, or the administration of chloral hydrate, 
would greatly facilitate the necessary manipulations of taxis by pre- 
venting the occurrence of straiming on the part of the patient. Cadeac 
advises that when the pelvic flexure is found to suddenly occupy the 
pelvic region, the animal should be placed in a position so that the hind- 
quarters are on a higher level than the fore part of the body; then 
attempts should be made to force back the intestine by means of the hand 
inserted in the rectum. When the patient is a mare, this author suggests 
that in the treatment of this condition, as well as all varieties of torsion, 
the manipulations are best carried out by making an incision in the 
vaginal wall, and introducing the hand and arm directly into the 
abdominal cavity. | 

This suggestion is hardly likely to be adopted in ordinary practice, 
as it is highly probable that the fatal termination which would in any 
event occur would be attributed by the owner of the horse to the surgical 
procedure adopted. Moreover, the diagnosis of these conditions has not 
yet reached a stage of exactness to justify operative interference. It is 
also apparent that if surgical measures are ever to prove of utility in such 
conditions, they must be adopted early, before serious alterations have 
occurred in the walls of the intestine, and before the strength of the patient 
commences to fail from exhaustion and absorption of toxins from the 
bowel. 

Torsion of the Small Colon. 


This lesion is generally associated with tumours of the mesentery, 
and in some cases these neoplasms are of considerable size. In rare 
instances torsion of this bowel is brought about by the violent movements 
accompanying intense colics. Complete torsion is rarely met with, a half- 
twist being the usual type of lesion. Cases are recorded in which the 
torsion was in the form of a spiral spring. Kitt observed instances in 
which the rectum suffered from a partial torsion associated with the 
presence of lipomata or melanotic tumours, which exerted traction on 


DISEASES OF THE INTESTINES: HORSE 257 


the posterior extremity of the intestinal tube, so that the superior aspect 
became inferior, and vice versa. 

In torsion of the small colon the portion of bowel anterior to the 
lesion shows a well-marked dilatation. 

The condition is recognised by rectal exploration. There is marked 
straining when the hand is introduced, and great difficulty is experienced 
in the process. At a short distance from the anus the progress of the 
hand is suddenly arrested, and the rectal mucosa shows the presence of 
very firm folds. In some cases it is possible to pass the finger beyond 
the seat of the lesion into the healthy intestine. | 


Volvulus in the Form of Knots. 


This form of volvulus may affect the small intestine per se, or different 
portions of bowel may be involved in a knot. Cases are met with in which 
the small intestine and the floating colon are engaged in the form of a 
knot, or the small bowel may become twisted around the cecum, the 
large colon, or the floating colon. Nothing definite is known with 
reference to the etiology of these lesions beyond what has already been 
mentioned in connection with ordinary volvulus. 

The small intestine in its free portion is the most common seat of these 
lesions, the usual form being that of a loop of bowel twisting several times 
around an axis formed by the mesentery. Various complications have 
been observed, such as invagination of the bowel and different forms of 
occlusion. 

Knots of the floating colon may occur at the anterior extremity of the 
rectum, and can be detected by rectal exploration. 


INVAGINATION OF THE INTESTINE. 


SynonyM.—Intussusception. 

GENERAL RemArKs.—In this condition one portion of intestine slips 
into an adjacent portion, and in the case of the small bowel only being in- 
volved, a cylindrical, sausage-shaped tumour of varying length is formed. 
The commonest seat of the lesion is the jejunum, and it is always an 
anterior segment of bowel which becomes invaginated into a posterior 
portion. The lesion on examination shows three layers of intestine : 
(1) The external, or outermost, or receiving layer, termed the Intussus- 
cupiens ; (2) the middle or returning layer ; (3) the innermost or entering 
layer. The condition can readily be illustrated by making the end of a 
glove-finger pass into the lower portion. The mesentery is also involved, 
and may be stretched, twisted, or torn at the point where the invagination 
occurs, so that its vessels are constricted or ruptured. 

VOL. Il. 17 


258 SYSTEM OF VETERINARY MEDICINE 


Serious alterations occur in the invaginated portion of bowel, due to 
interference with the circulation, and to resulting inflammatory changes. 
Congestion, cedema, and infiltration of the mucosa are first observed ; 
these are followed by inflammatory alterations in the muscular and 
peritoneal coats of the bowel and subsequent necrotic changes. Should 
the patient survive for a sufficient time, adhesions take place between the 
adjacent layers of the bowel, but such is not often observed in the horse. 
Invagination may occur in various divisions of the intestine, ind to these 
we shall briefly direct attention farther on. 

The lesion cannot be regarded as one of common occurrence in the 
horse, judging by the results of autopsies. Thus, in the Report of the 
Army Veterinary Service for 1911, only three cases are recorded, while 
twenty cases of volvulus and ten of strangulation of the intestine occurred 
during the same period. In the Report of the Army Veterinary Service 
in India, 1911-12, there are recorded: Invagination of the intestine, 
1 case ; volvulus, 14 cases ; and strangulation, 6 cases. 

ErioLocy.—lIrregular peristalsis, depending on various and generally 
unknown causes, is generally regarded as the causal factor in the produc- 
tion of intussusception. F. Smith* points out that “ the factor responsible 
for ‘ telescoping’ intestines is disordered muscular action, and disordered 
muscular action is the result of disordered nervous action. For teles- 
coping to occur, one portion of bowel must first contract until it becomes 
but a mere shadow of its former self; the contracted part must then be 
drawn within the dilated.” 

Cadéac states that for the production of the lesion it is essential to 
have inertia of one loop of bowel, coinciding with spasm of another loop 
in the vicinity. He regards any obstacle to the passage of alimentary 
material in the intestinal canal as predisposing to invagination, and points 
out that an obstructed loop of bowel soon becomes distended by fluid, 
which produces excito-motor impulses, and causes violent peristaltic 
movements, commencing at some distance anterior to the obturated 
portion, and extending to the obstruction. These movements differ 
altogether from the short and localised contractions occurring under 
normal conditions ; the result is that a narrowed loop of bowel enters the 
dilated portion, and becomes incarcerated therein. The same author 
states that the lesion is not an uncommon complication in cases of purpura 
hemorrhagica, as in this disease paralysis and dilatation of a loop of 
bowel may occur owing to the alterations present in the intestinal walls, 
and an anterior loop may become incarcerated. 

Morsip ANatTomy.—Various forms of invagination are recorded 


* “Veterinary Physiology.” 


x 


DISEASES OF THE INTESTINES: HORSE 259 


both by authors and by practitioners, and these may be classified as 
follows : 

Small Intestine—The lesion generally occurs in the jejunum. The 
invagination may be semple—z.e., consisting of the three layers already 
mentioned—or it may be double when the invagination enters another 
loop of intestine, in which case it consists of five layers. Cases are 
recorded in which the lesion was of a triple character, consisting of seven 
layers, and the portion of bowel involved was very voluminous. In the 
early stages the blood-supply is not interfered with to any extent, but 
later on, owing to the engorgement which is gradually produced, the 
circulation becomes cut off, and hamorrhage, followed by gangrene, 
results. In recent cases reduction can be carried out, but later on, owing 
to engorgement and to the occurrence of adhesions, this becomes im- 
possible. In some cases all the coats of the bowel are involved ; in others 
the peritoneal coat may be unaffected. The invaginated portion of 
bowel has its calibre very much reduced, and the orifice may be completely 
obstructed owing to the engorgement that is present. The mucosa, is 
congested, of a blackish tint, thickened and turgid, and covered by a 
greyish or reddish. exudate, which may be hemorrhagic. Adhesion be- 
tween the serous layers in contact is said to take place within ten hours. 
In cases where the invagination is extensive, rupture of the mesentery is 
observed, and acute peritonitis may be present. As the course of the 
affection is rapid in this variety of lesion and death occurs rather quickly, 
it is rare to find evidences of adhesions or of other alterations such as are 
met with in invaginations in connection with the large bowel, which 
usually run a longer course. 

A few cases are recorded of invagination of the duodenum into the 
stomach, but such are extremely rare. Invagination of the jejunum into 
the duodenum is also very rarely met with. . 

Ileo-Cacal Invagination—In this form the ileum enters the cecum. 
It is rarely met with. The cecum exhibits no morbid changes, but is 
observed to be very voluminous. On opening it, the invaginated ileum 
is found amongst the fluid contents ; its mucosa is thickened and dark 
in colour ; at its point of entrance necrotic changes are observed, which 
tend to bring about removal of the invaginated portion of bowel, and 
the contents of the cacum then become putrid and very offensive. 

Ileo-Colic Invagination—When a considerable extent of the ileum 
becomes invaginated into the cecum, the former may pass into the large 
colon ; this lesion is very rare. 

Mitaut records a case in which the jejunum became invaginated into 
the large colon, and, owing to the traction exerted on the duodenum, 


260 SYSTEM OF VETERINARY MEDICINE 


this latter was ruptured ; the small intestine then passed through the 
large bowels, and was expelled per anum. 

Invagination of the Caecum into the Colon.—This lesion has been ob- 
served by various practitioners even as early as 1829. It is said to 
occur when the opening from the cescum to the colon becomes very dilated. 


Various other conditions are regarded as predisposing causes, such as | 


the presence of a large accumulation of parasites in the extremity of the 
organ ; aneurisms of the ileo-ceecal arteries ; tumours in connection with 
the cecum, which, by exerting traction on the point of the organ when 
the horse rolls, brings about its invagmation into the colon. The point 
of the cecum first enters the opening into the colon; then the organ 
becomes invaginated, and is found thus in the colon. Generally the 
invagination is not complete, as the crook of the cecum, owing to its 
attachments to the right kidney, remains in its usual position. The 
invaginated portion of the cecum shows marked thickening of its walls, 
acute congestion of its mucosa, and serous infiltration of the sub-mucosa, 
Cases are recorded in which a portion of small intestine has been found 
in the colon associated with the invaginated cecum. Also it is found 
that cecal invagination is less rapidly fatal than the other forms men- 
tioned, as cases have been known to last for a week. Racow* records an 
instance of recovery from this form of invagination, the necrotic portion 
of bowel being expelled per anum. Invagination of the ceascum per se 
is seldom met with. 

Amongst very rare forms, we may mention invagination of the small 
colon into the rectum, and invagination of the small colon at its origin 
into the large colon. Jullian records a case of the latter lesion in a foal 
of two months old. 

Symptoms.—These resemble in the main the symptoms of internal 
strangulation of the bowel. Some practitioners have noted the absence 
of tympany, but this peculiarity may be observed in other lesions as 
well. Heney} recorded a case in which, just prior to death, there was 
a slight hemorrhage per rectum. The passage of blood-stained mucus 
has been observed by Moller. The duration of the affection may be 
rapid when the small bowel is involved ; death may result within seven 
hours after the first manifestation of abdominal pain. When the lesion 
consists of invagination of the caecum into the colon, the course is less 
rapid, and the passage of ingesta is still possible. Verrier and others 
have observed cases in which recovery resulted by cicatrisation of the 
two ends of the intestine after the invaginated portion has been cut off. 


* Revue Vét., 1897. 
{ Veterinary Record, February 8, 1913. 


DISEASES OF THE INTESTINES: HORSE 261 


Friedberger and Frohner drew attention to a case in which, after ten 
days of diarrhoea and apparent improvement, death took place in twenty- 
seven days. 

DIFFERENTIAL Diacnosis.—In spite of the attempts made by some 
authors to lay down rules for the differential diagnosis of this condition, 
clinical experience compels us to agree with Friedberger and Fréhner, 
who state that “a positive diagnosis can only be made when necrotic 
tubular portions of intestine are passed.” 

And as death generally takes place in the horse before the above 
phenomenon can occur, the lesion is only recognised at the autopsy. 

TREATMENT.—Until we possess some means whereby this condition 
can be recognised, or until exploratory laparotomy becomes a recognised 
diagnostic and surgical procedure in equine practice, we must regard 
invagination of the intestine in the same light as volvulus and internal 
strangulation—viz., beyond the aid of the therapeutist. All that can 
be accomplished is to give the relief to pain in the manner suggested for 
the treatment of enteritis (see p. 277). 


PROLAPSE OF THE RECTUM. 


Synonym.—Inversion of the rectum. 

When the mucosa of the rectum becomes everted and protrudes 
through the anus, the condition is known as “ prolapse of the anus.” But 
when, in addition to the mucosa, the rectal wall in an inverted con- 
dition protrudes, the term “ prolapse of the rectum ” is employed. The 
anterior end of the rectum can only pass outwards after rupture of the 
perirectal connective tissue has occurred. 

A portion of bowel anterior to the rectum may become invaginated 
into the latter, and protrude with it; this condition is termed “ prolapse 
with invagination.” 

EtroLogy.—Various causes may bring about the above conditions. 
These include severe diarrhoea accompanied by tenesmus, relaxation 
and paralysis of the sphincter ani ; constipation accompanied by straining 
efforts ; violent struggling such as may occur in some cases of abdominal 
pain, or when the horse is cast for an operation. It is also observed as 
a sequel to difficult parturition in the mare. 

Robertson observed cases in young horses grazing in pastures where 
the herbage was unusually dry and contained much woody fibre. These 
animals were unthrifty for some time, and prolapse of the rectum occurred 
without any appreciable cause. 

Symproms.—The condition is readily recognised by the presence of 
an elongated, red, tumour-like body protruding from the anus, and 


262 SYSTEM OF VETERINARY MEDICINE 


showing a central orifice, through which feces are expelled. The size 
of the protrusion varies according to the extent of the inversion. On 
digital examination of the central opening it is not possible to pass the 
finger towards the pelvis. When the prolapse is accompanied by in- 
vagination, the protrusion is more extensive and harder in consistence, 
and the entire hand can be introduced alongside the prolapsed part, and 
passed into the pelvic portion of the rectum. In some cases, owing to 
the continued straining that is present, a large amount of bowel may be 
protruded, and colicky pains may be observed. Owing to the constric- 
tion exerted on the protruded parts by the anal sphincter, strangulation 
and gangrene may occur, and in some instances a spontaneous cure 1s 
thus effected. 

TREATMENT.—When the protruded portion of bowel is not extensive, 
it can be replaced by careful manipulation, after first cleansing it 
thoroughly and applying a paste composed of opium and extract of 
belladonna. In order to overcome the straining which is usually present, 
and thus to prevent a recurrence, a dose of chloral hydrate should be 
administered. When these measures fail, various surgical methods of 
treatment may be applied, for the technique of which the reader is 
referred to works on veterinary surgery. Some practitioners advise that, 
unless much constitutional disturbance be present, operative measures 
should be delayed for some time, so as to permit of the gradual sloughing 
of the protruded portion of bowel, and the formation of adhesions between 
the rectum and the anal membrane. 

In connection with prognosis and treatment, it is of importance to 
differentiate simple prolapse from prolapse associated with invagination. 


ENTERITIS. 


Synonym.—Inflammation of the intestines. 

GENERAL Remarxs.—Although this affection has been described 
by authors from early times, and recognised as one of comparatively 
common occurrence, we must admit that our knowledge of its etiology 
and pathology is as yet very indefinite, and leaves much to be desired. 
It is quite true that clinical observation, combmed with the knowledge 
obtained from careful post-mortem examinations, has succeeded in 
demonstrating certain fallacies in connection with the disease. Judging 
by the number of cases recorded in former times, and the frequency with 
which a diagnosis of enteritis was made by practitioners, one would 
feel inclined to the belief that the acute, rapidly fatal type of the affection 
was less commonly met with in the present day. But in reality the 


~s 


DISEASES OF THE INTESTINES: HORSE 263 


explanation of the apparent lessened frequency of acute enteritis is 
that more attention is devoted to the clinical observation of abdominal 
affections and to the performance of autopsies. We have learned that 
the intestinal lesions which were formerly attributed to an acute attack 
of enteritis per se are in many instances due to volvulus or displacements 
of the intestine, verminous aneurism of the anterior mesenteric artery, 
or to anthrax. Hence, instead of regarding the lesions as originating 
from indefinite causes, such as over-fatigue, cold from exposure, etc., 
or attributing them to unknown influences in every instance, we are 
now able, in at least some cases, to recognise the etiological factors. 
Again, there was a prevalentidea, which, indeed, is held by some authors 
and practitioners of the present day, that cases of so-called ‘‘ spasmodic 
colic ” may, if unrelieved, terminate in enteritis. Such a view, however, 
is unsupported by any reliable evidence, and it is far more likely that 
by an error in diagnosis the true nature of the case was overlooked at 
the commencement. We have already drawn attention to the fact 
that the term “spasmodic colic” is a very indefinite one, and that the 
symptoms of abdominal pain manifested at the outset may depend on 
various affections. And in spite of the rules laid down for the differential 
diagnosis of enteritis, we find in practice that the greatest care is neces- 
sary in giving a definite diagnosis in connection with intestinal affections. 
Moreover, even when symptoms are present which point to the existence 
of enteritis, it is often difficult, if not impossible, to decide whether the 
lesion is one occurring swt generis, or associated with other morbid 
conditions. 

A comparison of the views held by various authors with reference to 
enteritis will show the lack of definite information that exists. Some 
observers, indeed, state that the lesions usually described as character- 
istic of the acute, rapidly fatal type of the disease really depend on 
strangulation of the bowel, and that the presence of the latter condition 
is overlooked at the autopsy. Thus, F. Smith,* while admitting that 
uncomplicated enteritis may exist, urges its relative infrequency, and 
is of opinion that lesions resembling those of enteritis are more often 
due to strangulation of the bowel. He considers the lesion in uncom- 
plicated enteritis as being confined to the mucosa, and that no external 
manifestations of its presence are observed on the bowel, as the general 
vascular supply is not interfered with. His view with reference to the 
frequency of the disease is, however, not supported by the statistics 
of the Army Veterinary Service, 1911 (see p. 267). 

Percivall ¢ described the lesion as an inflammation of the middle 


* “ Veterinary Physiology.” { “ Hippopathology.” 


264 “SYSTEM OF VETERINARY MEDICINE 


or muscular coat of the bowel, the other coats being secondarily and 
comparatively mildly affected. The course of the inflammation is rapid 
and destructive, and mortification of the affected portion of bowel may 
ensue in a variable period, often within eight or ten hours, the entire 
course of the affection being from twelve to twenty-four hours after it 
has first set in. The small intestines, especially the jejunum and ileum, 
he regarded as the common seat of the inflammation when it arose 
without mechanical obstruction, or followed spasm. The affected parts 
exhibited various patchy shades of redness, from pink or scarlet to a 
purple or even a black hue, the last indicating that the part had become 
mortified. Occasionally, when cut into, the bowel contained masses 
of dark-coloured congealed blood. He also remarked that “ colic, 
should it prove obstinate or protracted, is very likely to turn to 
enteritis.” 

Williams * regarded enteritis as “the most rapidly fatal inflammatory 
disease to which the horse is liable, destroying life in the course of a 
few hours.” In consequence of its course, progress, rapid termination, 
and post-mortem appearances, he considered that it partook more of 
the nature of apoplexy than of inflammation, and that it was a disease 
which originated sue generis, very often without the occurrence of an 
immediate and recognisable cause of direct irritation. The seat of the 
disease was more commonly in the cecum and colon, but no portion of 
the tube was exempt. The only causes recognised were “ over-fatigue, 
and cold from exposure or from washing with very cold water whilst the 
animal is heated, and thereafter inadequately clothed.” The lesions 
were chiefly marked in the mucosa, which showed a deep venous colour 
approaching to blackness, in patches of various extent, and associated 
in many cases with extravasation of blocd into the canal. The sub- 
mucous tissue was generally much thickened. In extreme cases all the 
coats were more or less implicated. In only rare instances did the disease 
terminate favourably in the horse. 

Now, although this author states that the affection originates sw 
generis, yet we find that in describing spasmodic colic he remarks that 
the latter “may run on to inflammation,” and also in connection with 
the same subject he cautions the practitioner not to leave the horse, 
when attacked by colic at night, without administering an aperient, 
otherwise the pains may return and the animal be found in the morning 
either dying or dead. We presume that in such an instance he means 
to convey that death results from enteritis, as impaction of the intestine 
could not terminate fatally in so short a time. 


* “ Principles and Practice of Veterinary Medicine,” 1909. 


DISEASES OF THE INTESTINES: HORSE 9265 


Robertson* regarded enteritis, apart from mechanical causes, as 
not of such frequent occurrence as many represent it, and also as not 
generally associated with gastritis. He found the large intestine was 
more commonly the seat of the lesions ; that in many instances the course 
of the disease was extremely rapid and the termination fatal, with well- 
marked lesions, while in others, with not very dissimilar clinical manifesta- 
tions, the course and termination were delayed and the lesions less 
distinctive. It was doubtful if ordinary indigestion or functional dis- 
turbance of the bowel, unless when repeated and remaining long un- 
relieved, tended to pass on to true inflammatory action, and more 
probably the cases started as enteritis from the commencement. Robert- 
son recognised various types of the disease as follows: (1) The rapidly 
progressive and generally fatal form, characterised by much sero- 
hemorrhagic effusion, and chiefly located in the large colon. In the 
submucous tissue of the intestinal wall, and in the subserous tissue of 
the attached mesocolon, large collections of colloid or jelly-like material 
are found. ‘This material is more or less coloured, and is frequently of 
a hemorrhagic appearance, while more rarely the ingesta appear blood- 
stained. In many instances a large amount of fluid is found mingled 
with the intestinal contents. (2) A less acute form, in which the lesions 
are more distributed in patches and a different portion of the intestinal 
canal is involved. Fibrinous or coagulable lymph tends to form on 
the mucosa, and is discharged with the feces in the form of shreds, 
flakes, or masses, when the inflammatory action has subsided. (This 
would correspond with the croupous form of the disease described by 
some authors.) (3) A catarrhal type, in which the epithelium of the 
mucosa becomes detached and shed with the liquid which is exuded. 
This is associated in some cases with atrophic alterations in the mucosa, 
and in the gland structures of the intestinal walls. (4) Enteritis asso- 
ciated with certain affections, such as influenza. The lesions are variable. 
In some instances extensive sero-hemorrhagic effusions in the sub- 
mucous tissue are observed ; in others the effusion is moderate, and there 
are prominent distended patches, in the centre of which a spot or sore 
exists, undergoing removal of tissue. Others, again, show a general 
removal of the epithelial covering and a peculiar granular appearance 
of the internal surface of the bowel, or the lesion may take the form of 
sharply-defined patches of various sizes and very dark colour, in the 
midst of slightly hyperemic surroundings or of normal tissues. 

Friedberger and Fréhner ¢ describe gastritis and enteritis together 


* * A Textbook of the Practice of Equine Medicine.” 
t “‘ Veterinary Pathology.” 


266 SYSTEM OF VETERINARY MEDICINE 


39 


under the heading of “‘ gastro-enteritis,” and state that in practice, as 
both stomach and bowels are usually simultaneously affected, it 1s not 
possible to separate the two diseases, nor can the inflammatory lesions 
of the various portions of the intestine be differentiated clinically. 
They also remark that it is difficult to distinguish from other forms of . 
colic a gastro-enteritis which first develops as a so-called “ inflam- 
matory colic’’; also that in many cases it is impossible to do so, and that 
‘“many a colic terminates in enteritis.” The progress of gastro-enteritis 
is said to be very rapid, its duration seldom exceeding two or three days ; 
but the chronic form usually lasts several weeks before terminating 
in death. 

Cadeac * does not describe the rapidly fatal form of enteritis. A 
consideration of the lesions and clinical phenomena which he depicts 
leads us to the conclusion that the affection resembles in many respects 
the catarrhal form of enteritis described by Robertson ; at any rate, 
neither the lesions, symptoms, nor termination, are in accord with the 
type of enteritis generally encountered in the British Isles. Thus he 
states that the lesions are usually found in the small intestine, the 
large colon being generally normal, and even in the severe form of the 
disease, when the large bowels are involved, diarrhoea is observed ; but 
this symptom is absent when the lesions are confined to the small in- 
testine, as the fluids become absorbed in the cecum and colon. Again, 
the duration of the affection is said to be from eight to twenty days, the 
termination being either recovery, death, or the chronic form of the 
disease. In fatal cases death may not occur until towards the twentieth 
day, and results from complications, such as ulceration of the intestine, 
absorption of toxins, etc. 

Law,f under the heading of acute catarrhal enteritis, Abenibes the 
identical conditions mentioned by Cadéac, and, in addition, states that 
the affection is often associated with gastritis. He also describes pseudo- 
membraneous or “ croupous enteritis,” an affection which is said by 
_ Friedberger and Fréhner to be very rare in the horse. 

A consideration of the views expressed by the authors mentioned, 
together with our clinical experience of enteritis, leads us to the belief 
that, although a large proportion of the peracute, rapidly fatal cases 
of the disease depend on volvulus or displacements, verminous aneurism, 
or anthrax, still, the affection occurs independently of such conditions. 
This opinion is strengthened by the fact that experienced clinicians such 
as Robertson, Williams, Cunningham, and Caulton Reeks, have recog- 
nised its presence as a disease per se. We freely admit that in the 


* “ Pathologie Interne.” t “‘ Veterinary Medicine.” 


DISEASES OF THE INTESTINES: HORSE 267, 


present day many practitioners employ the term “ enteritis” as a 
convenient one in the diagnosis of cases characterised by continuous 
abdominal pain and the presence of serious constitutional symptoms. 
Probably, if autopsies were conducted in every fatal instance, the 
diagnosis would prove to be erroneous on many occasions. But, per 
contra, similar remarks would apply to the diagnosis of “ twist of the 
intestine,” which is also a favourite term. As we shall point out later 
on, the importance of the matter is not in connection with the difier- 
entiation of enteritis and twist, because both are equally fatal. The real 
necessity for a correct diagnosis is with reference to distinguishing the 
above conditions from curable affections, so that rational treatment may 
be adopted for the latter. Moreover, from the standpoint of reputation, 
it is desirable to avoid giving a dogmatic opinion that a case will prove 
fatal unless we have very good grounds for arriving at such a conclusion. 

As regards the incidence of enteritis, it is interesting to note that in 
the Statistical and General Report of the Army Veterinary Service for 
1911, 59 cases are recorded, and of these 27 proved fatal and 5 were 
destroyed. On comparing the number of cases of enteritis with those 
of volvulus and strangulation of the intestine, we find that 20 of volvulus 
and 10 of strangulation were recorded, so that enteritis must be regarded 
as of more frequent occurrence than the other conditions mentioned 
above. In the Report of the Army Veterinary Service in India for 1911- 
1912, 35 cases of enteritis, with 27 deaths, were recorded, while 14 cases 
of volvulus and 6 of strangulation were reported. 

Eriotocy.—In those cases depending on volvulus, invagination, or 
strangulated hernia, the cause of the inflammation is the strangulation 
of the intestinal walls and the resulting interference with the blood- 
supply. In enteritis occurring as the result of verminous aneurism and 
embolism, the lesion is also produced by interference with the circulation 
in the affected portion of intestine. When inflammation of the intestines 
is associated with affections such as influenza or purpura hemorrhagica, 
the lesion should probably be ascribed to microbic influences. According 
to Cadéac, the enteritis in such instances is a secondary condition ; the 
toxins secreted by the infective microbes reach the intestine during 
their excretion from the body and set up a local secondary infection, 
unlegs, indeed, diarrhoea ensues, and the toxins are then removed from 
the system. This author concludes that “every blood infection may 
at times be complicated by enteritis. But this intestinal lesion, by 
altering the epithelium and interfering with the normal circulation of 
the intestines, favours the absorption of toxic products and of microbes ; 
it prepares in its turn new blood infections and new complications, and 


268 SYSTEM OF VETERINARY MEDICINE 


thus a vicious circle is established. Every enteritis is complicated to 
a marked extent with infection of the blood.” 

Irritant poisons produce enteritis, varying in degree according to 
the nature of the toxic agent. The small intestines show more marked 
lesions than the large, and some authors believe that owing to the injury 
inflicted on the intestinal epithelium the microbes which are always 
present in the bowel are enabled to exert a pathogenic action, yee thus 
induce secondary infections. 

Localised or limited enteritis, which sometimes occurs in connection 
with impaction or the presence of a calculus, cannot be ascribed to 
irritation alone; it is highly probable that the irritation lessens the 
resisting power of the mucosa, and permits the microbes to enter and 
to exert their effects. 

We have now to consider what knowledge we possess with reference 
to the etiology of those cases of enteritis that do not come under the 
above headings. As already pointed out, such cases have so rapid and 
fatal a course, and show lesions of so peculiar a nature, that it is doubtful 
whether the term “ enteritis ”’ is a correct or proper one for the affection. 
Hividently the lesions in the horse are something more than an ordinary 
inflammation of the intestines, such as we meet with in other animals. 

We have already drawn attention to the fact that some at least of 
such cases are due to anthrax, but, on the other hand, it is equally clear 
that this cause is not the constant one, as a bacteriological examination 
is only occasionally positive. 

F. Smith* states: ‘It is possible that in the horse the majority, if 
not all of the cases of pure enteritis met with are due to a poison produced 
during the process of digestive metabolism. That the presence of an 
irritant without a poison has no such effect is abundantly proved by the 
pounds of sand and gravel horses may carry in their intestines for months, 
perhaps for years, without producing any apparent ill effect, certainly 
without producing enteritis.” As already remarked, this author restricts 
uncomplicated enteritis to those cases in which the mucous membrane 
alone is inflamed and the vascular. supply is not interfered with, so that 
the affected bowel gives no external indication of the lesions present. 
With reference to those etiological factors which have been handed down 
from the pioneers of veterinary science—viz., over-fatigue, cold from 
exposure, or from washing with very cold water, especially the abdominal 
region, when the animal is heated—we must simply regard them as 
predisposing causes only. They lessen the vital resistance of the animal, 
and if we are prepared to hold that enteritis of the peracute type is 


* “ Veterinary Physiology.” 


DISEASES OF THE INTESTINES: HORSE 269 


microbic in origin, it is easy to explain how such factors can favouy 
infection. 

The microbic origin of enteritis is not definitely proved—it is onlr 
surmised—but on no other grounds can we account for the lesions in 
those cases that cannot be ascribed to mechanical causes, to verminous 
aneurism, or to anthrax. Cadéac* makes out a strong case for the 
microbic theory of this disease, although he describes a Jess acute form 
of the affection than we are familiar with in practice. He first draws 
attention to the natural means of defence possessed by the intestine. 
These include the epithelium, the presence of numerous glands, an 
abundant secretion of mucus, the antiseptic action of the bile, a well- 
developed lymphatic system, an active phagocytosis to resist invading 
and attacking microbes, and the presence of peristaltic movements to 
get rid of irritating products. The microbes which are always present 
in the intestinal canal are harmless so long as the mucosa is in a healthy 
state, but under certain conditions these micro-organisms are altered 
so that they possess pathogenic characters. These conditions include 
chills, fatigue, stasis of the intestines, the presence of irritants, debilitating 
diseases, etc.; phagocytosis is inhibited, and microbic infection of the 
intestinal wall results. The micro-organisms incriminated are the 
staphylococcus, the streptococcus, the coli bacillus, and the bipolar 
bacterium. They exist as saprophytes in the intestine, and are always 
ready to become pathogenic ; and not only are intestinal lesions produced, 
but also general effects on the system due to the toxins—e.g., auto- 
intoxication, which is well in evidence during the later stages of 
enteritis. 

As regards the association of enteritis with affections such as influenza, 
the theory advanced by some authors is that under the influence of all 
febrile maladies the various secretions entering the intestines are 
diminished in amount and weakened in their action, so that putrefaction 
of the ingesta is more likely to occur, and the micro-organisms are per- 
mitted to become pathogenic. 

Damaged forage is regarded by some authorities as a cause of enteritis, 
but there is no definite evidence to support this view. No doubt food 
of this kind tends to undergo excessive fermentation, and is likely to 
produce digestive disorders or intestinal tympany ; but we are yet unable 
to state that it is an etiological factor in acute enteritis. Cadéac, however, 
points out that even in forage of the best quality various micro-organisms 
can be demonstrated, but in damaged or mouldy food they become 
enormously increased in number. Such micro-organisms have no effect 


* “ Pathologie Interne.” 


270 SYSTEM OF VETERINARY MEDICINE 


on healthy animals; they simply increase the number of those which 
normally exist in the digestive canal. But when the system becomes 
weakened from any cause, the micro-organisms assume pathogenic 
properties and produce enteritis, which may extend deeply, and the 
microbes may gain entrance to the blood and cause a general infection. 
Chronic enteritis is said to occur as a sequel to an acute attack, or it 
may be associated with chronic valvular disorders of the heart and 
pulmonary emphysema, in which instance it depends on stasis in the 
portal vein. 

Morsip ANatomy.—The lesions described by the majority of British 
authors are those met with in the peracute type of the disease. As 
already remarked, they resemble the post-mortem appearances met with 
in cases of strangulation or volvulus of the intestine, and, to a certain 
extent, those of anthrax, and have been described on pp. 235, 264. We 
cannot agree with the view that in uncomplicated cases of enteritis the 
mucosa alone is involved, as we have seen several instances in which 
almost the entire length of the small bowel was affected, the lesions 
extending to the muscular coat, and their presence manifested externally 
by the dark red colour which is seen through the peritoneal coat. In 
this opinion we have the support of some very experienced practitioners. 

In those less rapid cases which last for several days we have often 
observed evidences of general septicemia and pulmonary gangrene. 
In some instances the Jesions may occur in both the small and large 
intestines. The enteritis described by some Continental authors appears 
to be of a less severe type. The lesions are found chiefly in the smal] 
intestine. The mucosa is covered by a whitish, opaque layer of mucus, 
of a gluey or mucilaginous consistence, and composed of pus cells, 
granular bodies, and epithelial cells which have undergone fatty degenera- 
tion. On removal of this layer the mucosa shows deep congestion in 
patches or striz. It is thickened and friable, and in some cases the 
epithelial layer has disappeared, and ulceration or necrotic changes are. 
observed. Amongst other alterations recorded are—Swollen villi, dilata- 
tion of the openings of the agminated and solitary glands, and small 
suppurative foci in their interior ; swelling of the follicles of Lieberkiihn ; 
serous infiltration of the submucous tissue, which occasionally may be 
hemorrhagic ; the muscular coat may show congestion with ecchymoses ; — 
the serous covering is generally normal. 

In chronic enteritis the lesions described by Cadéac are as follows: 
Sclerosis of the walls of the duodenum ; the small intestine is generally 
attenuated, and the large intestine, on the contrary, is sometimes 
thickened. The mucosa of the small intestine is of a deep red colour, 


DISEASES OF THE INTESTINES: HORSE 271 


and studded with greyish-brown or slate-coloured spots. The mucus 
is more or less abundant, the villi are thickened and sclerosed, the follicles 
are atrophied. The mucosa is hard and resistant, due to hypertrophy 
and sclerosis of the submucous tissue, less dilatable, sometimes dis- 
tinctly folded, and may show ulcerations in certain parts. The glands 
of Lieberkiihn are hypertrophied, and the interglandular tissue may 
form prominent projections parallel to the intestinal villi. The mesen- 
teric glands may be hypertrophied and indurated. 

Symptoms.—In the early stages of the affection constitutiona] 
symptoms are presented—viz., rigors, loss of appetite, accelerated 
respirations, a rapid hard pulse, and the frequent passage of small 
quantities of feeces, due to an irritable condition of the intestines. In 
some instances diarrhoea may be observed, but this is soon succeeded 
by obstinate constipation. The practitioner seldom sees the case at 
this stage, as his attendance is not generally requested until evidences of 
pain are manifested, and not uncommonly the owner or attendant treats 
the animal for ordinary colic, and only calls in professional assistance 
when he finds that the usual remedies fail to give any relief. The 
prominent symptom in acute enteritis is persistent abdominal pain ; 
there are no intervals of ease, and there are evidences of the existence 
of a grave condition manifested by serious alterations in the pulse, 
respirations, and temperature. But while admitting that the pain is 
gradual in development in enteritis, and is steadily continuous and very 
acute, we learn by experience that great care and discrimination is 
necessary at the outset of the disease in order to avoid an erroneous 
opinion in two directions: (1) In overlooking the serious nature of the 
case and ascribing the condition to one of severe colic ; (2) in regarding 
the symptoms as due to enteritis, when in reality the evidences of pain 
depend on conditions which are amenable to rational treatmient. When 
we come to consider the question of differential diagnosis, we shall have 
to discuss these matters fully, and to indicate their importance from a 
therapeutical point of view. 

The pain in enteritis is far more acute in some cases than in others, 
and, as we shall point out later on, instances occasionally occur in which 
throughout their entire course pain is little marked. 

But as a rule the pain gradually increases in intensity, and remains 
until near the termination of the case. The animal looks anxiously 
towards his flanks, strikes at the belly with his feet, paws with each fore- 
foot alternately, and keeps constantly rolling and rising to his feet. 
The expression of countenance is anxious, the visible mucous membranes 
are deeply injected, the temperature is raised 2° or 3° F., the respira- 


272 SYSTEM OF VETERINARY MEDICINE 


tions are accelerated, the pulse is hard, wiry, and quick, but as the 

disease advances it becomes gradually thready and imperceptible; the 

extremities are cold and general sweating is observed. Tympanites is 

often absent during the early course of the disease, and the abdomen 

has a “tucked-up ” appearance, due to contraction of the abdominal - 
muscles. But we meet with many instances in which a moderate degree 

of tympanites is present, and on palpation the abdomen is hard and 

tense. Pain is said to be evinced on pressure of the abdomen, but it is 

seldom that palpation of this region is of use as an aid to diagnosis, as it 

is resented by the majority of horses. 

Constant walking round the box is usually regarded as one of the 
symptoms of enteritis, and while admitting that it is observed in some 
cases, we must point out that it is absent in others, but can be readily 
induced by administering full and repeated doses of opiates. F. Smith 
drew attention to this matter, and demonstrated that the “ circus ”’ 
mode of progression could be induced in healthy horses by administering 
large doses of morphine. 

In some instances the pain becomes so severe that violent symptoms 
are manifested ; but it is generally found that the animal is more careful 
in lying down than is the case in some other painful abdominal affections. 

As a rule the symptoms become aggravated, the countenance assumes 
a haggard expression, the eyes appear smaller, the surface of the body 
becomes covered with cold sweats, the nostrils are widely dilated, the 
respirations are short and quick and in the form of painful sobs, and’ 
the abdomen is tympanitic. 

At a later stage all evidences of pain subside. This depends on the 
occurrence of gangrene in the intestine. Marked depression is also present, 
due to the action of toxins on the nervous system. The animal stands 
persistently, and may even partake of food in a listless manner, leading 
the onlooker to imagine that the case is improving. But the pulse is 
imperceptible, the extremities deathly cold, the eyes are amaurotic, the 
lower lip hangs pendulous, there is constant trembling of the muscles 
of the body. The animal, if made to move, staggers, and in a variable 
period he falls forwards, and dies after a few convulsive struggles. 

It not infrequently happens that when a horse is attacked by the 
disease at night-time, the practitioner may not be called in until the 
following morning. Then the acute symptoms may have disappeared ; 
evidences of the animal’s struggles during the night will be observed in 
the form of abrasions of the skin over the eyebrows, haunches, etc., and 
unless a careful examination of the case be made, an erroneous diagnosis 
may be given. ° 


DISEASES OF THE INTESTINES: HORSE 273 


Occasionally we meet with cases in young horses that exhibit little 
or no evidences of abdominal pain, and foetid diarrhoea and marked 
constitutional disturbance are present, and the autopsy reveals acute 
enteritis, depending on the presence of S. tetracanthus in the bowels. 

The duration of acute cases of enteritis varies from eight or ten 
to twenty-four hours. 

Continental authors recognise a mild and a severe form of enteritis. 

In the mild form slight colicky pains, tenderness of the abodmen 
on percussion, well-marked borborgymi, and the passage of small amounts 
Of dry feces covered with mucus, are the symptoms observed. Its 
duration is from seven to eight days, but intestinal impaction may occur 
as a complication, as the inflammation arrests the secretions and tends 
to produce stasis. 

In the severe form fever is present, the countenance is anxious, the 
appetite is in abeyance, the faeces are hard, dry, covered with mucus, or 
with fibrinous false membranes, and defecation is difficult and painful. 
In twenty-four to forty-eight hours the constipation is succeeded by 
a very foetid diarrhoea, and the animal becomes rapidly enfeebled. 
Colicky pains are observed, and symptoms of auto-intoxication may 
appear. The affection terminates in eight to twenty days by recovery 
or death, or the chronic form of the disease supervenes. In fatal cases 
marked feebleness is observed, the abdominal muscles are retracted, 
the recumbent position is assumed, and death occurs towards the 
twentieth day in a state of marasmus. 

The chronic type of enteritis does not present any pathognomonic 
symptoms. Slght intermittent colics, occasional attacks of tympanites 
of short duration, diarrhoea, or alternaté conditions of constipation and 
diarrhoea have been observed; but these are symptoms common to 
other chronic ailments of the alimentary canal. The disease is said to 
terminate in a variable period in feebleness, marasmus, and death. In 
cases where the lesions are localised, although nutrition can still be 
carried on, the animal is predisposed to attacks of intestinal impaction, 
due to alterations in the walls of the affected bowel. 

DiFFERENTIAL Diacnosis.—Probably the most important point in 
connection with diagnosis is the differentiation of enteritis from other 
conditions in which abdominal pain is a prominent symptom, and which 
are likely to yield to rational treatment. The majority of authors lay 
stress on the following points as indicating the presence of enteritis ; 
(1) The history of the case—i.c., its gradual development; (2) the 
persistent character of the pain, there being no periods of ease ; (3) the 
serious alterations in the character of the pulse; (4) the marked con- 

VOL. II. 18 


274 SYSTEM OF VETERINARY MEDICINE 


stitutional symptoms, the expression of the countenance, and the coldness 
of the extremities: (5) the course of the case—+z.e., the symptoms 
becoming progressively more grave. 

In addition to these, Caulton Reeks very properly points out that 
when the pulse, respirations, and temperature, taken collectively, show 
serious’ alterations, and the visible mucous membranes are highly in- 
jected, the diagnosis of enteritis is greatly strengthened. 

Now, while admitting that a case presenting the above symptoms 
is very suggestive of enteritis, clinical experience has taught us that 
occasions arise in which an erroneous diagnosis may be given. For 
example, on being called to a case, we may observe alarming symptoms, 
arrive at the conclusion that enteritis is present, give an unfavourable 
prognosis, and prescribe full doses of sedatives. But after-events may 
prove that a curable condition was present, and that the treatment 
adopted was inimical to recovery. 

Per contra, the symptoms presented may not be of so acute or serious 
a nature as to warrant us in giving a diagnosis of enteritis, and we 
recognise the error at a later stage of the case, or perhaps not until an 
autopsy is held. 

Robertson,* in discussing the differentiation of enteritis and ordinary 
functional disorder of the bowels (colic), stated: “In differentiating 
the symptoms of these two conditions much care is needed, and even 
after such has been exercised, much uncertainty remains.” 

Caulton Reekst observes: “In spite of the most careful reasoning, 
and in spite of the most painstaking examination and observation, cases 
of colic occasionally crop up in which the symptoms are, for a time, 
dangerously alarming.” 

The above views are in accordance with our own experience, and we 
desire to lay special stress on this question of diagnosis, as we find that 
many practitioners diagnose enteritis with apparent facility, and when 
the case terminates favourably, they claim a recovery from the disease. 
It is highly probable that in such instances a limited enteritis has been 
present, such as may occur in impaction and allied conditions. 

The important pot to remember is that at certaim times during 
the course of subacute obstruction of the double colon the symptoms 
may become alarming. Harding of Salisbury, in a paper on the “ Treat- 
ment of Intestinal Impaction,” { remarks that if relief be not afforded, 
“the animal will be up and down constantly, and when down, rolling, 

* “The Practice of Equine Medicine.” 


+ ‘The Common Colics of the Horse.”’ 
{ Veterinary Record, vol. xvi., 1901. 


DISEASES OF THE INTESTINES: HORSE 275 


in fact, not stillamoment. The tympany becomes much greater, and he 
breaks out in patches of sweat, the pulse and respirations being accelerated. 
Oftentimes we are too late to watch the subacute symptoms, but on our 
arrival the patient 1s i a desperate condition, perspiration literally 
pouring from him, great tympany, pulse nearly 100, respirations much 
accelerated, nostrils dilated, an anxious expression, in fact, apparently 
dying.” * 

As regards the differentiation between acute enteritis and twist, 
intussusception, etc., there are marked difficulties. Acute enteritis 
occurs as the result of the conditions named, as well as being an inde- 
pendent affection, and in many instances the symptoms presented do not 
enable us to state definitely whether a twist is the cause of the enteritis, 
or otherwise. No doubt by rectal exploration we often obtain definite 
evidences of certain forms of twist or displacement of the colon. We 
are then enabled to arrive at a correct diagnosis.* 

Robertson f stated: “‘Of the different modes or phases of physical 
change of the bowels which result in inflammatory action, there are 
probably no certain or diagnostic symptoms which may lead us to 
differentiate the one from the other. Occasionally we may be able, by 
the occurrence of some fortuitous symptoms, to make a happy guess, 
the same data, however, not serving us equally well on their next develop- 
ment in some other case. We may be able to indicate whether the dis- 
turbance and pain are the results of merely functional derangement 
or of some serious inflammatory action, but we are usually unable to 
determine whether this inflammation is the result of intussusception, 
strangulation, or some other equally potent but less easily understood 
operating agency.” 

The above remarks, although taken from a work published in 1889, 
are an excellent summing up of the knowledge we possess on the subject, 
and it cannot be said that in-the present day anything more definite 
can be added, so far as these lesions in the small intestines are concerned. 

With reference to the diagnosis of these forms of enteritis described 
by Continental authors, while admitting that they may occur, it is very 
probable that they would not be diagnosed as enteritis in Great Britain. 
As the majority of the uncomplicated cases are said to recover, it is 
difficult to draw conclusions as regards the diagnostic symptoms, or 
to differentiate the condition from acute gastric catarrh, with which it 
is admitted to be frequently associated. | 

The differentiation of acute enteritis from anthrax can, of course, 


* See “ Twists and Displacements of the Intestines,” p. 243. 
+ Op. cit. 


276 SYSTEM OF VETERINARY MEDICINE 


only be definitely carried out by a bacteriological examination. But there 
are certain characteristics in the intestinal lesions of anthrax which are 
very suggestive. These are—The large amount of amber-coloured fluid 
in the abdominal cavity; the discoloured, almost black, appearance of 
the bowel, not localised as in cases of volvulus, but extending throughout 
the intestine; the straw-coloured exudate which seems to follow the 
course of the muscular bands in the large colon in a very marked manner. 
Again, the mesenteric glands stand out prominently, are distended with 
broken-down blood, etc., and black in colour. 

Of course, if in addition to the above phenomena, the spleen is found 
enlarged, and if extensive swelling be present in the region of the neck 
and pharynx, the diagnosis of anthrax is greatly strengthened. 

Proenosis.—Although some recoveries are said to occur from acute 
enteritis, it is rational to be sceptical on the matter, and to suggest that 
in the favourable terminations recorded the diagnosis was at fault. 
Judging by our experience of the lesions met with at autopsies, we feel 
justified in statg that in acute enteritis of the type recognised and 
described by British veterinarians, recovery is almost impossible. We 
are quite prepared to admit that cases of limited enteritis can and do 
recover, and also that the milder type of the disease as described by 
Continental authors, can, if uncomplicated, terminate favourably. 
Hence, if a case presents the symptoms we have described, an unfavour- 
able prognosis should be given. At the same time, owing to the fact 
to which we have already referred—viz., that alarming symptoms will 
occasionally appear during the course of obstructive colic, we should 
avoid offering a dogmatic opinion with reference to a fatal termination 
until evidences are presented which leave little room for doubt. 

TREATMENT.—If we are satisfied, after a careful examination, that the 
case 1s one of acute enteritis, the only therapeutical measure indicated in 
our present state of knowledge is to administer full doses of sedatives 
in order to give the animal relief from the agonising pain that is present. 

The practice of administermg agents such as eserine or arecoline 
indiscriminately, when evidences suggestive of acute enteritis are present 
cannot be too strongly condemned. Not only is it irrational but also it 
is cruel to add to the sufferings of the unfortunate patient. On the 
other hand, as already mentioned, we should avoid jumping to the 
conclusion that the animal is suffering from enteritis, and that the only 
indication for treatment is to administer full doses of opiates. It is 
quite possible that the symptoms may depend on obstructive colic, 
with probably a limited enteritis, and the above agents would then 
prove inimical to recovery. 


DISEASES OF THE INTESTINES: HORSE 277 


For many years we have discarded the employment of opium or 
morphine as sedatives, even when we have satisfied ourselves that a 
hopeless condition is present. When administered in the usual doses, 
little or no analgesic effects are produced in cases of the kind, while if 
the amounts be increased, an exciting, rather than a sedative action, is 
produced, 

We now rely on full and repeated doses of chloral hydrate. This 
agent not only gives perfect relief from pain, but also, should the diagnosis 
prove to be erroneous, the treatment adopted does not militate against 
the employment of other measures afterwards. In cases where it is 
difficult to administer this drug, we adopt instead the employment of 
chloroform anesthesia, and find that the latter can be continued for 
long periods without difficulty. | 

Anyone who has witnessed the difference between a horse semi- 
delirious from full doses of opiates and one under the sedative influence 
of chloral hydrate or chloroform, will have little difficulty in deciding 
which is the most suitable course to adopt when it is found necessary to 
“smooth the path to death.” 

At one time we employed cannabis indica largely for this purpose, 
but further experience showed that it possessed no advantages over 
chloral hydrate or chloroform. Moreover, its price at the present time 
prohibits its employment in general practice. 

As regards the use of local applications to the abdominal walls, 
we fail to see what beneficial effect they can produce in the affection we 
are discussing. No doubt their employment gives the owner of the 
animal and the attendant the idea that “‘ something is being done for 
the patient,”’ but we much prefer to leave the animal under the influence 
of the sedative, and to avoid annoying him in any way. 

If we remember the post-mortem lesions observed in cases of acute 
enteritis, we cannot but regard the list of remedial agents advised in 
some textbooks as anything but mere “ placebos.’’ Finally, we may 
remark that when we hear of a number of cases of recovery from this 
malady ascribed to certain forms of treatment, we can only conclude 
that those who assume such powers of diagnosis and such therapeutical 
skill were not dealing with acute enteritis at all, but with affections that 
presented symptoms which simulated those of the disease in question. 


ENTERITIS IN FOALS. 


Synonym.—Diarrheeal enteritis. 
This affection merits a special description, as it presents certain 
peculiarities, and is often a source of great losses to the breeders of 


278 SYSTEM OF VETERINARY MEDICINE 


horses. It must not be confounded with ordinary diarrhea, popularly 
known as “‘ scouring,” which, if rationally treated, is a simple affection 
and will receive attention later on (see p. 300). The disease we now 
propose to discuss is characterised by the presence of enteritis, which 
varies in intensity, a persistent diarrhoea, and marked constitutional 
symptoms. It may attack the foal at any period from birth to the time 
of weaning. In our experience, the enteritis is frequently associated 
with gastritis, and in many instances the evidences of pain are little 
marked, so that the lesions found at the autopsy often come as a surprise. 
According to Cadéac, the affection is distinctly a microbial one, the 
micro-organism chiefly responsible being the coli bacillus, the para- 
coli bacillus, associated with streptococci, staphylococci and other 
microbes. He describes a simple form of the disease in which the lesions 
are limited to the intestines, and a septicwmic form in which the micro- 
organisms gain entrance to the blood, and a general infection is produced, 
associated with pyemic arthritis, laminitis, pleuro-pneumonia, peritonitis, 
icterus, etc. (septicémie des nouveau-nés). This septicemic form is said 
to occur as an enzo6tic in breeding establishments, and is regarded as 
infectious. We have not observed this type of the disease, and our 
experience is confined to those cases showing symptoms attributable to 
disorder of the intestines. 

Errorocy.—Assuming that the causal factor is a microbial one: 
there are certain conditions which favour infection, and must be regarded 
as predisposing causes. These include insanitary surroundings, errors 
in feeding, exposure to chills and to inclement weather, etc. Subjecting 
the dam to severe exertion, and only permitting the foal to suck her at 
long intervals, tend to render the milk unfit for digestion by the young 
animal ; diarrhoea is induced, and this may be the starting point of the 
infection. 

We have met with several cases in foals that were just commencing 
to pick grass, and were suddenly changed into a rich, succulent pasture. 

Ordinary diarrhoea, if neglected or irrationally treated, may terminate 
in enteritis. | 

Symproms.—The first symptoms observed are dulness, disinclination 
for movement, a tendency to lie down for long intervals ; the animal 
refuses to suck the dam, the abdomen has a “ tucked-up”’ appearance. 
Colicky pains may be manifested in some cases, but in others only un- 
easiness and pawing are observed. Diarrhoea appears in a variable 
period ; in some instances it is the only symptom observed by the owner> 
and the case is regarded as one of simple “scouring.” The feces are 
liquid, yellow in colour, very foetid, and contain undigested material; 


DISEASES OF THE INTESTINES: HORSE 279 


the evacuations soon become very frequent, and the colour alters to a 
greyish-white or a greenish tint ; they contain particles of mucus, and 
may be passed involuntarily, soiling the skin in the vicinity of the 
anus and causing it to assume an erythematous condition. Marked 
debility is present, the animal hangs his head and shows evidence of 
gradual exhaustion, the countenance has a haggard expression, the — 
pulse becomes imperceptible, the respirations are accelerated, and death 
may occur in from three to ten days. Some cases of a less severe type 
may last for two weeks. In many instances no evidences of pain may 
be observed throughout the entire course of the disease. 

It must be remembered that parasitic invasion of the intestines by 
the S. tetracanthus will give rise to similar symptoms to the above. 

Morsip ANnatomy.—Evidences of gastritis are found in many 
instances associated with those of enteritis. The intestinal lesions may 
be limited to the small bowels, but in some cases the colon is also in- 
volved. The submucous coat is infiltrated, and ecchymoses may be 
present. Infiltration and hypertrophy of the villi and of Peyer’s patches 
may be observed. In some instances the enteritis is of a croupous type. 
The contents of the large colon are fluid, of a greenish tinge, and very 
foatid. 

Proenosis.—This is always grave, and the mortality is high, especially 
in young foals. 

TREATMENT.—In the early stages a laxative dose of castor oil is 
indicated. Various lines of treatment are advised, but in severe cases 
all therapeutical measures are likely to fail. Probably the time-honoured 
mixture of chlorodyne, chalk, and peppermint-water gives as much 
success as any. Cadéac advises a combination of antiseptic agents, 
with antipyretics and astringents administered in the form of electuary, 
such as salicylate of soda, boric acid, citric acid, benzo-naphthol, salol, 
iodoform, and tannin. To check the diarrhcea he prescribes tincture of 
opium with subnitrate of bismuth. In some cases, although the animal 
refuses to suck the dam, he can be persuaded to drink fluids, and should 
be allowed, milk drawn from the mare, to which lime-water should be 
added. Rice-water, barley-water, and thin starch gruel should also 
be offered. To combat the extreme weakness, port wine and brandy 
may be given, and subcutaneous injections of normal saline solution 
may be employed as a cardiac stimulant. 

Great care is necessary in administering fluid medicaments to foals ; 
unfortunately, in too many instances inhalation pneumoniais produced by 
the carelessness of the attendant in this respect, 


280 SYSTEM OF VETERINARY MEDICINE 


COLIC DUE TO VERMINOUS ANEURISM. 


Synonyms.—Thrombo-embolic colic; Intestinal congestion and 
hemorrhage ; Intestinal apoplexy. 

GENERAL RemarKs.—From a comparatively early period the associa- 
tion of colic with a verminous aneurism of the anterior mesenteric artery 
was recognised by several observers, including Rigot, Hering, Bruck- 
miiller, etc. Bollinger conducted extensive researches, and published a 
work on the subject. Many of these authorities held that the lesion was 
of very frequent occurrence, especially in aged animals. Thus, Ellen- 
berger, in the case of horses used for dissection, found only one animal 
out of eighty-five free from the disease. According to Bollinger, 50 per 
cent. of all cases of colic are thrombo-embolic in origin, and Zurn held 
that three-fourths of the cases were of this nature, but this view is not 
generally accepted. Verminous aneurisms of the anterior mesenteric 
artery have been observed in foals three months old by Cocu and Hue, 
and also by Francke ; while, according to Poppel, the lesion may develop 
during foetal life. 

The cause of the aneurism is the presence of the larve of the 

‘trongylus vulgaris, and perhaps the immature forms of other species. 
According to some authorities, the parasites reach the anterior mes- 
enteric artery from the intestine by penetrating the mucosa and 
submucous coats of the bowel, gaining entrance into the bloodvessels, 
and thence to the general circulation, finally reaching the great 
mesenteric artery, which is their seat of predilection. Other observers, 
including Sticker, hold that the larve penetrate the vasa vasorum of the 
great mesenteric artery, remain a certain time in the wall of the vessel, 
and set up at first an inflammatory condition of the tunica media. 

For a full description of the biology of the parasite the reader is 
referred to the section on Parasites. We are here concerned with the 
clinical aspect of the subject, and with the manner in which the intestinal 
lesions are produced. 

As already remarked, the verminous aneurism results from the pre- 
sence of the parasites, which, according to Sticker, produce their effects 
first on the tunica media of the arterial wall, and set up a destructive 
inflammatory action therein. Other observers state that the tunica 
intima is first affected. The result, however, is the occurrence of endar- 
teritis, the formation of a thrombus, and ultimately the development of 
an aneurism (see section on Diseases of the Bloodvessels), The 
parasites are generally found in the thrombus, but in some instances they 
are imbedded in the arterial wall. The aneurism occurs most frequently 


DISEASES OF THE INTESTINES: HORSE 281 


in the right division of the anterior mesenteric artery. As this division 
of the vessel gives off the two cecal arteries, the right colic, and the ileo- 
cecal arteries, the effects produced are chiefly observed in the cecum 
and large colon. In rare instances only does the thrombus completely 
obstruct the circulation in the main artery (anterior mesenteric). The 
left division, which is composed of fifteen to twenty arteries supplying 
the small intestines, is seldom obstructed so as to produce serious or fatal 
results, as in consequence of the collateral circulation the blood-supply 
is not interfered with to a marked extent. The posterior mesenteric 
artery 1s seldom found affected. 

In addition to the presence of the aneurism and its accompanying 
thrombosis, which interferes with the flow of blood to the intestine, there 
are other important pathological conditions contributing to the same 
results. These include the formation of emboli from the thrombus, which 
produce serious effects on the intestinal circulation, also alterations in the 
bloodvessels, andthe occurrence of lesions in the intestinal walls. Various 
causes are suggested to account for the formation of emboli, such as 
retrogressive changes in the thrombus, or the movements of the parasites. 

The portions of the thrombus detached are carried by the blood- 
stream to the smaller branches of the anterior mesenteric artery, and 
cause obstruction therein, and also inflammatory changes in the walls of 
the vessels involved. The obstruction may be total or partial. If total 
and affecting a terminal artery, a single embolus can produce very 
serious alterations in the portion of intestine supplied by this vessel. 
But when affecting vessels that are provided with free anastomoses, 
serious or fatal results do not ensue unless several emboli block up a 
number of arterial branches simultaneously. 

The alterations produced on the intestinal circulation and on the 
intestines are important. The blood-supply to the portion of intestine 
supplied by the affected vessel is either limited or entirely suppressed, 
and a condition of anemia of the intestinal wall results. At the com- 
mencement, increased peristalsis occurs, which is attributed by some 
authors to an abnormal amount of carbon dioxide in the blood; spasm 
of the intestine results, which produces acute colicky pains, due to com- 
pression of the nerve-endings in the intestinal walls. This is succeeded 
by cessation of peristalsis, attributed to lack of oxygenation, and finally 
by intestinal paralysis, with excessive fermentation of the ingesta in the 
large colon, leading to the occurrence of tympany and other serious: 
phenomena. 

Important alterations occur in the intestinal walls. In the region 
affected by arterial anemia blood flows in a backward direction into the 


282 SYSTEM OF VETERINARY MEDICINE 


stagnant vessels ; a serous and sanguineous infiltration of the walls and 
lumen of the intestine follows, and the walls of the capillaries become 
altered, so that hemorrhages occur into the bowel. 

Morsip Anatomy.—The lesions are generally found in the large 
colon and in the cecum. Extravasations of blood occur in the intestinal | 
walls. The latter are much thickened and friable, of a blackish or 
brownish colour, and, when incised, they are found to be infiltrated with 
a reddish serosity, and it is not possible to distinguish the various layers 
composing the structure. Hemorrhage also occurs into the Jumen of 
the intestine. The ingesta are impregnated with blood, and the latter 
is also found free, being partly fluid and partly coagulated. In the 
abdominal cavity blood may be observed in the subserous cellular tissue, 
in the layers of the mesentery, or in the omentum. This results from 
rupture of the peritoneum and associated bloodvessels. Disseminated 
hemorrhagic foci (infarcts) involve the mucous and muscular coats of 
the intestine, and are especially observed in the vicinity of the insertion 
of the mesentery. 

Dark-coloured, slightly-prominent spots may be observed under the 
serous coat of the ileum, cecum, and colon. They are hemorrhagic 
infarctions due to verminous emboli. One aneurism or several may be 
found in the right trunk of the anterior mesenteric artery, and sometimes 
in the anterior division of the latter. The affected arteries may be com- 
pletely obstructed by thrombi, and the portion of intestine supplied by 
these vessels may show areas of necrosis and even perforation. Rupture 
of the right colic artery has been observed but is rare. When a vessel 
of the left division of the anterior mesenteric artery is involved, and 
its lumen obstructed by a thrombus, lesions occur in the small intestine. 
The portion of bowel supplied by the affected vessel shows a narrowing 
of its lumen, marked thickening of its walls, and an cedematous con- 
dition of its serous covering, these changes being due to a reflux of 
blood from the anastomoses in the vicinity. But in consequence of the 
free anastomoses in the left division, total obstruction to the circulation, 
producing fatal lesions, does not occur unless several adjacent divisions 
of the artery are simultaneously obliterated, which is a rare occurrence. 

In addition to the above morbid conditions, secondary changes in 
the circulation occur. Thus, when the circulation in the arteries of the 
right division of the anterior mesenteric becomes obstructed, the blood- 
pressure in the vessels of the left division and in the anterior division is 
increased, so that intense congestion and sometimes ecchymoses and 
abundant exudation occur in the small intestines, the large colon, and 
the floating colon. The increased vascular tension may also affect the 


DISEASES OF THE INTESTINES: HORSE 283 


circulation in the brain and lung, and induce congestion in these 
organs. 

Invagination of the intestine is another lesion that may be observed, 
and occurs when a contracted portion of bowel passes into a paralysed 
portion in its vicinity. Volvulus, displacements, and rupture of the 
intestine, may also be met with. According to Friedberger and Fréhner, 
volvulus of the left part of the double colon is a frequent result of throm- 
bosis and embolism, and the explanation suggested is that the arterial 
anzmia causes at first greatly increased peristalsis, which brings about 
the displacement of the bowel. 

According to Cadéae, the liver is always found in a state of advanced 
decomposition, even when the autopsy is carried out immediately after 
death. This alteration is said to result from the effects of toxic sub- 
stances and micro-organisms in the parenchyma of the organ, which they 
reach by way of the lymphatics and by the radicles of the portal vein. 
The spleen, in cases that last for more than twelve hours, is congested, 
or is studded with hemorrhagic foci consecutive to secondary intoxica- 
tion. 

Symproms.—An acute and a chronic form of the affection are recog- 
nised. 

Acute Form.—This is characterised by the sudden appearance of violent 
and continuous abdominal pain. As the case progresses, the violence 
of the symptoms increases, and the animal throws himself about and 
struggles in a. convulsive manner. If forced to walk, he carries his head 
low and his limbs in a semi-flexed manner, and he is liable to fall at any 
moment. The expression of countenance is anxious and haggard, the 
visible mucous membranes injected, the pulse full and quick at first and 
the cardiac impulse strong, the respirations accelerated and difficult, the 
surface of the body and extremities cold, and general sweating is often 
observed. Frequent attempts at defecation are made, but only small 
amounts of dry feces are passed, and this is followed by obstinate con- 
stipation. In some cases the animal frequently stretches out as if to 
micturate, but only a few drops of urine escape. 

Occasionally, instances are met with in which hemorrhage into the 
bowel and a paralysed condition of the viscus occur so rapidly that 
evidences of abdominal pain disappear early, or the colicky symptoms 
may be very slight; but the depressed head, cold sweats, imperceptible 
pulse, and unsteady gait, point to the serious nature of the case. 

Course.—In the peracute cases, the course is rapid, and death may 
occur within two, three, or four hours. The average duration is from 
two to ten hours. Death may result from various causes, such as intes- 


284 SYSTEM OF VETERINARY MEDICINE 


tinal tympany, volvulus, invagination, rupture of the intestine, hemor- 
rhage into the bowel, or septic absorption. Cases occur in which the 
pain is intense, and a fatal termination results in a short space of time. 
The horse falls to the ground, trembles violently, makes convulsive 
struggles, the head is drawn to the sternum, sweating is profuse the 
mouth is kept open, and the animal grinds his teeth and utters plaintive 
cries prior to death. 

In the cases that recover—at any rate, temporarily—the course is 
brief, although the pain exhibited may be very acute. In such instances 
it is probable that the vessel involved is only partially blocked by the 
embolus, or that the collateral circulation overcomes the effects of the 
obstruction. Evidences of recovery are the disappearance of the colicky 
pains, the passage of feces, which may be liquid and either normal in 
colour or blood-stained, free urination, and the return of appetite. 

In cases where hemorrhage into the intestine occurs, the following 
symptoms are observed: The colicky pains disappear or become less 
marked, the pulse is feeble, the visible mucous membranes are pallid, 
the surface of the body is covered by a cold sweat, the respirations are 
difficult, the nostrils dilated, the animal staggers if forced to move, 
general muscular tremors are observed, in some instances sanguinolent 
material is passed per anum, and finally the animal falls and dies in 
convulsions. Cases are recorded in which rupture of the verminous 
aneurism produced death by internal hemorharge; these are, how- 
ever, rare. 

Chronic Form.—According to some observers, this form is more likely 
to arise from thrombosis than from the presence of multiple emboli, as 
the latter tend to cut off the circulation to a portion of intestine in a 
more complete manner than the former. The small intestine is generally 
the seat of this type of the affection, as in consequence of the free anasto- 
moses in the circulation there is less tendency for acute symptoms to 
follow complete blocking of a vessel. 

- But in spite of the free anastomoses, there is considerable interference 
with the normal function of the intestine, and peristalsis is inhibited. 
Moreover, the presence of thrombi and emboli in the vessels of the left 
division of the anterior mesenteric artery, causing partial obstruction to 
the circulation, may produce a narrowing of the lumen of the bowel. 

After the disappearance of the acute symptoms, the appetite does 
not return, evidences of slow, intermittent, abdominal pain are observed, 
and constipation and diarrhoea may alternately succeed each other. 
Chronic catarrh of the intestine may persist, accompanied by debility 
and emaciation, and an attack of enteritis in varying degrees of severity 


DISEASES OF THE INTESTINES: HORSE 285 


may at any time ensue. In some cases fever, accompanied by slight 
intermittent colicky symptoms, may continue for several days or even 
weeks, and terminate in death, due to absorption of toxic materials from 
the intestinal canal. In other instances we observe high fever, weak, 
rapid pulse, emaciation, debility, recurring attacks of colic, thirst, blood- 
stained feces, weakness in the hind-quarters, gradually followed by 
evidences of hemorrhagic inflammation of the intestines. 

DIFFERENTIAL DiaGnosis.—This cannot be carried out with any 
degree of certainty. Sudden and violent evidences of abdominal pain 
occur under so many different conditions that it is very difficult to ascer- 
tain the lesion on which their presence depends. There is little doubt 
but that many cases now diagnosed as enteritis would, if careful autopsies 
were carried out, prove to be due to verminous aneurism and verminous 
emboli. If, in a case showing the symptoms described, a sanguinolent 
condition of the feeces was observed, it would be suggestive of thrombo- 
embolic colic. 

TREATMENT.—It is quite obvious that the therapeutical measures 
adopted can only be symptomatic. In the majority of instances treat- 
ment of any kind will fail to prove of benefit. Drastic purgatives are 
contra-indicated. Cadéac advises the iypodermic injection of morphine; 
also the administration of chloral hydrate in the form ofan enema. Cagny 
recommends codeine by subcutaneous injection. Ergotine is suggested 
to control the intestinal hemorrhage. Venesection is recommended by 
Continental authorities to overcome the intestinal congestion, and it is 
advised to practise this freely and rapidly. Friedberger and Frohner 
depend on calomel or neutral salts to overcome the intestinal paralysis 
and remove the accumulation of ingesta, but they deprecate the employ- 
ment of eserine as likely to induce volvulus or displacement of the 
bowel. 

It is obvious that anthelmintics cannot exert any effect on the para- 
sites lodged in the bloodvessels. 

For details of treatment with a view to destroying the worms present 
in the intestine, and for preventive measures, see the section on Parasites. 


ULCERATION OF THE INTESTINE. 


From a clinical point of view, it may be stated that the above con- 
dition is but seldom observed in the horse. The lesions are occasionally 
met with at autopsies, although their presence was not suspected during 
the life of the animal. They are generally secondary to other diseased 
conditions, especially in connection with the intestines, but they are also 


286 SYSTEM OF VETERINARY MEDICINE 


met with in certain specific affections. The following types of ulcers have 
been recognised : 


1. Catarrhal erosions, consisting of superficial abrasions of the 
epithelium. 

2. Follicular ulcerations. 

3. Round or perforating ulcer, occurring in the duodenum. 


The lesions have been observed in connection with the following 
morbid conditions: In enteritis catarrhal erosions may occur in the 
duodenum and other portions of the small bowel, while the follicular 
variety is met with in the large colon. In chronic enteritis, especially 
when accompanied by diarrhoea, a number of irregular ulcers may be 
found in the ceecum and large colon. In influenza and in purpura hemor- 
rhagica ulcers may occur in various portions of the intestines, and occa- 
sionally in cases of glanders ulcers are formed in the duodenum and 
other parts of the small bowel. Intestinal ulcers have occasionally been 
discovered in cases of epizodtic lymphangitis and ulcerous lymphangitis. 
The presence of foreign bodies, calculi, or fecal accumulations, may 
induce ulceration of the portion of bowel involved. Amongst other 
causal factors we may mention neojlasms of the intestine, the presence of 
parasites and of parasitic aneurisms, and the effect of certain toxic agents, 
such as arsenic. 

Morsip ANaTomy.—Catarrhal] erosions may be isolated, or may 
coalesce by their borders. Follicular ulcers cause the mucosa of the large 
colon to assume’a sieve-like condition ; the follicles become necrotic at 
their centres, and ultimately crater-like lesions result. When a number 
of these coalesce, an extensive surface of the mucosa is involved. Ulcers 
formed in connection with neoplasms of the intestine are irregular in 
shape and of a vascular fungous character. The ulcers formed in con- 
nection with aneurisms of the intestinal bloodvessels are generally 
located in the vicinity of the posterior extremities of the ileum ; they are 
more or less deep, and may be isolated or multiple. In some instances 
perforation occurs, and peritonitis results. Occasionally the lesion is 
complicated by rupture of the intestine. When perforation occurs in 
the duodenum close to the stomach, the ingesta may be confined between 
two layers of the mesentery, and so be prevented from entering the 
peritoneal cavity ; but suppuration may occur in the sac thus formed, 
and the resulting abscess may rupture into the peritoneum, setting up a 
septic peritonitis. 

We met with one case in which a deep round ulcer was situated in the 
duodenum, directly over the openings of the bile-duct and pancreatic 
duct. The lesion was complicated by dilatation of the stomach. 


DISEASES OF THE INTESTINES: HORSE 287 


Symproms.—In the majority of instances there are no characteristic 
symptoms observed in connection with ulceration of the intestine. In 
some cases the symptoms resemble those occurring in chronic enteritis. 
Occasionally certain phenomena are presented which enable us to diag. 
nose the condition. These are diarrhea of a dysenteric or hemorrhagic 
character, and the occurrence of colicky pains after the ingestion of solid 
food. The diarrhcea is profuse, and the dejecta contain bloody strie, 
fragments of intestinal mucosa, and, in the case of neoplasms, portions of 
the latter are expelled. When a limited haemorrhage occurs from the 
ulcers, the dejecta are of a black colour ; but when it is profuse, they 
contain blood in abundance. A general septicemia is present in some 
cases, depending on an invasion of the system by micro-organisms and 
absorption of toxins. When perforation occurs, the usual symptoms of 
septic peritonitis are in evidence. Occasionally cicatrisation of the 
ulcers is brought about, and stenosis of the intestine results. 

TREATMENT.—Opiates are advised to check the hemorrhage and 
diarrheea. Intestinal antiseptics, such as naphthol, salol, etc., are also 
indicated, while attention to diet is essential ; food of a soft nature only 
should be allowed. In severe cases it is hardly likely that any treatment 
will prove of service. 


ABSCESS OF THE INTESTINE. 


This lesion is sometimes met with as a complication in cases of 
irregular strangles. The abscess may form on the walls of the intestine 
or in connection with the mesenteric glands. Occasionally, as a sequel 
to catarrhal enteritis, small abscesses may form in the mucous glands 
or Peyer’s patches. Traumatic injuries of the abdomen, such as punctures 
by sharp instruments, may be followed by abscess formation in the bowel. 
The presence of sharp foreign bodies, also of certain parasites, in the 
intestine may induce suppurative lesions. When occurring in connection 
with strangles, the abscesses may be of large size, and adhesions may form 
between the intestine and organs in the vicinity, or the abdominal 
walls. In some cases a series of very small abscesses may be found in 
the intestinal wall or between the folds of the mesentery. The abscesses 
may contain inspissated pus, or they may rupture into the intestine, into. 
the peritoneal cavity, or through the abdominal wall. 

Symproms.—There are no characteristic symptoms in connection with 
this lesion. The affection can only be diagnosed when the abscess can 
be detected by rectal examination. The history of the case is of im- 
portance, and if the animal had suffered from an attack of strangles some 
time previously, this fact would assist in the diagnosis. The general 


288 SYSTEM OF VETERINARY MEDICINE 


symptoms observed are loss of condition, debility, the occurrence of 
colicky pains and tympany shortly after feeding, the emission of groans 
when lying down, rising, or turning round sharply. When the abscess 
extends to the abdominal wall, a swelling is observed in the region of the 
flank, at first firm and solid, but later on fluctuating in the centre. By ~ 
rectal exploration it is sometimes possible to detect the abscess as a 
round, fluctuating tumour, which may be of large size, and is tender on 
palpation. Occasionally, when the abscess ruptures into the intestinal 
canal, pus may be passed per anum. When rupture takes place into 
the peritoneal cavity, the usual symptoms of septic peritonitis will be 
in evidence. 

TREATMENT.—When the abscess 1s beyond the reach of surgical inter- 
ference, nothing can be done in the way of treatment ; moreover, it is 
hardly likely that a definite diagnosis could be arrived at. When, how- 
ever, the abscess approaches the surface of the abdominal wall, its con- 
tents should be evacuated and the abscess cavity irrigated with an anti- 
septic solution. Occasionally it may be possible to locate the abscess 
per rectum and to remove the contents by means of a trocar and cannula, 
carefully inserted and manipulated. 


e 


STRICTURE OF THE INTESTINE. 


In this condition the calibre of the intestinal tube is diminished, due 
to morbid alterations in the walls of the portion of bowel involved. In 
most cases it 1s associated with dilatation of the intestine just anterior 
to the lesion. Stricture may result from a variety of causes. Cicatricial 
contractions of the intestinal wall account for a number of cases. These 
may follow wounds due to foreign bodies, injuries inflicted by parasites, 
compression due to intestinal concretions, ulceration of the bowel, ver- 
minous embolisms, etc. The lesion is more frequent in the small intestine, 
especially at the termination of the ileum. Mauri records a case of 
stricture of the rectum associated with a dilatation anteriorly. The 
stricture is generally very short, and the intestinal wall at this part very 
thick and rigid ; the calibre is much reduced, but complete occlusion is 
rare. In some instances a thick external layer of adipose tissue surrounds 
the stricture. The serous coat may be normal, or it may show thicken- 
ing and the presence of partly organised exudates. Dupas records a case 
in which a series of strictures were observed in the duodenum associated 
with dilatations. Anterior to the stricture, the intestine may be saccu- 
lated and filled with ingesta or distended by gas. Abscess formation 
and ulceration may occur as complications. 

Stricture may be due to interference with the circulation, depending 


DISEASES OF THE INTESTINES: HORSE 289 
on verminous emboli, causing what is termed an ‘inflammatory stric- 
ture.” The exudate in the intestinal walls becomes organised, producing 
thickening and constriction of the tube, while secondary dilatation 
develops anterior to the lesion. 

Neoplasms of the intestinal walls may also be factors in the produc- 
tion of stricture. A sublumbar tumour may produce a similar condition. 

Symproms.—From the clinical history given by those authors who 
have observed cases of intestinal stricture, it would appear that no charac- 
teristic symptoms are presented. Slight intermittent attacks of colicky 
pains at irregular intervals, especially after feeding, have been observed for 
a lengthy period. If the lesion occurs in the small bowel, close to the 
pylorus, gastric symptoms will be in evidence. Constipation is generally 
present, but in some cases the accumulated ingesta anterior to the 
stricture cause a chronic purulent catarrh, and diarrhea results. When 
the stricture depends on the presence of a tumour in the sublumbar region, 
this can be detected by rectal exploration. The stricture may remain 
incomplete for an indefinite period, or it may become complete. When 
incomplete, progressive emaciation is observed, and appetite is interfered 
with ; the animal becomes unfit for work, and tends to assume the 
recumbent position for long intervals. The stricture is liable to become 
complete at any time ; then the usual symptoms of complete obstruction 
of the intestine will be in evidence. Retching, vomiting, and even 
rupture of the stomach, have been observed as complications. The 
closer the lesion is to the pylorus, the more marked are the symptoms. 
When the stricture occurs in the rectum, difficulty in defecation is present, 
and the feces become altered in appearance, being small and ovular in 
shape. 

TREATMENT.—Beyond adopting dietetic measures to prevent ob- 
struction of the bowels—i.e., allowing soft food—nothing can be done 
in the way of treatment. When the lesion is situated in the rectum 
within reach, attempts at gradual dilatation may be made by means of the 
hand, or with suitable instruments. 


DILATATION OF THE INTESTINE. 


This lesion may occur in connection with a variety of conditions. 
A temporary dilatation accompanies impaction of the large intestine, 
which, however, disappears when the affection yields to treatment. 
Dilatation of a permanent character may occur in connection with 
stricture of the bowel, the presence of foreign bodies, such as large 
quantities of sand, calculi, tumours, etc. The dilatation is found 
anterior to the obstruction, and the intestinal walls are in a paralysed 

VOL. II. 19 


290 SYSTEM OF VETERINARY MEDICINE 


state. Aneurisms, thrombi, and emboli, affecting the blood-supply of 
the intestines, interfere with the circulation in the walls of the bowel, 
induce paralysis therein, stasis of the contents, and finally dilatation as a 
result. Amongst other causes may be mentioned lesions of the nerve- 
supply of the bowels, such as pressure from neoplasms, strictures depend- — 
ing on adhesions between the peritoneal covering of neighbouring loops 
of intestine, due to a circumscribed peritonitis. 

A circumscribed dilatation may result from a partial rupture, in which 
the mucosa passes through an opening in the muscular coat of the 
bowel. 

Dilatation may occur in various locations. In the duodenum the 
lesion has been observed anterior to a stricture, and sometimes in the 
form of a large diverticulum containing parasites. 

In the ileum diverticula of various forms have been met with. (1) A 
congenital form of large capacity, with walls composed of muscular 
fibres and connective tissue, and communicating with the bowel by a 
narrow passage. (2) At the termination of the ileum (the so-called 
ileo-czecal valve) one or a series of diverticula have been observed, of 
various sizes. Their walls are thin and composed of a mucous and serous 
coat, reinforced with new growths of connective tissue. They are of 
the nature of an incomplete hernia of the intestinal wall, and some authors 
regard them as having a congenital origin. Cases are recorded in which a 
diverticulum of this nature contained a large amount of sand. (3) The 
diverticulum of Meckel (see p. 233) may form a large pouch or dilatation 
connected with the ileum 3 or 4 inches in front of the so-called ileo-cecal 
valve. Cases are on record in which this form of diverticulum was of 
very large size. According to Cadéac, if the terminal extremity of the 
diverticulum reaches the umbilicus, it is possible that, owing to traction 
exerted by the umbilical cord, an artificial anus may be formed at the 
umbilical opening, through which ingesta may escape. 

In the cecum, when its walls become paralysed, alimentary stasis 
occurs and dilatation ensues. According to Degive, under these conditions 
it may occupy a large portion of the abdominal cavity. Diverticula of 
congenital or traumatic origin have been observed in connection with 
this viscus, which may be of extensive size and contain large amounts of 
ingesta. 

The large colon, owing to external injuries or congenital defects, may 
show diverticula of large size filled with ingesta. These lesions have 
been observed in newly-born foals. 

The floating colon rarely shows dilatation or diverticula. 

The rectum may show dilatation, either in connection with a stricture 


DISEASES OF THE INTESTINES: HORSE 291 


or following a paralysed condition of the organ, depending on a spinal 
affection. 

Symproms.—There are no characteristic symptoms of dilatation of 
the intestine, except when the rectum is involved. Slght intermittent 
colics, with or without tympany, may be observed. Complications, such 
as acute intestinal obstruction, or lesions, such as strangulation in con- 
nection with diverticula, may occur (see p. 233). Rupture of the bowel 
has resulted in some cases, followed by peritonitis. 

In dilatation of the rectum this organ is found distended with feces, 
and the lumen is increased in extent. On removal of the contents 
temporary relief is given. 

TREATMENT.—The therapeutical measures are similar to those advised 
for cases of impaction and paralysis of the bowels. Obviously, when the 
small intestines are the seat of the lesion, treatment cannot prove of any 
value. In the majority of instances the condition is only recognised 
post mortem. When the rectum is involved, the treatment is similar 
to that advised for paralysis of this organ (see p. 215). 


NEOPLASMS OF THE INTESTINE. 


These are of more interest to the pathologist than to the clinician. 
Except in cases where the tumour is situated within reach by rectal 
examination, diagnosis is impossible ; and even if the lesion was recog- 
nised, treatment could not prove of any value. The effect of these 
tumours is to interfere with the lumen of the intestine, either by their 
presence in the bowel wall or by the compression they induce when occur- 
ring in the mesentery. But in addition to the above effect, they may 
interfere with other organs in the abdominal cavity by exerting com- 
pression thereon, or by forming adhesions. The most common seats of 
these tumours are the pylorus and the rectum ; after these come the duo- 
denum, the terminal portion of the ileum, the caecum, and the large colon. 
The small colon is generally unaffected. ‘The tumours found in connec- 
tion with the pylorus, duodenum, and other parts of the small intestine, 
are generally of small size, and at a post-mortem may be overlooked 
unless carefully sought for. On the other hand, the tumours found in 
connection with the cecum and large colon may be of large extent even 
before they interfere with the lumen of the bowel. 

In connection with the small intestine the tumour may be motile, 
but after a time it may become fixed by adhesions ; while the neoplasms 
associated with the cecum and colon are fixed and adherent. 

In the case of malignant tumours, extensive adhesions may be present 
between the neoplasm and organs in the vicinity. Generalisation may 


292 SYSTEM OF VETERINARY MEDICINE 


occur, the lymphatic glands being involved, and the omentum and 
mesentery become covered with a mass of secondary neoplasms. 

The tumour may be situated in the submucous tissue, and extend 
into the lumen of the bowel ; it may involve the mucosa; it may extend 
around the bowel in the form of an annular ring; or it may originate in - 
the mesentery. In some forms, such as lipomata, the neoplasm may be 
pedunculated. When the mucosa is involved, it becomes soft and friable, 
and may be ulcerated and hemorrhagic. When stenosis of the bowel is 
produced, the part anterior to the lesion becomes dilated, and the mus- 
cular coat may show hypertrophy, due to the efforts of the intestine to 
overcome the obstruction. Malignant growths, such as encephaloid 
carcinomata and sarcomata, tend to produce ulceration of the mucosa 
rather than to induce stenosis. | 

Carcinomata, epitheliomata, and adeno-carcinomata are not common, 
but a number of cases have been recorded. The portions of intestine 
involved are the duodenum, the czecum, and the large colon, and stenosis 
of these structures is produced. 

Sarcomata may involve any part of the intestines, and a variety of 
forms have been met with. Melanotic sarcomata have been observed in 
the small bowel and in the point of the cecum. A case of ossifying fibro- 
sarcoma of the colon is recorded by Baranski. 

Lipomata are of comparatively common occurrence. They are usually 
found in connection with the small intestine or the rectum. They may 
be sessile or pediculated, and in the latter instance, when growing from 
the mesentery or at its connection to the bowel, volvulus may be induced 
(see p. 234). 

Chondromata are very rare. They develop between the mucosa and 
the muscular coat ; they may be of large size, and show centres of calcifica- 
tion. Ossification may occur in these tumours, as well as in adenomata. 
Drouin records instances in which osseous plates were found in the depth 
of the intestinal wall. 

Polyyi belong to the fibro-myxomata. They may occur in the 
rectum, and occasionally in the small intestine. Friedberger and Frohner 
record cases in which a polypus originating in the stomach entered the 
duodenum and stretched this portion of intestine even to rupture. The 
polypus is generally single, but a number may be present. Its pedicle 
varies in thickness, and in some instances may resemble a fine thread. 
When occurring in the rectum, a polypus may be torn from its pedicle by 
the efforts of defeecation and expelled with the faeces. 

Amongst other tumours, of which cases have been recorded, we may men- 
tion adenomata, myomata, fibromata, myxomata, and lymphadenomata, 


DISEASES OF THE INTESTINES: HORSE 293 


SymptToms.—Until there is some interference with the lumen of the 
intestine, no symptom may be observed. When stenosis results, the 
symptoms of this condition will be in evidence (see p. 288). ~Unless the 
tumour can be detected per rectum, a diagnosis cannot be arrived at. 
In the case of malignant growths, emaciation, debility, anemia, and a 
cachetic condition will be present. Gastric symptoms predominate in 
some cases. Alternate attacks of constipation and diarrhcea, have been 
observed in some instances ; the feeces may contain blood or portions of 
the tumour, and are very foetid. In the majority of cases the lesions 
are only discovered after death. 

TREATMENT.—Except in cases where the neoplasm is situated in the 
rectum and within reach of surgical interference, no treatment can prove 
of service. Rectal polypi should be removed by means of the écraseur. 
Cases of spontaneous cures are recorded in which the tumour, when 
pediculated, was discharged with the feces. 


HEMORRHOIDS. 

Synonym.—Piles. 

These are small projections or tumour-like bodies, formed by a varicose 
condition of the hemorrhoidal veins. Two varieties are recognised : 

1. Hxternal.—They are of comparatively rare occurrence in the horse, 
and may consist of a cluster of small cutaneous projections, made up 
chiefly of hypertrophied perirectal connective tissue, occurring secondary 
to inflammation of the mucosa of the anus, and not truly hemorrhoidal 
in character. Or the external veins in this vicinity may be involved, 
and suffer from phlebitis, leading to thrombosis ; rupture of these vessels 
may occur, and soft tumours result. 

2. Internal.—This is the variety met with in the horse. The pro- 
jections arise from the posterior end of the rectum close to the anus, 
They are composed of enlarged veins, hypertrophied connective tissue, 
and mucous membrane. In long-standing cases they may occur in the 
form of tumours, composed of a varicose vein, connective tissue, and an 
arterial twig, which protrude from the anus during defecation. Occa- 
sionally they occur as sessile ulcerative excrescences, which bleed readily 
when irritated by the passage of hard feces. 

The cause of hemorrhoids is stasis in the hemorrhoidal plexus, 
depending on a sluggish portal circulation ; this latter occurs in derange- 
ments of the liver or of the heart. The anatomical conditions of the 
hemorrhoidal veins predisposes to the occurrence of hemorrhoids, as 
they are situated in comparatively lax structures and contain no valves. 

No symptoms may be noticed in some cases beyond the protrusion of 


294 ~ SYSTEM OF VETERINARY MEDICINE 


the hemorrhoids during or for a short time subsequent to defecation. 
In other cases, and but rarely, switching of the tail and a tendency to 
rub it against walls, etc., may be observed, and the feces may be tinged 
with blood. 

TREATMENT.—When the hemorrhoids are large and tend to protrude 
from the anus, they should be removed either by ligature or by means of 
the thermo-cautery. In other instances attention to the diet, laxatives, 
and the application of ointments containing hazeline, galls, and opium 
to the affected parts, will constitute the treatment. 


RUPTURE OF THE INTESTINE. 


Rupture of the intestinal walls occurs under a variety of conditions. 
Thus, it may result from over-distension due to excessive tympany, or 
to extreme impaction. Again, it may follow degenerative changes in 
the intestinal] walls, or alterations due to the presence of parasites. In 
such instances, owing to interference with normal peristaltic action, 
impaction or tympany are induced, so that the conditions may be com- 
bined. The employment of eserine, arecoline, and barium chloride in 
the treatment of intestinal impaction is not infrequently followed by 
rupture, owing to the violent muscular contractions produced, especially 
when the obstruction is unaffected by the agents, or if the intestinal walls 
are weakened from any cause. As already mentioned, it may occur in 
connection with stricture, dilatation, or ulceration of the intestine, also 
from intestinal calculi. The presence of foreign bodies is occasionally 
found to be a cause of rupture. Rupture of the intestine has occurred 
when an ordinary aloetic physic ball has been administered by error in 
cases of volvulus or torsion. The lesion is observed just anterior to the 
obstruction, and is due to the distension produced by the ingesta en- 
deavouring to pass along the bowel, the wall of the latter being of course 
much weakened by inflammatory changes. Mechanical injuries, such 
as violent falls, contusions, kicks, etc., may produce the lesion. Violent 
exertion is recognised as an etiological factor. Thus F. Smith* records 
a case in which a horse in a cavalry charge ruptured the ileum “ as com- 
pletely as if the parts had been torn asunder by hand.” 

The lesion may be small in extent, and is then termed a perforation ; 
or it may be extensive, in which instance death occurs in a short space of 
time. The large intestines are more commonly affected than the small 
bowels. 

As regards the incidence of the lesion, we find in the Report of the 
Army Veterinary Service for 1911 that twenty cases were recorded, 


isi Veterinary Physiology.” 


DISEASES OF THE INTESTINES: HORSE 295 


and in the Report of the Army Veterinary Service in India, 1911-12, 
eleven cases were recorded. 

Certain portions of the intestine, as follows, seem more likely to be 
affected than others. 

Duodenum.—In the cases recorded by authors and by practitioners, 
the lesions occurred in connection with tumours, or with parasites such 
as the Ascaris megalocephala, which accumulate in a mass, or in a pouch 
in connection with the wall of the bowel. Foreign bodies, such as pieces 
of wire, etc., may beacause. Law met with a case in which the duodenum 
at the pylorus was perforated by portions of woody plants. Rupture has 
also been recorded in connection with purpura hemorrhagica. 

Ileum.—The lesion generally occurs close to the termination of the 
ileum in the cecum. It may follow obstruction, ulceration, or the pres- 
ence of a tumour; also impaction of the cecum, owing to the stasis of 
ingesta in the ileum which is thus induced. Cases are recorded of um- 
bilical hernia in which adhesion between the ileum and the hernial sac 
was present, and on the clamp being applied, perforation and rupture of 
the intestine followed. . 

Cecum.—Rupture may occur from mechanical injuries. Impaction 
of the ceecum is generally followed by rupture. Certain parasites cause 
degenerative changes in the walls of the bowel, and rupture may result. 
The lesion may occur at the base of the viscus, or in its longitudinal 
direction. We have met with a case of perforation of the cecum follow- 
ing the employment of Degive’s operation for umbilical hernia. At the 
autopsy the bowel was found adherent to the abdominal wall in parts, 
and death occurred from peritonitis. As no symptoms appeared until 
the sixth day after operation, it seems hardly likely that the bowel could 
have been included in the clamp. Law states that post-operative in- | 
flammation extending from the umbilicus may determine adhesion and 
perforation of the cecum. 

Large Colon.—Severe impaction, tympany, the presence of calculi, 
parasites, tumours, torsion, abscess formation, mechanical injuries, etc., 
may lead to rupture of this organ. Necrotic changes in the wall of the 
bowel, associated with obstruction, render the lesion more liable to occur. 
The most common seat of the lesion is anterior to the pelvic flexure. 

Rectum.—Rupture of the rectum has been observed under a variety of 
conditions. It may occur in connection with paralysis and degenera- 
tion of the rectal walls, the presence of a tumour, and in the mare as 
the result of an accident during parturition, one of the feet of the foal 
passing through the rectal wall. Cases may also occur when, during 
attempts at copulation, the penis of the stallion enters the rectum of the. 


296 SYSTEM OF VETERINARY MEDICINE 


mare instead of the vagina. Williams records a case that resulted from 
an aneurism of the hemorrhoidal arteries, the pressure of the aneurismal 
tumour having caused atrophy, not only of the muscular and peritoneal, 
but also of the mucous coat of the intestine, and rupture of these was 
caused by some sudden effort; hemorrhage then occurred into the 
intestinal canal and peritoneal cavity. When the rupture occurs anterior 
to the portion of the bowel covered by peritoneum, fecal matters and 
blood enter the peritoneal cavity and set up a fatal peritonitis ; but if the 
lesion is situated posterior to the above-mentioned region, it is not 
necessarily fatal. 

Symproms.—There are no characteristic symptoms of rupture of the 
intestine. In some instances violent colicky pains are suddenly mani- 
fested ; the animal may sit on his haunches and make attempts at vomi- 
tion. Robertson observed that when the lesion occurred in connection 
with impaction and tympany of the large colon, the symptoms of pain 
disappeared and an apparent relief was exhibited ; but the following 
phenomena were manifested—viz., rapid exhaustion; a haggard ex- 
pression of countenance ; a frequent, small pulse, which becomes thready 
and finally imperceptible ; cold sweats ; short, catchy respirations ; a dis- 
inclination and inability to move, the animal balancing himself, as it 
were, on the limbs until death took place. 

In the case of perforation of the cecum already alluded to, we found 
no evidences of pain, but greatly accelerated respirations, slight tympany, 
a temperature of 106° F., a gradually imperceptible pulse, and a hard, 
tense condition of the abdominal muscles. In rare instances the lesion, 
when in the form of a perforation, may become attached to the abdominal 
wall, or to the umbilicus, a fistula being formed without the peritoneum 
becoming infected. 

DIFFERENTIAL D1AGNosIs.—Some observers state that by the employ- 
ment of the trocar and cannula a valuable diagnostic feature will be put 
in evidence—viz., in rupture of the intestine a foetid, blood-stained fluid 
will issue from the cannula. We presume, however, that such does not 
occur until some time has elapsed subsequent to the rupture, and in the 
case of a small perforation this period would be still further delayed. 

With reference to diagnosis we are in agreement with Robertson, who 
tersely remarks : ‘‘ With many there is nothing attractive or diagnostic in 
the symptoms to differentiate this condition from ordinary fatal bowel 
affections in which inflammatory action plays an important part, and the 
lesion is not even suspected until an after-death examination has been 
made. In cases of rupture of the rectum, when the lesion is within reach 
of the hand, a diagnosis can be made by rectal exploration.” 


DISEASES OF THE INTESTINES: HORSE 297 


TREATMENT.—It is quite obvious that, except in cases of rupture of 
the rectum with the lesion within reach, treatment of any kind is hope- 
less. For the surgical treatment of rupture of the rectum the reader is 
referred to works on veterinary surgery. , 

Willams records a case in a mare in which the rectum was pierced by 
the foot of the foal during parturition, causing a recto-vesical (sic) fistula. 
The lips of the wound were brought together by metallic sutures, and the 
animal made a perfect recovery. 


HAMORRHAGE OF THE INTESTINES. 


This is in reality a symptom which may occur in various affections of 
the intestines, and in certain diseases of a hemorrhagic nature. It must 
be remembered that in hemorrhage of the stomach the blood may be 
carried to the intestine, and it is not then possible to ascertain its source. 
The following conditions may be associated with intestinal hemorrhage : 
Foreign bodies, certain parasites, irritants, ulcers, volvulus, invagination, 
cirrhosis of the liver, dysentery, anthrax, purpura hemorrhagica, injuries 
of the rectum, tumours, and hemorrhoids. 

Symproms.—In cases such as volvulus, the hemorrhage is retained in 
the imprisoned portion of bowel, and is not discharged per rectum. The 
condition is then evidenced by pallidity of the visible mucous membranes 
and other signs of internal hemorrhage. A similar state of affairs some- 
times occurs in purpura hemorrhagica, owing to paralysis of the bowel. 
In other instances the phenomenon present is the passage of blood with 
the feeces, which present hemorrhagic characters, or may be dark-coloured 
or tarry owing to the effects of digestion on the blood in the intestinal tube, 
and this condition is sometimes termed melena. When the hemor- 
rhage originates in the rectum, the blood may be passed in an unaltered 
condition, either mingled with the feeces or expelled after defecation. 

TREATMENT.—Various agents of a styptic nature are suggested to 
control the hemorrhage. These include alum, tannin, acetate of lead, 
etc., also intestinal astringents and sedatives, such as opium, chlorodyne, 
etc. Vascular constrictors, such as ergot or adrenalin, are also advised. 
Soft, unirritating diet should be ordered and perfect rest. It is obvious 
that there are certain conditions presenting intestinal hemorrhage as a 
symptom which are beyond the aid of the therapeutist. 


DYSENTERY. 


Dysentery is a condition in which certain morbid changes occur in the 
mucosa of the large intestines, consisting of hyperemia, hemorrhages, 
removal of epithelium in patches, and the presence of diphtheritic deposits, 


989 SYSTEM OF VETERINARY MEDICINE 


followed by the formation of ulcers. It is regarded as being of compara- 
tively frequent occurrence in cattle, but is said by many authors to be 
very rarely met with in the horse. Williams describes the disease as 
much more commonly seen in cattle, dogs, etc., than in horses, and 
occurring “ as an inflammation having a tendency to terminate in ulcera- 
tion of the mucous membrane and glandular structures of the large, and 
sometimes the small intestines.” Farther on he states that the disease 
may be induced in horses as well as in cattle by bad food or putrid water, 
but he gives no clinical description of the affection in equines. We find 
no mention of the malady in the Report of the Army Veterinary Service 
for 1911, nor in the Report of the Army Veterinary Service in India for 
1911-12. 

Robertson* appears to be the only British author who gives a detailed 
description of dysentery in the horse. He defines it as “‘ an intestinal 
inflammatory action of a peculiar or specific character, attended with 
fever, occasional abdominal pain, and fluid alvine discharges mingled with 
blood or albuminous materials, the tissue changes, which are usually 
regarded as special, being situated chiefly in the minute gland structures 
and interconnective tissue of the large intestine, and of an ulcerative or 
gangrenous character.” Although closely allied to diarrhoea in many of 
its features, it is distinguished therefrom by the presence of constitutional 
disturbance and of local inflammatory action, with special tissue changes. 
It may follow an existing attack of diarrhcea, or occur as a disease per se, 
and is chiefly met with in young horses exposed to adverse climatic con- 
ditions, but is encountered in all classes when subjected to improper 
feeding and unsanitary surroundings. There is no evidence of microbic 
infection as an etiological factor. The number of cases met with are not 
numerous. The lesions observed were at first small spots or elevations of 
the mucosa, projecting from a swollen and hyperemic base, and when 
closely examined gave the idea of increased vascularity and swelling, 
either of the minute glands of the intestine, of the connective tissue sur- 
rounding them, or of both. Necrotic changes and ulcerous sores are 
produced ; a diphtheritic-looking exudate is in many cases found, chiefly 
on the free surface, but this in several instances is the altered covering 
membrane during the process of its removal. A similar exudation is 
found in the submucous tissue. The ulcers, when healing is complete, 
appear as scars, and show a dense texture and an absence of gland 
structure. The gland structures of the mesocolon in connection with the 
portion of bowel involved are swollen, softer than normal, and dark- 
coloured. The symptoms observed were diarrhea, fever, marked pros- 


* « Wguine Medicine.” 


DISEASES OF THE INTESTINES: HORSE 299 


tration, occasionally persistent rigors, diarrhcea accompanied by occasional 
and irregularly occurring pain, the dejecta fluid and rarely containing 
hardened masses of fecal matter, the liquid portion composed largely of 
mucus and a jelly-like material mingled with shreds of membrane or 
blood, the whole being of a tenacious gluey character and very offensive. 
In severe cases the appetite is lessened, thirst is present, also abdominal 
pain, and all treatment has no effect, the animal dying of exhaustion in 
a short time. In other instances the course was slower, extending over 
three weeks. The animals showed marked marasmus, with an anxious 
countenance. The treatment advised by Robertson was careful attention 
to diet, the food allowed being soft, emollient, and nutritious. When 
exhaustion is marked, milk, raw eggs, beef tea, and port wine should be 
given. If there is a tendency to retention of feeces, raw linseed oil is to 
be given in the food. When pain is present and the dejecta are very 
foetid, glycerine of carbolic acid with opium is prescribed every four to 
six hours. Ipecacuanha (1 drachm), with powdered opium (} drachm), 
administered in the form of bolus two or three times daily, proves useful in 
some cases. Other agents, such as sulphate of copper or acetate of lead, 
in combination with opium, may also be tried. 

We have deemed it advisable to give the above description of the 
disease, taken from Robertson’s work, as we have never met with cases 
of dysentery in the horse. That such a careful clinical observer as 
Robertson recorded this affection is sufficient indication of its existence, 
and renders it worthy of insertion in a work on veterinary medicine. 


DIARRH@GA. 


This term is applied to a condition in which the feeces are more or less 
liquid and discharged at frequent intervals, but constitutional phenomena 
and morbid alterations in the intestinal walls are absent. It should be 
regarded as a symptom rather than a disease per se, as it is met with 
during the course of various affections. Not uncommonly it must be 
regarded as an effort of Nature to eliminate irritating ingesta from the 
intestines. Sudden changes of diet may induce diarrhoea, especially 
from dry food to soft, or to grass or roots. New hay or new oats may 
cause the condition in some horses. Chills, drinking cold water after 
feeding, chronic indigestion, liver derangement, etc., are recognised as 
etiological factors. Some authors regard the condition as accompanied 
by congestion of the mucosa and profuse secretion into the intestinal 
canal. Some horses are subject to diarrhcea without any apparent cause. 
Such animals are often of a peculiar formation, being narrow-loined, flat- 
sided, and showing a long space between the ilium and the last rib. Again, 


300 SYSTEM OF VETERINARY MEDICINE 


some nervous, excitable horses are prone to purge when starting on a 
journey. Asa rule it is very difficult to get such animals into condition. 

Diarrhcea is observed as a premonitory symptom in certain intestinal 
affections, such as enteritis and impaction of the cecum. It may also 
occur towards the termination of debilitating affections, and is found in 
connection with certain parasites in the alimentary canal. 

Diarrhcea in foals is of so much importance that it merits a special 
description (see p. 301). : 

Symproms.—In simple diarrhoea there is no constitutional disturb- 
ance. In the more severe form, which we shall consider later (see p. 303), 
serious symptoms develop, and even a fatal result may ensue. In the 
simple form the liquid feeces may not show much alteration in colour or 
odour, but in some instances they are of a dirty-brown appearance, or 
may be clay-coloured and fcetid. The condition tends to cease either 
spontaneously or with rational treatment. If neglected, the case may 
proceed to the more serious condition—viz., superpurgation (see p. 303). 

As a symptom, diarrhoea should not be lightly regarded, as it may be 
the forerunner of a serious or fatal affection. 

TREATMENT.—In simple diarrhoea the cause should be ascertained, if 
possible. When depending on the presence of undigested material in the 
alimentary canal, a small dose of raw linseed oil is indicated. The animal 
should be kept at rest ; the drinking-water should not be given cold, but 
a proper amount of warm water should be added to it. Diet is of import- 
ance ; boiled starch or flour-gruel is indicated, and unless the diarrhcea is 
profuse a small amount of hay may be given. It is unwise to commence 
treatment with astringents, as a sudden check to the diarrhoea may lead 
to complications. But if simpler measures fail to check the condition, a 
moderate dose of chlorodyne, with prepared chalk, should be given. Some 
practitioners advise the employment of dilute sulphuric acid in small 
doses. Should depression occur, a stimulant, such as a good dose of 
brandy, will prove useful. After an attack of diarrhcea the horse should 
not be put to work until the bowels return to a normal condition. 


DIARRH@GA IN FOALS. 


We have already drawn attention (p. 278) to a serious form of 
diarrhcea in foals depending on a catarrhal form of enteritis. In the 
present section we purpose to deal with what is probably one of the 
commonest affections in foals from one to two weeks old. In a breeding 
district the practitioner meets with a large number of cases of what is 
popularly known as “ scouring ” in foals, the leading symptom of which 


DISEASES OF THE INTESTINES: HORSE 301 


is the presence of diarrhoea in various degrees of severity. Mild cases 
readily yield to simple treatment, but when such are neglected or irration- 
ally treated, or occur in animals of a weak constitution, colicky pains may 
be manifested, with marked depression, and death may result from exhaus- 
tion. Clinically, it may not be possible to differentiate these latter from 
cases depending on catarrhal enteritis, but we do know that the lesions found 
post mortem in many cases are not those of inflammation of the intestines. 
In some instances a moderate degree of congestion of the intestinal 
mucosa is the only lesion present, and the intestines are generally found 
empty. In others a catarrhal exudate is found on the mucosa, and 
superficial erosions are observed. Robertson in some instances met with a 
moderate amount of dark-coloured serous fluid in the abdominal cavity 
and a few patches of ecchymoses on the serous coat of the intestine, while 
the mesenteric glands in connection with the portion of bowel affected 
were somewhat enlarged, darkened in colour, and rather softened. 
(Edema of the mucosa, due to infiltration of a gelatinous material, was also 
observed, and the exudate on examination showed the presence of a large 
quantity of epithelium, associated with micro-organisms, the nature of 
which was undetermined. The liver was found anemic and of a pale 
clay colour. 

ErroLogy.—In some cases it is not possible to discover the etiological! 
factors. Various causes have been suggested, such as defective sanitary 
surroundings and alterations in the lacteal secretion of the dam, so that 
the milk is unfit for digestion, and sets up irritation of the intestinal 
mucosa. But we know that the condition may arise in the absence of 
such causes. Certain foods given to the dam may produce changes in 
the milk, which cause diarrhoea in the foal. One etiological factor we 
are fully acquainted with—viz., the custom of separating the foal from 
the dam for long intervals while the latter is kept at work. In such 
instances the mare may return to the foal in a fatigued condition, the 
milk probably long retained in the udder (unless the attendant has 
sufficient common sense to draw it off) may undergo alterations, rendering 
it unfit for digestion. Again, the foal being kept without nutriment for 
a long period, generally ingests more milk than his stomach, weakened by 
the enforced abstinence, is able to digest. Dyspepsia results, and the 
irritating products formed induce diarrhoea. Unhealthy foals in weak 
condition are specially predisposed to diarrhoea, and the latter may be 
associated with joint-ill in some cases. When a foal has to be reared on 
cow’s milk, owing to the death of its mother, diarrhcea is not uncommon. 
In such instances a little water and sugar should be added to the milk 
as a prophylactic measure. 


302 SYSTEM OF VETERINARY MEDICINE 


Symptoms.—In mild cases the prominent symptom is the frequent 
passage of liquid feces of a yellowish-white appearance. Ifthe cases be neg- 
lected, or if the affection be severe from the outset, the faeces are very foetid, 
the skin around the anus and posterior aspect of the thighs becomes soiled 
and irritated, constitutional disturbance is present, and in some instances 
colicky pains and tenesmus appear. The animal loses condition rapidly, re- 
fuses to suck the dam, exhaustion supervenes, and death takes place in a 
variable period. Pneumonia is sometimes observed as a complication, but 
this is probably due to careless drenching in many of the cases met with, 

Proenosis.—In mild cases subjected to early and rational treatment 
the prognosis is favourable; but if neglected, or if the affection be 
severe from the commencement, the mortality is high. In some country 
districts the annual loss from this source is a very serious one to breeders 
of horses. A number of the cases perish from inhalation pneumonia, 
owing to careless administration of medicines. 

TREATMENT.—In the early stages and when the animal is fairly strong 
a laxative should be given with a view to cause removal of the irritating 
products of digestion from the intestinal canal. For this purpose the 
best agent is castor oil. For a foal about a week old the following mixture 
is advised by Caulton Reeks, and we can testify to its efficacy : Castor 
oil, 1 ounce ; liq. potasse, 30 minims ; oil of peppermint, 5 minims ; water, 
to 2 ounces. This to be given mixed in a little of the mare’s milk. In the 
case of an older foal the above dose may be doubled. When the animal 
shows evidences of weakness, a dose of sweet spirit of nitre or of brandy 
should be given. Should the above treatment fail, it will be necessary 
to administer intestinal astringents, sedatives, and antacids. Care 
should, however, be taken not to bring about constipation by these 
agents, and as soon as the diarrhoea is checked the medicines should be 
discontinued. Various formule are adopted for astringent mixtures. 
A combination of chlorodyne, compound tincture of camphor, prepared 
chalk, and peppermint water, will probably be as successful as any. Some 
practitioners prescribe a mixture containing catechu, prepared chalk, 
tincture of opium, and aromatic spirits of ammonia. Should constipation. 
ensue as the result of the astringent mixture, a laxative must again be 
given, consisting of castor oil, 1 ounce ; glycerine, $ ounce ; oil of ae 
mint, 5 minims, and water to 2 ounces. 

In severe cases, when accompanied by colicky pains, intestinal seda- 
tives are indicated, and chlorodyne should be administered as required. 
Tn such cases marked weakness is generally present, and stimulants, such 
as port wine and brandy, with raw eggs, must be given in small doses, 
repeated at intervals. 


DISEASES OF THE INTESTINES: HORSE 303 


When the cause of the diarrhoea can be traced to alterations in the 
quality of the milk due to some constitutional disturbance in the dam, 
treatment should be directed to overcome this condition. The adminis- 
tration of antacids, such as bicarbonate of soda, to the dam seems to 
prove of benefit in some cases. 

In cases where a foal has to be artificially reared on cow’s milk, and 
diarrhoea occurs, lime-water should be added to the milk, or the milk 
may be prepared by boiling. 


SUPERPURGATION. 


Although this is an aggravated form of diarrhoea, it merits a special 
description in consequence of some points in connection with its etiology, 
symptoms, course, and termination. Moreover, it includes the con- 
sideration of an important matter in relation to forensic medicine, as the 
administration of an ordinary aloetic physic-ball may occasionally be 
followed by superpurgation, with fatal results. Excessive purging, long- 
continued, associated with serious constitutional symptoms, and with a 
tendency to certain complications, are the essential features in super- 
purgation. 

Etiotogy.—There are two chief conditions under which super- 
purgation may occur'in the horse. One occurs in connection with the 
administration of purgatives for therapeutical purposes, the other is the 
result of the ingestion of certain foods. _ 

Dealing first with purgative medicines, it is of importance that horse- 
owners should be made aware of the fact that aloes is often an uncertain 
drug in its action, and that special precautions are necessary in the 
preparation of a horse for purgative medicine, and in the after-treatment. 
Yet we find the greatest ignorance displayed in these matters. The 
majority of horse-owners regard the administration of an aloetic physic- 
ball as a very trivial matter, unattended with any risk, and requiring 
little or no attention on their part. The practitioner is directed by his 
client to administer an aloetic purgative, although there is very often no 
necessity for such a procedure. It is a custom handed down from one 
generation to another that the horse requires physic at certain periods in 
order to keep him in health. (Similar views were at one time held with 
reference to bleeding.) If the medicine fails to produce the desired 
purgative effect, the veterinary surgeon is blamed ; either the dose has 
not been sufficiently strong, or the drug of bad quality. On the other 
hand, should superpurgation result he is also blamed ; the dose is then said 
to have been excessive. To obtain the happy medium is by no means 
an easy matter so far as some horses are concerned, but we generally find 


304 SYSTEM OF VETERINARY MEDICINE 


that in both extremes it is the attendant who is to blame; either the 
horse has not been properly prepared for physic, or he has been subjected 
to ignorant or careless treatment while the purgative is acting. 

But there are instances where, in spite of every precaution, aloes will 
produce superpurgation, and it is quite evident that the practitioner who — 
administers a suitable dose and orders suitable after-treatment cannot be 
held responsible. Williams* states that in some instances as little as 
4 drachms of aloes has produced superpurgation with fatal results. He 
has also found that small doses of aloes repeated have a much more 
depressing effect, and are more likely to produce serious consequences than 
a full dose given at one time. In the latter instance the agent is expelled 
from the system more rapidly, while in the former it is likely to be retained 
for a longer period, causing nausea and weakness. Horses suffering from 
ordinary nasal catarrh, influenza, etc., are very susceptible to the effect of 
purgatives, and cases of superpurgation are not uncommon when aloes 
is administered under such conditions. Neglect of ordinary precautions 
after the administration of aloes is often followed by superpurgation. 
Thus, if a horse is allowed ordinary food, or green food, roots, etc., or cold 
water, or is put to work before the physic has “ set,” serious results may 
ensue. Full and repeated doses of aloes in cases of impaction of the colon 
may be followed by superpurgation and a fatal result, hence discrimination 
is necessary in prescribing this drug. 

From a consideration of the above points, it is apparent that aloes 
cannot be regarded as a perfectly safe cathartic for the horse. Still, we 
are forced to admit that an ideal purgative for this animal has yet to be 
discovered. The practical deduction is that aloes should not be indis- 
criminately prescribed, and that special precautions are necessary when 
it is employed. 

Raw linseed oil is generally regarded as a simple and safe agent, yet 
we have observed many instances of serious superpurgation to follow 
full and repeated doses of this agent. No doubt it is often slow and un- 
certain in its action, but once severe purging sets in it is In our experience 
quite as dangerous as that resulting from aloes ; moreover, the nausea is 
even more extreme. We once met with an instance in which 2 pints of 
raw linseed oil, administered to a large shire stallion in high condition, 
produced superpurgation, laminitis, and death. We have seen several 
serious cases of superpurgation due to large doses of this agent adminis- 
tered in cases of impaction of the colon. 

Certain foods are liable to produce superpurgation, and of these it is 
admitted by many authors that raw potatoes are the most dangerous, 


* “ Principles and Practice of Veterinary Medicine.” 


DISEASES OF THE INTESTINES: HORSE 305 


These exert a toxic action on the nervous system, and also an intense 
irritating effect on the intestinal mucosa, so that a fatal termination occurs 
rapidly, and after death acute enteritis is found. 

Severe attacks of superpurgation occur in the absence of any appreci- 
able causes. We have observed several instances in posting-horses. The 
animals leave the stable in apparently good health, but before half the 
journey is completed they purge violently, become exhausted, and have 
to be placed in the nearest stable. In some of these cases acute laminitis 
develops. Others recover within twenty-four hours. New oats and new 
hay are regarded as the exciting causes in some instances, but cases occur 
in which these factors could be excluded. 

Symptoms.—When the affection results from the undue response to a 
dose of aloes or of raw linseed oil, free purging continues for a longer period 
than is usual, and may be accompanied by constitutional symptoms, such 
as a frequent pulse tending to become weak, and a pasty condition of the 
tongue. Colicky pains are observed in some cases, the abdomen may be 
“ tucked up,” or slight tympany may be present. Thirst is also a common 
symptom. Unless relief be obtained, exhaustion sets in, the pulse becomes 
weak and thready, the extremities are cold, and death may result. A 
common complication is acute laminitis, and this in our experience is 
more likely to be met with in cases of impaction of the intestines in which 
full and repeated doses of aloes or of raw linseed oil have been administered 
in order to overcome the obstruction. Pneumonia has also been observed 
as a complication. 

In cases of superpurgation arising as the result of ingestion of raw 
potatoes the prostration is extreme from the commencement, the visible 
mucous membranes are pale, abdominal pain may be well marked, the 
feeces are pale in colour, very watery, and have a penetrating odour. 
Robertson has observed that somewhat similar symptoms may occur when 
cooked potatoes are partaken of in large amount. 

When the condition depends on the presence of Strongylus tetracanthus, 
the weakness may be extreme, and the feces are excessively foetid. 

Morsip ANATOMY.—In some instances lesions of catarrhal enteritis 
may be found. In others intense congestion of the intestinal mucosa is 
present. In others, again, no intestinal lesions can be discovered. 

Prognosis.—This must always be guarded, as complications may set 
in even in cases that do not seem to be serious. 

TREATMENT.—In cases following the administration of a cathartic, 
when purging continues longer than is usual or desirable, but no consti- 
tutional symptoms are present, it is not wise to administer agents such 
as opium with a view to check the diarrhceea. If the purging be restraincd 

VOL. Ile 20 


306 SYSTEM OF VETERINARY MEDICINE 


too suddenly, it not infrequently happens that intestinal stasis with 
tympany sets in, and serious symptoms are produced. The animal should 
be warmly clothed, and demulcent drinks, such as thin flour-gruel, should 
be allowed, but no cold water. Should, however, constitutional 
symptoms be present, accompanied by pawing and other evidences of - 
abdominal pain, a moderate dose of chlorodyne with prepared chalk is 
to be administered in flour-gruel. If the weakness be marked, 10 to 15 
ounces of brandy, or a bottle of port wine, should be given. 

Emollient drinks, such as flour-gruel, should be placed before the 
animal, as the thirst is generally intense, and he will take the fluid of his 
own. accord. 

When the superpurgation depends on the effects of raw potatoes or 
similar irritating material, stimulants are urgently required, and great 
discrimination is necessary as regards the employment of opiates, so as to 
avoid checking the purging too suddenly, and thus causing retention of 
the irritants in the bowels. In these cases we have found the compound 
tincture of camphor very useful. If the pain be severe, a dose of chloral 
hydrate is safer treatment than repeated doses of opiates ; moreover, it 
also acts as an intestinal antiseptic. As regards hot applications to the 
abdominal walls, although so universally prescribed, we doubt their 
efficacy ; moreover, we are not aware of any means by which the procedure 
can be efficiently carried out in practice. 


CONSTIPATION. 


This is a symptom present in a variety of abdominal affections, and 
varies in degree. The term is applied in a general sense to a condition 
in which the feeces are abnormally retained in the intestines, or when 
passed are less in amount and harder in consistence than normal. 

The former condition has already been dealt with under the various 
forms of intestinal obstruction. It now remains for us to make a few 
remarks with reference to the latter condition. It is well known that 
some horses have a tendency to this variety of constipation. The feces 
are dry and hard in consistency, and passed in the form of small-sized 
balls as compared with the normal appearance. Atony of the muscular 
walls of the intestine is responsible in some cases ; in others, liver derange- 
ment is the cause, or the diet may be too dry, and sufficient water is not — 
allowed. Want of sufficient exercise is another cause, also the condition 
is observed during the course of febrile diseases. In some cases loss of 
condition 1s present, and the horse has a ¢apricious appetite. There seems 
little doubt but that this torpid condition of the bowels predisposes to 
intestinal disorders. 


DISEASES OF THE INTESTINES: HORSE 307 


The treatment indicated is to pay attention to the food, and allow diet 
of a laxative character. Small doses of sulphate of magnesia or of sulphate 
of soda should be given in the food or drinking-water, and if the animal 
will take it, small amounts of raw linseed oil may be administered in the 
food. Nerve tonics, such as nux vomica, are required in some cases. 
Repeated doses of purgatives are of no service, as when their action 
ceases constipation again occurs. A combination of bicarbonate of soda, 
common salt, and sulphate of soda, often proves useful when the action 
of the liver is sluggish. In such cases the feces are excessively foetid, 
and hyposulphite of soda, given at intervals will overcome this condition. 
Attention should be directed to the teeth, as dental irregularities interfere 
with proper mastication, and indigestion results, which tends to bring 
about constipation. A proper supply of drinking-water should be 
allowed. 


DISEASES OF THE DIGESTIVE SYSTEM IN 
CATTLE | 


By H. BEGG, F.R.C.V.S., Hamitton, County anpD District VETERINARY 
INSPECTOR, LANARKSHIRE. 


Examiner in Materia Medica, Pharmacy, Therapeutics, and Toxicology, Royal 
College of Veterinary Surgeons. 


INTRODUCTORY REMARKS. 


Or all the ruminants, bovines are pre-eminently the most important. 
Their great and increasing value to mankind as meat and milk producers 
is gradually raising them towards the first place as veterinary patients. 
We believe it to be true that the sum of our knowledge of digestion. 
and digestive diseases of cattle is, comparatively speaking, much less 
than what is known regarding these subjects in equines. That it is 
inferior to what it ought to be, and less reliable, is due to a variety of 
causes. Few, if any, of our teachers are engaged in cattle practice, and 
consequently the diseases of cattle are not presented to the student in 
the masterful way that characterises the lectures and demonstrations 
on equine diseases in our colleges. Then, the amenities of our schools are 
such that it is only with the greatest difficulty that even a little practical 
demonstration on the nursing and treatment of cattle can be attempted. 

For these reasons the recent graduate finds himself considerably more 
handicapped as a bovine than as an equine practitioner, and we have no 
hesitation in saying that if it were possible to have bovine diseases ideally 
taught, the ripening of the young country veterinarian when he engages 
in practice would be considerably hastened. Country practitioners are 
also much to blame, in that, of those of them who are full of experience 
and possessed of settled convictions, but very few ever put on record 
the fruits of their labours, and so the net ultimate legacy to the profession 
of these rich reservoirs of knowledge of cattle diseases is almost nil. 
And it is worthy of remark how closely successive authors on bovine 
diseases have followed the methods and copied the material of their 
predecessors when discussing digestive disorders. So much is this the 
case that the reader has not been indulged with the presentation of 
material sufficiently reflective of our present-day conceptions to remove 

308 


DISEASES OF THE DIGESTIVE SYSTEM: CATTLE — 309 


the impression that the authors were not practically conversant with their 
subject nor free from the charge of mere compilation. It will be our 
endeavour to deviate considerably in this respect, and risk the destructive 
criticism of later writers who may be better able to hold the balance of 
truth. 

When we endeavour to reckon the importance of sporadic bovine 
diseases according to their obscurity and the difficulties they present to 
the veterinarian in diagnosis and treatment, the disorders of the digestive 
apparatus rank first easily ; and, even when we base our calculation on 
the amount of loss which stockowners sustain through the diseases which 
affect the different systems, it is only in dairy herds where intensive 
methods are adopted to maintain the milk-supply that we find the dis- 
eases incident to parturition contending for first place, and these are 
by no means confined to one system. 

It is therefore becoming more and more imperative that veterinarians 
should apply themselves with increased devotion to the many obscure 
problems that envelop bovine diseases, and thus emancipate oxen from 
many indignities that are too commonly perpetrated to-day in the treat- 
ment of digestive troubles. The shedding of more light on this increas- 
ingly important branch of veterinary science would hasten alike the rise 
of our professional credit and the welfare of the stockowner. 

It is peculiarly true that to the man who says he finds no perplexity 
in this branch of our work, the administration of Epsom salts and tonic 
powders form a trusted recipe (ad infinitum) that still stands as the acme 
of perfection in the treatment of all the ills that disturb the digestive 
organs of cattle. To nothing else than this limited conception of bovine 
pathology and therapeutics on the part of some veterinarians can we 
attribute the fact that many dairymen stock and make use of blindly, 
in their own herds, more purgative medicine than many professional men 
who intelligently seek the truth employ in the whole of their practice. 
Being first of all economists, these clients are apt imitators; and 
when they discern that the trusted practitioner who has gained their 
confidence, it may be, as an accoucheur, adopts a stereotyped method 
in the treatment of sick cows, need we wonder when we find that patients 
suffering from pneumonia, pleurisy, pericarditis, metritis, etc., have 
had their digestive tract outraged by purgatives before we are called in ? 

The veterinary student, when he turns his attention from the diseases 
and disorders of the digestive apparatus of the horse to those of the ox, 
is at once confronted with a new set of problems. These problems 
originate from and depend, not only on the peculiarly complex anatomical 
and somewhat mysterious {physiological characteristics of the bovine 


310 SYSTEM OF VETERINARY MEDICINE 


alimentary canal, but also on the nature, quality, and sudden changes 
that are often made in the animal’s diet, the manner in which it disposes 
of its food, the varying bovine temperament, the idleness and vicissitudes 
of the animal’s domestic life, and the great sympathy which—in dairy 
cows particularly—exists between the digestive and other systems, es- 
pecially the generative. 

While the ruminant is generally regarded as having four stomachs, 
this is not true in a physiological sense, since the first three—the rumen, 
reticulum, and omasum—are but dilatations of the cesophagus, elaborately 
designed. The fourth compartment—the abomasum—is the only true 
digestive stomach, and during the first few weeks of the young ruminant’s 
life, when its food consists chiefly of milk or milk substitutes, this organ 
is relatively large and important, and secretes a special milk-curdling fer- 
ment called “ rennin,” while during this early stage of life the other com- 
partments are quite rudimentary. Soon, however, with the complete 
assumption of the herbivorous habit, the latter speedily develop in size 
and importance as the designed recipients and manipulators of the 
coarsely comminuted food which the animal devours. 

There is a marked dissimilarity in the size of these compartments in 
the fatted calf fed chiefly on milk, and an equally old animal that has 
been put entirely on herbaceous food at an early stage—a beautiful illus- 
tration of Nature’s capacity to provide the means for the maintenance 
of robust life under varying conditions of dietary. When the young 
animal is weaned from the simpler food of its early days and put 
entirely on the provender of older animals, the development of the 
first three compartments—and particularly the rumen—in capacity and 
muscular strength proceeds rapidly, so that the animal may be enabled 
not only to store the roughly masticated and comparatively innutritious 
diet of its more adult days, but to carry on effectively the great process 
of rumination, and the proper maceration of the food that fits it for entry 
into the true digestive portion of the alimentary tract. 

It is not difficult to conceive how organs of such enormous size and 
utility should be liable to the special series of disorders that will be 
referred to later. It will also be apparent as we proceed that, in marked 
contrast to equine digestive diseases, bovine intestinal disease is relatively 
uncommon and unimportant, and that gastric disorders are both frequent 
and important. These important stomachs of the ox are influenced 
pathologically in great measure by the nature, quality, and quantity of 
the food allowed, and the extremely rapid transitions that are often 
made from one diet to another. Not only is the food swallowed quickly 
and in large quantities, but much of that which the animal devours with 


DISEASES OF THE DIGESTIVE SYSTEM: CATTLE 311 


ereatest relish is of such a nature that, in the absence of the highest degree 
of tonicity in the stomach walls, rapid fermentation of the material ensues, 
and leads to serious illness. 

Cattle are not less guilty than horses in the matter of overloading the 
stomachs, if a special temptation is provided. But the healthy ox, when 
feeding, is not so fastidious as the horse, and, whether in the cowshed 
or on pasture, it makes grist of much that the horse would eschew. 
The bulky, indiscriminate mouthfuls which its rough, strong tongue 
places between the incisors and the dental pad receive only the minimum 
of treatment from the molar teeth, but a thorough mixing with saliva 
fits the rough bolus for easy deglutition. 

These peculiarities explain to some extent the facility with which the 
animal, perhaps unconsciously, swallows poisons and foreign bodies in 
great variety—leather, bones, cloth, and pieces of iron often sharp- 
pointed—that in the stomach often produce serious ill-effects. Indeed, 
it may be said that what an ox takes into its mouth it will make a bold 
attempt to swallow, irrespective of the inability of the molar teeth to deal 
with it, 

The idle life and lymphatic temperament of many bovines are respon- 
sible for the mouth-play they at times give to very large foreign bodies 
of the nature already referred to, which they endeavour to swallow, and 
produce those cases of serious and often fatal choking that most of us 
have met with, and many have put on record. The predilection, which 
some newly-calved cows have, to adopt the carnivorous habit of swallow- 
ing, or attempting to swallow, the newly-discharged and bulky foetal 
membranes, is difficult to explain. In some cases this is accomplished 
with impunity, while others die in the attempt or are sick for some time 
afterwards. It is difficult also to estimate the sinister influence of an 
unbroken spell of stall-feeding, without exercise, on the digestive apparatus 
of an animal that has roamed about all the summer gathering its food. 
This we do know: that in certain cases of atony of the rumen, etc., 
nothing is more helpful than systematic massaging of the abdomen and 
thorough grooming, followed by judicious exercise in the open air. 

Again, the vicissitudes of the animal’s life in the early spring and late 
autumn, when exposed day and night in badly sheltered pastures, when 
the temperature is variable and the weather changeable and often in- 
clement, wet, cold, or frosty, predispose it to chills that shock the system 
and induce such circulatory disturbance as results in impaired digestion 
or something more serious. 

Further, the practitioner experienced in the treatment of heavy- 
milking cows is aware that a special type of digestive disorder that 


312 SYSTEM OF VETERINARY MEDICINE 


commonly affects these animals is dependent on the intimate reciprocity 
that exists between the digestive organs and those that are physiologically, 
or it may be pathologically, active in the parturient animal. The 
symptoms of indigestion in these cases are not characterised by acute 
vastric disturbance, though the sickness, want of appetite, and general 
stagnation of the digestive functions, are often profound. Whatever the 
source of their cause may be, these cases are doubtless due to auto- 
infection —some form of intoxication—and while the paresis of the 
digestive functions is first apparent, the signs of indigestion and general 
lassitude, if unheeded, are often the prelude to a violent attack of hysteria, 
or it may be a fatal epilepsy. The severity of these neurotic cases 1s, we 
believe, as much influenced by the individual temperament of the patient 
as by the potency or virulence of the elaborated poison. With the 
probable causes and treatment of these cases, which in the main are 
amenable to measures calculated to restore the innervation of the digestive 
organs, we will deal later on. 

We have also to bear in mind that, compared with the horse and other 
domesticated animals, cattle are victimised by certain specific affections 
of the digestive organs—e.g., tuberculosis, actinomycosis, etc.—the 
occurrence of which is not entirely due to any special susceptibility of the 
bovine tissues. 

If sheep were subjected to similar conditions of feeding and housing, the 
likelihood is that our flocks would soon be decimated by tuberculosis. 

The reason is rather to be found—in the case of tuberculosis—in the 
probability of the milk supplied to the young animal being infective, and 
the great danger of animal to animal infection that obtains in the cow- 
shed, where no attempt is made to segregate open or suspected cases of 
tuberculosis, and where the animals are often in close cohabitation for 
months on end, it may be in sadly defective premises. And if the truth 
were known regarding the influence of tuberculosis on the production of 
bovine digestive disorders, the knowledge might appal us; for not only 
is it, in many cases, the actual exciting cause of many disorders, but its 
vitiating influence at all times on the economy of an affected animal 
constitutes a potent predisposition to digestive derangements. 

In the artificial life of stall-fed cattle we recognise the dominating factor 
in the occurrence of illness, and particularly the neurotic ailments in which 
the signs of digestive disorder are outstanding. 

In upland herds, where the food of the animals is almost entirely 
grown on the farm, serious cases of digestive disease—excluding those 
that result from accident or misadventure—are almost unknown, and the 
members of the herd, if tubercle-free, maintain a constant degree of health 
and utility to a ripe old age. 


DISEASES OF THE MOUTH: CATTLE 313 


But if, as is often the case, these animals are drafted at maturity to 
those herds where everything is done and arranged to develop the highest 
degree of milk-production, those that respond liberally through the pail, 
and fail to maintain their bodily condition, become, after one or two 
seasons, the victims of many ailments of the digestive and other organs, 
that are the direct heritage of the intensive use of concentrated artificial 
food-stufis, and the pampered conditions of the animals’ stall-fed lives. 

To these stimuli the subject of incipient tuberculosis is often most 
responsive for a time ; but if her dry period is so short that the body fails 
to recuperate sufficiently before her next calving, the specific affection 
gains the mastery, her tale is told, and she pines away. 

The liability of the ox to actinomycosis depends on the presence of 
the “ ray fungus ” in its plant-food and other diet, while the predominance 
of the tongue, maxillary bones, the lips, and salivary glands as seats of 
disease is doubtless due to the carelessness of the animal in feeding, whereby 
wounds and abrasions of the buccal mucosa arise, which constitute 
inoculable surfaces, as well as suitable fields for the colonisation of the 
implanted actinomyces. 

In teething animals the breaches in the mucosa that accompany the 
shedding of teeth may be the seats of inoculation in those cases of actino- 
mycosis that are commonly met with in young stock. 


DISEASES OF THE MOUTH. 
GENERAL REMARKS. 


In the foregoing section—Diseases of the Digestive Organs of the 
Horse—the editor has dealt in comprehensive detail with many diseases 
and symptoms of disease in which, particularly in disorders of the mouth 
and pharynx, his remarks are so applicable to similar conditions met 
with in cattle that the writer is relieved of the necessity of doing more 
than directing attention to whatever modifications characterise their 
appearance in bovine animals. 

The following are the salient anatomical features of the mouth of the 
ox compared with that of the horse—viz., its well-developed prehensile 
tongue, which is stronger, thicker, rougher, and more pointed than the 
equine tongue ; its incomplete and less pendulous soft palate, providing 
a patent isthmus faucis, so that the animal can not only return the 


314 SYSTEM OF VETERINARY MEDICINE 


food to the mouth during rumination, but, unlike the horse, can breathe 
through the mouth—a phenomenon often well marked in the coma of milk 
fever, certain cerebral affections, in painful chest complaints, etc., and 
when death is impending in other diseases. 

Its cheeks are provided anteriorly with large conical papillee pointing 
backwards, which assist in retaining food in the mouth. Its lips are tae 
and rigid, possessing little mobility or prehensile power. 

Its dentition is characteristic, the upper incisors being replaced by a 
“dental pad’ composed of cartilage covered by dense mucous membrane 
continuous with that of the hard palate, while the eight incisor teeth of 
the lower jaw that oppose it have their crowns completely covered with 
enamel, and their fangs are so set in the alveoli that, without being very 
loose, they have such a degree of mobility as prevents injury to the dental 
pad when the animal nips off each morsel of food. 

Note.—Smith, in his excellent “‘ Manual of Veterinary Physiology,” 
says : “‘ It is a remarkable fact that in all herbivora the teeth never leave 
off growing.” 

However true this may be of equine teeth or of the molars of the ox, 
our observations lead us to doubt the accuracy of the statement when 
applied to the incisors of cattle. If we examine the fan-shaped display 
of the incisors in oxen from four to six years of age, we note that their 
broad, full-sized crowns meet laterally. Very soon, owing to wear, and 
because the width of the crown diminishes gradually from its free border 
to where it becomes continuous with the fang, spaces appear between 
the teeth, which gradually increase in size as wear proceeds with increasing 
years. Eventually, in the very old cow we find the crowns are entirely 
gone, and nothing is left but the fang stumps, the free surfaces of which 
scarcely project beyond the level of the gum. 

We conclude, therefore, that if any part of an ox’s incisor teeth is 
reproduced, the crowns do not share in the growth. This gradual change 
in the appearance of these teeth enables an intelligent observer to estimate 
with fair accuracy the age of oxen, while a knowledge of the state of the 
incisor teeth clearly indicates whether roots should be fed whole or in a 
pulped condition. 

The molar teeth of the ox call for little remark. Like equine molars, 
their tables are compound, but they are rougher and less flat, indicating a 
clipping as well as a grinding capacity. They are smaller and more 
square than the horse’s molars, and, since the upper and lower rows are 
set at almost equal width, the wear is more horizontal, and the tooth-rasp 
is seldom needed. 

Its submaxillary and sublingual salivary glands are well developed, 


DISEASES OF THE MOUTH: CATTLE 315 


while the parotid is comparatively small, though it is said to secrete 
four or five times as much saliva as the submaxillary. The importance 
of these glands is apparent when we consider that they provide daily one 
hundredweight of saliva (Colin) to facilitate the chewing, swallowing, 
remastication, and digestion of the food. 

As in the horse, the masticatory muscles are well developed, for 
though the trituration of food in the first instance is very perfunctory 
and the boli of rumination are in a pulpy condition, so that in both 
cases less crushing and grinding power is necessary than the horse has 
to exert on its dry food to fit it for immediate gastric digestion, still, their 
great development is essential on account of the longer periods during 
which they are kept on the move (seven to eight hours per day). 

The muzzle of the ox varies in tint according to the colour of the animal. 
In health it is always moist with the secretions of numerous small sub- 
cutaneous glands. In the sick animal the function of these glands is in 
abeyance, and the muzzle is dry and parched. When the animal is only 
slightly indisposed, it 1s interesting to observe the change that occurs 
on the dry muzzle when the patient is being drenched with medicine that 
is markedly saline, bitter, or otherwise pronounced in taste. The glands 
simultaneously become active, and pour out their secretion in little beads, 
which gradually increase in size and soon coalesce, making the entire 
surface uniformly moist. This restoration of function, temporary though 
it may be, occurs through sympathy with the salivary and other glands 
that have been directly stimulated to activity by the presence of the 
tasty material in the mouth. It is to be noted that the tendency of 
these glands to respond in this manner decreases as the severity of the 
illness becomes more pronounced. 

We have already referred to the relative heedlessness of the ox as to 
what its prehensile tongue includes in each mouthful, so long as the taste 
is not disagreeable. 

This culpability in selection, as well as the animal’s proclivity for 
lifting and chewing—in idleness and for long periods — foreign sub- 
stances, large or small, soft or hard, blunt or sharp, predisposes the softer 
tissues of the mouth to bruises, various wounds, and often septiceemic 
inoculation. But Nature has contrived to neutralise this weakness of 
the bovine temperament by providing the ox with a dense buccal 
mucosa so thick and protective that the animal can with impunity 
indulge in mouth-play with materials that would prove disastrous to 
a tissue so sensitive and delicate as the mucosa of the horse’s mouth. 
This provision not only protects the deeper tissues from traumatic 
injury, but, in virtue of its lesser sensibility, enables the ox to partake 


316 SYSTEM OF VETERINARY MEDICINE 


of and swallow quickly soft food at a much higher temperature than a 
horse would dare to touch. 

Nevertheless, grievous harm is often done to the mucosa and under- 
lying tissues by overwarm food, by splinters of wood, spicula of bone, 
pieces of wire, etc. ; while, on occasion, foreign bodies become transfixed 
on or between the molar teeth, and, projecting laterally, they lacerate 
the tongue or the cheek, till they are detected and removed; moreover, 
the ox has not the intelligence to cease chewing as a dog or a cat does in 
similar circumstances. 

For the proper examination of the mouth for foreign bodies, wounds 
caused by them, or other lesions, a ratchet gag such as the “ Reliance,” 
fitted with rubber-covered mouth-plates, is very servicable. 

If artificial light is required, a bull’s-eye lamp or an electric bulb 
such as many motorists carry serves the purpose well. The latter can 
be bought fitted with a hook for fixing to the operator’s headgear, and a 
sufficient length of wiring for giving a connection to the poles of an 
accumulator. Failing these, the operator can, by means of a small re- 
flector on his forehead, fixed by a strap round the head, so reflect the rays 
of any good light that the mouth can conveniently be seen and examined, 
one, or at most two, assistants being needed to steady the patient’s head. 


Ptyalism, or excessive secretion of saliva, as a symptom of disorder is 
not uncommon in the ox. It usually depends on causes similar to those 
that account for it in equines; but when it accompanies cesophageal 
obstruction, it is often aggravated to an extent never seen in the horse. 
When an excitable cow is badly choked, the salivary glands become 
inordinately active, and pour great quantities of saliva into the mouth. 
This the animal swallows as far as the obstruction, with the object of 
displacing it ; but, failing to get through, the fluid overflows unnaturally 
into the pharynx, causing the animal to cough, and inducing vomition of 
the saliva, which is accompanied by champing of the jaws, etc. The 
process is repeated again and again, and very soon the feeding-trough 
may be almost filled with foamy saliva. But for this ejection the animal 
would inevitably be drowned by its own secretions, which cannot under 
the circumstances reach the stomach. 

Salivation more or less profuse accompanies actinomycotic affections 
of the mouth, and the condition known as bacillary necrosis in calves. 
It is also present in malignant catarrh and cattle plague, and is such 
a significant symptom of foot and mouth disease that, in these days of 
stringent regulations to prevent its spread, a salivating animal at once 
commands the attention of the lynx-eyed inspector. 


DISEASES OF THE MOUTH: CATTLE 317 


Dry Mouth, the antithesis of salivation, is met with in oxen affected 
with acute febrile disease, chronic diarrhoea, dysentery, or advanced 
Johne’s disease, as well as in animals that have received full doses of 
common salt or belladonna. 

It is also seen as a temporary condition some time after an animal has 
been deeply salivated—e.g., after choking. 

The Odour of the mouth of the healthy ox varies according as we 
examine it after feeding or after rumination. 

In certain digestive disorders the odour simulates that of burnt hay, 
while in others it has an odour all its own—mawkish, heavy, and sicken- 
ing, without being foetid. This latter condition is quite common in 
certain conditions in cows of all ages from one to six weeks after calving, 
and the peculiar odour permeates the milk and renders it almost unfit 
for use. It is a result of impaired digestion, and is sufficiently important 
to merit attention later on. 

Foetor Oris in the ox is often dependent, as in the horse, on the dis- 
eased conditions of the mouth and pharynx mentioned in the equine 
section. It also arises from the lesions of such specific affections as 
malignant catarrh, foot and mouth disease, cattle plague, bacillary 
necrosis in the calf, and actinomycocis. And, since the ox can breathe 
through the mouth, the foetid exhalations of septic states of-the respira- 
tory tract are observed when the mouth is opened, or when, owing to 
pain and distress, oral breathing 1s present. 

Difficult or Painful Mastication in the ox is not often due to disease or 
irregularities of the teeth, though. it is frequently occasioned by foreign 
bodies becoming fixed between them. 

Stomatitis and glossitis of every form, as well as diseased conditions 
of the maxillary bones, give rise to much pain during mastication, and 
interfere more or less seriously with its due performance; and a similar 
result is seen in animals that suffer from any swollen and painful state of 
the muscles of mastication, the salivary or other glands, etc. 

We have also to reassert the inability of old animals, whose incisors 
are worn away, to tackle raw, hard roots that have not been sliced, 
fingered, or pulped. 

The bovine economy suffers exceedingly during a period of difficulty 
in mastication on account of the almost impossibility of negotiating the 
bulky food so essential for rumination, and the animal’s reluctance to 
persevere, through pain, with a function so essential for the maintenance 
of health. 

Difficulty in Prehension arising from local causes is almost invariably due 
to affections of the tongue, and of these actinomycosis is the most common. 


318 SYSTEM OF VETERINARY MEDICINE 


In milk fever and other affections associated with cerebral aberration, 
prehensile power is much modified or in complete abeyance. 

In the early stages of many such cases the tonic spasm of the muscles 
of mastication keeps the mouth so rigidly clenched that prehension is 
impossible ; and when the reaction sets in, the want of power to perform 
or co-ordinate the necessary movements renders the prehension even of 
liquids exceedingly tedious, though the patient may show a keen desire 
to drink. | 


STOMATITIS. 


The buccal mucosa of the ox is denser, less sensitive, and consequently 
less vulnerable, than that of the horse to the causes acting locally which 
produce inflammation of the mouth. Nevertheless, the various forms of 
sporadic non-infectious stomatitis described in the equine section do 
occur in bovines; but, since they are essentially similar in causation, 
symptoms, and therapeutical requirements, the reader is referred to that 
section for details. 

There, also, will be found in Vol. I. an article on Mycotic Stomatitis, 
a disease not uncommon in ill-cared-for, badly nourished, and weakly 
calves. 


NOTE BY EDITOR. 


Stomatitis Erosiva.—T his is a form of stomatitis occurring in cattle 
and sheep, and described by Hutyra and Marek. It receives full con- 
sideration in the section devoted to the digestive diseases of sheep 
(see p. 426). 

Desquamative Stomatitis, popularly known as “dirty mouth.” This 
is a form of stomatitis which was occasionally observed by practitioners 
in the northern counties of Ireland over a considerable number of years; 
but as it caused the affected animals no inconvenience, little attention 
was paid to it. In 1912, however, in consequence of the outbreak of 
foot and mouth disease in Ireland, and the fact that a certain similarity 
exists between the lesions of this form of stomatitis and the disease 
mentioned, special attention has been directed to the subject. The 
affection was discovered in the counties of Armagh, Fermanagh, London- 
derry, and Meath, and appears only in the autumn and winter months. 
It is confined to young bovines, and has been observed in animals from 
a few months to two years old. No cases have been recorded in adult 
or old cattle, although they have remained in contact with affected 
animals. It is not transmissible to pigs, sheep, or rabbits. 

ETioLogy.—Scrapings from the lesions in naturally affected cases, 


DISEASES OF THE MOUTH: CATTLE 319 


when rubbed on to the buccal mucous membrane of healthy young cattle, 
have transmitted the disease. The virus is evidently present in the 
altered epithelium of the mouth in affected cases, but the specific micro- 
organism has not yet been determined, although various organisms 
have been isolated and cultivated. The results of experiments show 
that the disease is not due to an ultravisible virus. The affection appears 
in cattle at grass. In certain outbreaks the cattle on neighbouring 
fields were found free from the disease. It is suggested that the virus 
is located on certain lands, and grows there as a saprophyte, and that 
inoculation may occur in the later periods of the year by means of the 
hard stubble or strands when the grass is very short. Contact of healthy 
with affected animals does not of itself convey the disease, judging by 
the results of quarantine at Birkenhead, when these cases were confused 
with those of foot and mouth disease. 

In later experiments contact with affected animals only resulted in 
lesions of the lips. Experimentally the disease has been set up in every 
case when scrapings from the lesions were rubbed on to the gums and 
tongue of susceptible bovines, after scarification or rubbing with sand- 
paper. Attempts at infection by intraperitoneal and intrajugular in- 
oculations apparently proved negative. 

Pgeriop oF IncuBaAtion.—In experimental animals the incubative 
period varied from two to four days. 

Symptoms.—There are no constitutional symptoms, and the only 
evidences of the disease are the lesions in the tongue, gum, upper lip, 
and occasionally the dental pad. .In one case the lower lip was slightly 
involved. The lesions on the tongue appear on the dorsum and at the 
side of the bulb. The early lesions consist of a small brownish, slightly 
raised, rounded area which may be smaller than a threepenny-piece. 
These areas are frequently multiple. No vesicles are present. The 
thickening consists in an increase of the surface epithelium; it is readily 
removed by scraping, and comes off in the form of small scales or thin 
flakes. The deeper layer of the epithelium is not involved, there is no 
separation of the epithelium by serum, the corium is not exposed, the 
base is still covered by a thin epithelial pellicle, and presents the appear- 
ance of the normal mucosa, but is remarkably soft and smooth. The 
first part of the tongue affected is usually at the junction of the fixed 
and free portions. The lesions are generally multiple, and soon extend 
rapidly along the mucosa, until the larger portion of the dorsum, upper 
lip, and gum are involved. During this extension, well-marked depres. 
sions are formed, owing to sloughing of the epithelium. Some of these 
are rounded and vary in size from that of a sixpenny-plece upwards, 


320 SYSTEM OF VETERINARY MEDICINE 


The base of the depression is very smooth, soft, and not congested; the 
border is very prominent, ragged, and of a brownish colour. At this 
stage the lesions in the tongue may be mistaken for those of an old case 
of foot and mouth disease, but the distinguishing features, are the brownish 
colour, the involvement of a large proportion of the organ, and on 
microscopical examination of the scales there is no separation of the 
epithelial cells. The cells are not necrosed, and stain normally. The 
desquamation extends until the entire excess of epithelium is removed 
from the tongue, the free portion and the back of the fixed portion of 
the organ being the last to be subjected to this process. In many 
instances the lesions on the upper lip and gum develop before those of 
the tongue. The desquamative process may involve the entire mucosa 
of the upper lip. The line or ridge surrounding the depressions stops 
short at the free border of the lip, at the junction of skin and mucous 
membrane. At the side it passes backward in a curved direction to the 
dental pad, at the margin of which it lies. Occasionally it affects a slight 
portion of the muzzle, but never attacks the skin. 

Course.—The lesions usually pass through their course in about 
two weeks. In the later stages the dental pad may become involved, 
and the lesions on this structure vary in size from that of a barley-grain 
to the whole breadth of the pad. A peculiarity of the lesions in this struc- 
ture is that the thickening is more marked, and more difficult to remove; 
the scales when removed are very thick and not perforated. In many 
instances after this stage secondary lesions appear after a new growth 
of the stratum corneum, consisting of lines or ridges, or small areas 
varying in size from that of a barley-grain to a sixpenny-piece, but not 
nearly so pronounced as in the first instance. 

IMPORTANCE OF THIS DispasE.—The disease is of no clinical importance. 
It does not appear to cause the animal any inconvenience The chief— 
indeed, the only—importance arises in distinguishing it from foot and 
mouth disease. The following are in brief the characteristic features: 

1. The animal shows no symptoms. The disease is only suspected 
or diagnosed on examining the mouth. 

2. It is not transmissible to pigs or sheep. 

3. It is not nearly so infectious as foot and mouth disease, and mere 
contact is not sufficient for the transmission of the disease. It is not 
transmitted by intraperitoneal or intravenous injection. 

4, The lesions are confined to the mouth, and are yellowish or brownish 
in colour, and affect only the surface epithelium. When the excess of 
epithelium peels away, the corium is not exposed and the base is not 
congested. There are no vesicles, and the whole of the tongue may be 


DISEASES OF THE MOUTH: CATTLE 321 


diffusely involved. There is no separation of the epithelial cells in 
sections of the flakes which peel off. 

5. There are no foot lesions. 

6. It is not due to a filtrable virus. 

For the details in connection with the above disease, we are indebted 
to Professor J. F. Craig, Royal Veterinary College of Ireland, who has 
made a special study of the affection. 


Stomatitis also occurs in bovines as a marked and typical symptom of 
some important specific diseases—e.., foot and mouth disease, cattle 
plague, and malignant catarrh (see Vol. I.). See also the sections on 
Actinomycosis and Tuberculosis for a description of the mouth lesions 
that accompany these diseases. 

Mercurial Stomatitis deserves mention here because of the special 
susceptibility of the ox to mercurialism or hydrargyrism, of which con- 
dition sore mouth is a well-marked toxic symptom. 

HitT1oLoGy.—Bovines are so sensitive to the action of mercury that 
mercurialism is liable to occur even when the practitioner has prescribed a 
comparatively limited use of the preparation, and the condition is most 
often seen as a result of actual treatment with some mercurial salt. 

Whether for internal or external application, these medicaments must 
be prescribed with extreme caution. Salivation occasionally follows the 
administration of a 2-drachm dose of calomel to a cow, and it occurs after 
small daily doses of calomel, corrosive sublimate, or mercuric iodide. 

But the cases met in practice as a result of treatment are usually 
due to repeated use of sublimate solutions in the disinfection of the womb 
after removal of the foetal membranes. A recently handled womb 
affords many places more potent than a healthy mucous membrane for 
the absorption of the antiseptic solution. When sublimate solutions are 
employed on extensive wounds or for the cleansing out of large or multiple 
abscess cavities, similar results accrue. Mercurialism also readily follows 
the use of biniodide of mercury as a counter-irritant, particularly if the 
ointment basis is a paraffin preparation. Two cows suffering from thioat 
affections were each blistered over the throat, after clippmg, with not 
more than 2 ounces of a freshly made ointment composed of biniodide 
of mercury 1 part, and soft paraffin 8 parts. Next day the animals were 
enormously swollen from the throat to the brisket, and many vesicles 
were present on the face, ears, and eyelids. They suffered from slight 
sore mouth, salivated for a time, and for several days were unable to 
bend the neck or partake of bulky food ; indeed, it seemed as if they 
might die of suffocation. We had not encountered results so marked 

VOL. I. 21 


322 SYSTEM OF VETERINARY MEDICINE 


when lard was used as a basis for this ointment; nevertheless, in later 
days we preferred other counter-irritants as being safer for bovines. 

But mercurial-poisoning may be caused maliciously or occur accident- 
ally. Further, itis said that in the neighbourhood of quicksilver furnaces 
mercury in a finely-divided state pervades the atmosphere, and produces 
in cows grazing in the vicinity sore mouth, unthriftiness, and abortion. 
Mercurial salts are absorbed into the blood-stream from the mucous 
membranes, the skin, or the areolar tissues; they are determined to the 
lymphatic glands, the liver, and kidneys, and, being excreted mainly by 
the kidneys and bowels, it is likely that any pre-existing disease of these 
organs may favour the occurrence of mercurialism. 

The manner in which stomatitis arises In mercurialism is somewhat 
obscure. The toxic effect of the drug on the salivary glands alters the 
nature and properties of the saliva, and the tone of the buccal mucosa 
becomes so prejudiced that the saprophytic organisms are able to invade 
and flourish in the tissues setting up stomatitis. 

Draenosis.—In the majority of cases the history combined with the 
symptoms is conclusive. The lesions are sufficiently characteristic to 
render diagnosis easy, if it is known that the patient has had mercury ; 
and perplexity only arises in cases produced maliciously, or in which it 
is not possible to trace the source of the mercury. 

Symproms.—Ptyalism often profuse and blood-tinged. The open 
mouth emits a fcetid odour, and an examination reveals a painful mucosa, 
which is red, hot, and swollen. The tongue also is swollen and painful, 
and its power to prehend food is materially lost. Alveolar periostitis 
appears; the teeth loosen and may fall out, so that mastication of 
food is often impossible. Later, necrotic patches are seen on the sides 
and under-surface of the tongue, the commissures of the lips, the gums, 
and inner aspect of the cheeks, which, when shed, leave behind angry- 
looking ulcerations. In some cases portions of the covering of the muzzle 
are exfohated. Though there is little or no pyrexia, the victim’s inability 
to feed leads to anzemia and rapid loss of flesh, and very often the in- 
flammation extends to the pharyngeal mucous membrane, causing dys- 
phagia and reluctance to swallow even liquid food. By-and-by the 
mucous membranes of the alimentary tract, as well as of the other 
systems, become affected, and the animal presents a sorry, loathsome 
spectacle, suffermg from dysentery, urinary complications, persistent 
cough, and painful respiration, ultimately succumbing from starvation 
and exhaustion. Jn the milder forms of mercurialism the patient soon 
shows improvement, and, if proper treatment be adopted, many well- 
marked cases make a protracted return to a fair measure of health. 


DISEASES OF THE SALIVARY GLANDS: CATTLE — 323 


PROGNOSIS is usually grave, for mercurialism is readily fatal, while even 
the milder forms of it have a vitiating influence on the animal’s economy. 

TREATMENT.—Make the patient comfortable. If the case is due to the 
administration of mercurials, this must at once be stopped and a saline 
purge given. When arising from the absorption of a mercurial com- 
pounded in a blistering or insecticide ointment, the part to which this 
has been applied must be washed with soap and water, and dressed 
with a soluble sulphide which will combine with the unabsorbed mercury 
and form an inert sulphide. Mouth lesions are to be frequently washed 
with water and dressed with alum lotion (1 to 4 of water), boracic 
lotion of like strength, carbolic (4 per cent. in glycerine and water), 
or salicylic acid (1 in 50 of water). When necrosis or ulceration appears, 
creolin lotion may be used. Albumin, in the form of eggs mixed with 
barley-water and infusion of linseed, should be given. Sulphur, 
hydrogen sulphide, sulphate of iron, and potassium iodide, are reckoned 
the best antidotes. Potassium chlorate is recommended by some 
authorities, in daily doses of 2 drachms ; this drug is eliminated by the 
salivary glands. 


DISEASES OF THE SALIVARY GLANDS. 


‘The parotid gland of the ox is smaller than that of the horse,‘is pale 
pink in colour, and Stenson’s duct enters the mouth opposite the fourth 
or fifth superior molar tooth. 

The submaxillary gland is larger than the horse’s, is of a yellowish- 
brown colour, and Wharton’s canal terminates close to the incisor teeth. 


PAROTITIS. 


In the ox the great majority of cases of parotitis are of a specific nature, 
and due to actinomycosis (see Vol. I.). Cases resulting from external 
violence such as horn-gores, etc., are comparatively commoner than in 
the horse, and are usually unilateral; but non-specific inflammation of 
the parotid gland is nevertheless a somewhat rare affection, and the causes, 
symptoms, and treatment detailed in the equine section are equally 
applicable to the bovine parotitis. 


MAXILLITIS. 


Inflammation of the submaxillary glands due to other causes than 
actinomycosis is probably less rare than simple parotitis in the ox. 
The situation of the orifices of Wharton’s canals immediately behind 


324 SYSTEM OF VETERINARY MEDICINE 


the incisors on the floor of the mouth would seem more favourable for the 
penetration of awns, thorns, and other pointed foreign bodies that are 
carelessly prehended by this animal. 

External violence is frequently to blame in beasts given to fight with 
their neighbours in the open, and penetrating wounds of the intermaxillary 
space involving the submaxillary glands are often met with in animals 
difficult to confine, and that come to grief in their endeavour to force their 
way through thorny hedges, etc. | 

For further information as to causes, symptoms, and treatment, see 
Diseases of the Salivary Glands in the Horse (p. 31). 


DISEASES OF THE PHARYNX. 
PHARYNGITIS. 


Inflammation of the pharynx is comparatively rare in the ox. The 
mucosa of the bovine pharynx is less sensitive than that of the horse, 
but the rarity of pharyngitis in bovines compared with equines finds 
explanation in their immunity to certain equine diseases, such as strangles 
and influenza, of which sore throat is a common accompaniment. 

Further, cattle are not subject to violent and exhausting exercises, 
which so readily predispose to chill and lead to affections of the pharynx 
and respiratory organs in horses, and the infrequency of the disease in 
working oxen is referable to the greater resistance which the bovine 
mucosa offers to microbic invasion. 

Non-specific pharyngitis is usually the accompaniment of traumatic 
lesions of the mucosa, which constitute favourable points of attack for 
pathogenic bacteria. Such lesions arise from careless handling of the 
probang or its substitutes, especially if the instrument used has a rough- 
ened extremity. 

Injury is frequently done by awkward manual exploration of the 
pharynx during attempts to remove an upper cesophageal obstruction, 
and after the removal of tumours in this region a certain degree of pharyn- 
gitis usually results. 

More pronounced than these are the cases that follow the serious 
lesions caused by penetrating, sharp-edged, or rough foreign bodies that 
bovines are prone to pick up and attempt to swallow. | 

On occasion pharyngitis, as well as stomatitis of an acute type, is 
caused by animals licking quicklime carelessly left within reach, and 
similar cases, more or less severe, follow the administration of over-hot 


DISEASES OF THE PHARYNX: CATTLE 325 


fluids and concentrated or carelessly mixed irritant medicaments, such 
as strong liquor of ammonia, oil of turpentine, etc. 

The symptoms, diagnosis, and treatment described on p. 37 apply 
equally to non-specific bovine pharyngitis. 

Specific Pharyngitis.—Specific forms of pharyngitis occasionally occur 
in the ox. The cause may be— 

1. Actinomycosis (see Vol. I.). 

2. Malignant Catarrh (see Vol. I.). 

3. Malignant Aidema.—The bacillus of malignant cedema may be the 
infecting agent of a pharyngeal wound or abrasion, and give rise to 
pharyngeal angina associated with extensive cedema of the throat, etc., 
which crackles and pits on pressure. 

Pseudo-Membranous or Croupous Pharyngitis——This term has been 
applied to those cases of pharyngitis that are characterised by the 
formation of false membranes. When a diphtheritic state of the mucosa 
does occur, the type of microbic infection is responsible. This affection 
is described by some authors as an infectious disease occurring among 
young stock, especially calves, and as being rarely seen in older animals. 
Though we have occasionally seen a somewhat diphtheritic state of the 
mucosa in some acute cases of sporadic pharyngitis, we cannot claim to 
have met the infectious disease they describe. 

The symptoms and lesions related seem to bear a close analogy to 
those we recognise as characteristic of malignant catarrhal fever or 
gangrenous coryza of the ox, a very fatal diphtheritic affection of the 
upper digestive and respiratory passages met with in almost every 
country (see Vol. I.). 


PHARYNGEAL TUMOURS AND PHARYNGEAL ABSCESS. 


Bovines are rather subject to tumours and abscesses of the pharynx. 
In the West of Scotland 2 per cent. is not an exaggerated estimate of the 
number of Ayrshire cattle over three years of age that are known as 
roarers, snorers, or wheezers, and the cause of roaring in the majority 
of cases is Some adventitious swelling in the pharynx. 

Eit1oLocy.—Actinomycosis is the cause in a very large number of 
cases, especially in certain districts, and cases occurring during adolescence 
are almost invariably actinomycotic. 

Tuberculosis is also a common factor, and doubtless those cases of 
abscess which are quickly developed and become alarming within a day 
or two of the appearance of the first signs of roaring are the result of a 
penetrating lesion of the mucosa, followed by sepsis and acute abscess | 
formation. A similar condition may occur as a sequel to phlegmonous 


326 SYSTEM OF VETERINARY MEDICINE 


pharyngitis from whatever cause arising. The ripening of an abscess 
is unfavourably affected by the comparatively insensitive and dense 
mucosa of the bovine pharynx. 

The character of the tumours which constitute the minority of adven- 
titious growths of the pharynx varies, and includes carcinomata, epi- 
theliomata, fibromata, lipomata, and sarcomata. 

Symproms.—Though the diagnosis of internal pharyngeal swelling 
is not difficult, it is of much importance to determine whether the cause 
of roaring is situated in the pharynx, larynx, or posterior nares. Unless 
in the exceptional cases of acute abscess referred to, the development 
of a pharyngeal abscess or tumour is usually so gradual that the animal 
very slowly becomes a persistent roarer. The earlier signs are usually 
noted when the animal is recumbent and ruminating with a full stomach, 
and the same is true of pregnant females towards the end of the period 
of gestation. The modified sounds that indicate future trouble readily 
pass unheeded, for they disappear when the animal rises, and at this 
stage healthis unimpaired. As the swelling increases in size the symptoms 
become aggravated, the noise made is louder and more persistent, being 
most marked under the conditions (fulness of abdomen) referred to 
above, or when the animal is engaged in the consumption of roots or 
long food. Some animals remain mild or moderate roarers for 
months, or it may be for a year or two, and it is noticeable in dairy 
cows so affected that they experience some relief after parturition. 

Occasionally, however, chronic signs suddenly become acute, from 
rapid increase of the swelling or from some alteration in its shape leading 
to pronounced difficulty in deglutition and respiration. 

The more aggravated symptoms of advanced cases are—Extension 
of the head, with the nose poked out to facilitate respiration. The roaring 
noise is heard at a distance even when the animal is not feeding or 
cudding, and the slightest run makes the animal stop and gasp for breath. 
Salivation is often noticed; the amount of food consumed becomes less 
and less, till fluids only, and that in small quantity, can be taken ; rumina- 
tion becomes perfunctory or ceases altogether ; emaciation proceeds, and 
milch cows become dry. 

Growths that are at first sessile on the roof of the pharynx, giving 
rise to little disturbance, have a tendency to become elongated and 
pedunculated, when, by blocking the orifice of the gullet and interfering 
with the epiglottis, they give rise to alarming symptoms. 

When feeding, the animal makes a gurgling, choking noise, is sali- 
vated, and coughs to displace the obstruction so that swallowing may be 
accomplished. This may occur with almost every mouthful, and the 


DISEASES OF THE PHARYNX: CATTLE: 327 


hungry animal becomes greatly excited; but the symptoms vary with 
the site, size, and shape of the swelling. 

Though in many cases enlargement of the salivary and lymphatic 
glands (often considerable) may coexist with an internal abscess or 
polypus of the pharynx, ageravating the symptoms, and perhaps 
giving a clue to the character of the infection responsible for the 
internal swelling, nevertheless, many of the worst cases of roaring 
due to pharyngeal mischief present no trace of abnormal tissue 
externally. 

Draenosis.—lf the symptoms exhibited and the results of ausculta- 
tion and external manipulation of the throat are not sufficiently con- 
clusive to enable us to differentiate whether stenosis is located in the 
pharynx or elsewhere, a careful manual exploration of the pharynx via 
the mouth is usually conclusive. By digital examination of the larynx 
through the pharynx the presence of intralaryngeal tumours, which 
cause roaring, persistent cough and difficulty in respiration, may be 
detected. 

In the live animal the specific character of an intrapharyngeal tumour, 
in the absence of circumstantial evidence elsewhere of tuberculosis or 
actinomycosis, is difficult to settle, unless we can secure a portion of 
it, or a suitable swab for smear-making, staining, and microscopical 
examination. 

-Proanosis.—This depends entirely on the possibility of removing the 
swelling by operation (or by joint operative and medicinal measures 
if the growth is actinomycotic), and is only distinctly bad when the lesion 
is a very large, flat, non-suppurating, or otherwise awkwardly-shaped 
tumour, causing grave symptoms and deemed irremovable by the ordinary 
operation ; and if we have reason to believe the growth is malignant, 
the case is more hopeless. 

TREATMENT.—It is not to our credit that in most cases very little 
treatment beyond some external application to the throat is at- 
tempted for the relief of animals suffermg from pharyngeal abscess or 
tumour. 

Roarers, if bound to a stake or stall division, should have an easy 
binding in the best ventilated part of the cowshed. They are too often 
bound tightly and hidden in a dark corner, with their nose close up to the 
wall. And, because actinomycosis is the predominating cause of pharyn- 
geal growths, the administration of large doses of iodine and iodide of 
potassium, or of iodide of mercury and iodide of potassium, is advisable 
in the early stages of every case of roaring, as in the following 
formula: 


328 SYSTEM OF VETERINARY MEDICINE 


I Hydrarg. biniod. ~.. at af , 3 LY 
Potass. iod. .. ae “A F ac Bu: 
Aquam ‘f * si * ad 3XXv. 


M. ft. mistura. Sig.: Two to four tablespoonfuls to be given three 
times daily in food, drinking-water, or administered in 4 pint of 
cold water. 


When pronounced symptoms are due to a tumour, it should be re- 
moved if possible ; if due to an abscess, this should be opened. In either 
case iodine may be prescribed for a period thereafter. 

Recognising the need for operative procedure in cases of pharyngeal 
abscess and abscess of the velum pendulum palati, Principal McCall 
many years ago consistently recommended that they should be opened 
by means of a sharpened piece of cane or whalebone, and in recent 
years Cunningham of Slateford vividly described the good results that 
follow the opening of pharyngeal abscesses in bovines. For operation, 
the animal may be taken outside and fixed to a post, with the 
“Reliance” gag in position, and held by assistants in the manner advised 
for the manual extraction of an upper cesophageal obstruction (see 
p. 334). Bulging soft swellings on the roof or sides of the mouth may 
be burst by a forcible thrust of the finger or opened with a guarded 
lancet, and afterwards explored with the finger to facilitate discharge of 
the abscess contents, which are often, in part, cheesy in consistence and 
difficult to evacuate. Pedunculated tumours may be lassoed with the 
ecraseur and removed. A long ecraseur fitted with strong, flexible steel 
wire serves the purpose well and seeks the root of the tumour. For 
the same purpose a modification of “ Defay’s * wire extractor”’ may be 
used. If the situation of the tumour is such that the soft palate interferes 
with the use of a straight rod, the instrument may be bent near the end 
and have a ring attached at the bend for conducting the wire portion 
of the instrument. By a suitable alteration in the shape of the instrument 
the wire loop can be placed on the base of the tumour, and obviates the 
need for making a lesion in the soft palate. The successful opening of an 
abscess or the removal of a tumour has an immediate and salutary effect. 
In all extreme non-tubercular cases when the need for slaughter is 
imminent, operation should always be attempted unless the animal is 
ripe in flesh ; for if successful, it bestows a new lease of life on many helpless- 
looking animals, and if unsuccessful, the loss is not increased. If roaring 
be associated with marked pulmonary tuberculosis, operative treatment 
is inadvisable. 


* This instrument was invented for use in canine obstetrics (vide « F.eming’s 
Veterinary Obstetrics,” Third Edition, p. 354; also Veterinary Record, December 13, 
1902, p. 388. 


DISEASES OF THE GHSOPHAGUS: CATTLE 329 


If it be thought necessary at any time to apply a smart blister to the 
throat of an ox, it should be halter-bound in the centre of the stall, so 
that it may have no place to rub the throat on. The roaring animal 
should on no account be turned out with the herd soon after the applica- 
tion of a throat blister, or it will be made the butt of the others, and 
get severe treatment when it falls in the chase asphyxiated. We 
consider the compound liniment of iodine, repeatedly painted on the 
closely-clipped skin with a tooth-brush, the most suitable external applica- 
tion for bovine throat mischief. 


DISEASES OF THE @SOPHAGUS. 
CESOPHAGEAL OBSTRUCTION. 


Choking as a symptom of cesophageal obstruction in the ox is 
exceedingly common in certain districts. This is due to several factors. 
We have already referred to the animal’s imperfect mastication of 
bulky food and its tendency to play with and attempt to swallow foreign 
substances, often bulky or solid, which on occasion prove too large for 
passage through the gullet. This natural predisposition to choking in 
bovines is so marked that the great majority of cases are quite 
unagssociated with any diseased condition or structural defect in the 
cesophagus, and are dependent on the physical impossibility of effectually 
passing to the stomach the large pieces of roots and various foreign 
bodies which the animals at times contrive to swallow. The nature and 
quality of their food are also eminently responsible, since it consists 
largely, in many districts, of roots—e.g., turnips, mangolds, potatoes, etc. 

As examples of foreign substances which have produced choking— 
occasionally fatal—in bovines, we may mention bones, pieces of wood 
and iron, wire, etc., portions of old boots, bulky rags, linen and other 
apparel which has been hung on hedges to dry, or spread on the grass to 
be bleached ; and several deaths are recorded of animals choked through 
swallowing newly discharged foetal membranes. 

We have not encountered a single case of dry impaction of the gullet 
in the ox, nor have we been able to prove that rumination has been 
responsible for any marked case of choking. 

The seat of obstruction may be— 

1. At the entrance to the gullet, with a portion of the obstacle pro- 
jecting into the pharynx. 

2. In the lower portion of the upper third of the cervical division of 


330 SYSTEM OF VETERINARY MEDICINE 


the gullet. This is the most common situation, because the organ is 
narrower here than elsewhere. 

3. At the lowest point of the cervical portion of the gullet just at the 
entrance to the chest. 

4. In the thoracic part of the gullet. 

Symproms.—The animal suddenly ceases to feed—it may be when 
half through with its root rations—it is restless, coughs and gulps, and 
there is an abundant flow of saliva from the mouth, which is often forcibly 
ejected in quantity during attempts at vomition. 

This the animal bespatters all around, and the quantity of saliva lost 
may be sufficient to fill the feeding-trough and cover up the uneaten 
roots. 

A varying degree of tympany is always present, except in those cases 
caused by materials so shaped that they interfere but little with the 
physiological eructation of gases from the rumen. Rumination is, of 
course, suspended. According to the seat, size, shape, and nature of the 
obstruction, the symptoms vary in degree and urgency. When a large 
body is fixed in the gullet entrance or is lying loose in the pharynx, there 
is immediate danger of suffocation from local interference with respiration. 
An animal so affected stretches and stiffens the neck and extends the 
head towards the ground, the eyes becoming bloodshot and protruding. 
It is seized with violent, frantic coughing and gasping respiration, 
salivation is profuse, and the onset of acute and sudden tympany threatens 
the patient’s life. 

When the offending body is fixed in the cervical division of the gullet, 
it can be seen and felt on the left side of the neck. If it be so rounded 
and large that the mucosa of the tube is closely adapted to it all round, 
rendering the natural to and fro passage of gases and fluids almost 
impossible, the animal may die of asphyxia in a short time from a sudden 
unrelieved tympany. Round, smooth, and large unbroken potatoes are 
common causes of these dangerous cases. 

But the symptoms of cervical choking, though always sufficiently 
characteristic to make diagnosis easy, are not in the majority of cases 
threatening, because it is often the case that the obstacle is a portion. of 
root irregular in outline. Its awkward shape and angular outline may 
be the actual cause of the lodgment of a portion that cannot be called 
bulky, but these features make the creation of a perfect seat in the tube 
impossible, and according to the facility with which the normal eructation 
of gas can be carried on past the obstruction, tympany and danger to 
life are negligible, or vice versa. Indeed, in some cases associated with 
little tympany or salivation, oils and other fluids, cautiously administered, 


DISEASES OF THE G2SOPHAGUS: CATTLE 331 


find their way past the obstruction, and the comparative absence of 
ptyalism is due to the fact that much of the saliva secreted is effectively 
swallowed. Thus salivation and tympany in cases of cesophageal 
obstruction go hand in hand, as the degree of either present depends on 
the effectiveness of the block in the gullet. 

In some cases of intrathoracic obstruction the symptoms are so 
indefinite that a mistake in diagnosis may be made; in others there is 
grunting and marked tympany. If the animal partakes of fluid (and 
the victim of low choking occasionally offers to drink), it is immediately 
returned—in fact, when the animal sickens and retches after swallowing, 
choking is always to be suspected. In many cases the symptoms are 
mild in character for some hours, and occasionally for a day or more, 
when rational efforts to remove the foreign body have been unavailing. 
Sometimes, however, a slight alteration in the relation of the obstacle 
to the gullet leads to exacerbation of the symptoms. Per contra, violent 
cases are often modified by a little manipulation of the foreign body. 

CoursE.—As in the horse, recovery may be, and often is, spontaneous 
when the obstruction is feebly grasped by the cesophagus, has fragile 
borders, or is so sized and shaped that the descending saliva and ascending 
gastric fluids can get around and beyond the obstacle, lubricating it and 
the seat of impaction. 

As soon as the obstruction disappears, tympany decreases, salivation 
ceases, and the animal, if allowed, will return to its feed. Like results 
follow successful manipulatory removal of the obstruction. On account 
of the danger that attaches to inordinate use of the probang, many 
cases are wisely allowed to remain in statu quo pending a spontaneous 
recovery, a trocar and cannula being left for puncture of the rumen in 
case of need. Tympany is so sudden in acute cases that the animal 
may die of suffocation if not attended to in a very short time. 

Choking is apt to recur, because in all but the mildest of cases some 
degree of structural change takes place in the gullet at the seat of im- 
paction, limiting its capacity temporarily or permanently. We have 
on several occasions attended animals that were choked twice within 
twelve hours because they managed to get hold of a root displaced from 
a neighbour’s trough, and, having devoured it greedily, a portion failed 
to pass the original site of obstruction, which was still swollen. 

CoMPLICATIONS AND SEQUELZ.—These are the same in the ox as in 
the horse so far as the cesophagus is concerned. It may be wounded, 
when cesophagitis readily results; or it may be ruptured; while ectasis 
and diverticulum may accrue, or septic broncho-pneumonia may be set 
up. Tympany of the rumen is, of course, a special complication of 


332 SYSTEM OF VETERINARY MEDICINE 


cesophageal obstruction in ruminants, and this is on occasion the direct 
cause of subsequent abortion in pregnant animals. 

Proenosis.—Generally speaking, this is not so serious in the ox as 
in the horse, for bovine patients are relatively more easy to handle. 

The peculiar urgency of the bovine case from tympany is readily 
removed by puncture of the rumen, and the animal's life is not in 
much danger even when cautious and moderately applied measures for 
the removal of the obstruction fail, for by leaving the cannula in the 
rumen the recurrence of tympany is avoided, and usually nothing unto- 
ward happens, even though twelve to forty-eight hours elapse before the 
offending root is loosened and swallowed. 

As already explained, the saliva and gastric fluids which are churned 
about the obstruction cause maceration of its borders and facilitate 
displacement. 

Many clients are doubtful of the expediency of this waiting policy, 
but the wisdom of it is best known to those who have been tempted to 
overpress the probang and thus produce a lesion of the gullet, a result 
that is almost inexcusable when we know that with proper caution and 
patience the animal would have made a recovery, provided the offending 
body was a portion of a root. 

DIFFERENTIAL Dracnosis.—Though it is not always possible to be 
sure of the nature of the obstacle in the gullet—and this is a factor on 
which the progress of the case much depends—the difficulty in diagnosing 
whether the occlusion is due to something recently swallowed only arises 
in cases of intrathoracic choking. Even in these a knowledge of the 
history removes doubt. If the symptoms, however mild, arise suddenly 
when the animal has been eating roots, and especially if some are left 
uneaten, the evidence is conclusive, especially if the animal is not subject 
to chronic tympany. 

But progressive organic disease, as well as constrictions and diver- 
ticula of the thoracic part of the cesophagus, are not uncommon, and not 
only predispose to stenosis, but some of these pathological conditions, 
when advanced, induce phenomena akin to those of impaction. Equally 
culpable are enlarged glands, tumours, and abscesses which press on or 
surround and so involve the esophagus that its normal power to dilate 
and contract is considerably modified. Here, again, the history helps 
to decide, for an incompetent gullet is a potent predisposition to choking 
in normally fed animals when the morbid condition is advanced. 
The failing health, persistent tympany, and other signs of chronic 
cesophageal obstruction that prevail, clearly negative the possibility of 
the existence of a temporary stenosis. 


& 


DISEASES OF THE GSOPHAGUS: CATTLE 333 


Even if we fail to pass a well-lubricated probang to the stomach, we 
cannot conclude that the impediment is caused by something swallowed, 
for a diverticulum or constriction of the gullet may so impede the passage 
of the instrument that the cautious practitioner ceases the attempt rather 
than risk injuring the gullet, and the failure of the attempt sheds no light 
on the diagnosis. 

PROPHYLAXIS.—T0 prevent choking when animals are eating roots 
or tubers, these may be sliced, fingered, or pulped; but if given whole, 
the animals should be temporarily bound, so that they cannot raise the 
head more than two feet from the ground. 

The accident usually occurs when the feeding animal raises its head 
high in its endeavour to fix between the molars an awkward, hard portion 
of a root or a smooth potato, and the morsel inadvertently passes over 
the root of the tongue, through the pharynx, and into the gullet, which 
has not the capacity to pass it on. It is the practice in many herds 
where potatoes are daily fed to the cows to fix down the binding of 
each animal by a special arrangement prior to giving the potato ration. 
Some cow-feeders are in the habit of halving or quartering each turnip 
with a shovel. This is not to be recommended, for, while it certainly 
facilitates their consumption, it multiplies the danger from choking, for 
this almost invariably occurs when an animal is negotiating the remnant 
of a root. Animals that have suffered from choking and have been 
relieved should be so placed in the byre for some days that they cannot 
have access to whole roots of any kind. During that period the roots 
allowed should be fingered, pulped, or cooked. 

Cases of choking occur most readily at the beginning of the root-feeding 
season, and in animals that have for the first time been put on whole 
roots. On these occasions the cattle attendant should be specially vigilant. 
Pastures should be inspected, and all foreign materials removed that 
the animals would be likely to pick up. This is particularly essential 
in fields top-dressed with city manure or that are liable to contamination 
with refuse. Portions of wire cut off during fencing operations should 
be carefully collected. 

TREATMENT.—If asphyxia from tympany is so threatening that we 
have not time to deal with the obstruction in the gullet as the first pro- 
cedure, the rumen should at once be punctured with a trocar and cannula, 
failing which a sharp knife will serve the purpose. A smaller trocar 
than the usual one may be employed, since the need for it may be 
temporary. 

For the removal of the obstruction the following methods may be 
tried : 


334 SYSTEM OF VETERINARY MEDICINE 


1. Manual Extraction —This is only possible when the obstacle is 
partly in the pharynx or near to it in the gullet. 

A gag is placed in the mouth of the animal—a “ Reliance ”’ is best, 
because of the freedom it allows—but any gag will do that permits the 
passage of the hand and arm; even a roomy stirrup-iron may be used - 
in an emergency. Then, with an assistant steadying the head, and another 
instructed to apply external upward pressure on the impacted gullet, 
the operator seizes the tongue in one hand, and deftly passes the other 
through the mouth and pharynx and endeavours to remove the ob- 
struction. 

2. External Manipulation.—Attempts to dislodge the obstacle by 
pressure from without are almost invariably directed upwards towards 
the pharynx. With a little experience and dexterity, practically all 
cases of upper cervical obstruction by roots can be quickly relieved by 
external upward taxis, and in our experience these cases embrace over 
80 per cent. of those met with in practice. 

By means of a rope or an assistant the animal’s head is kept low to 
extend the throat. The operator then, standing in the same direction 
as the animal and on whatever side he chooses, places his head firmly 
on the patient’s neck to avoid injury from the horns. He then passes 
the arm next to the animal over the neck, and having planted the thumb 
of each hand in the jugular furrows behind and below the obstruction, 
he applies to it cautious, firm, and unyielding pressure. The animal 
resents this, gulps and swallows; but these efforts, though opposing the 
operator, facilitate the release of the impediment, though if pressure is 
relaxed they serve to replace the impaction. The hands should not be 
removed till the root has fallen to the ground (this often happens even 
when the animal is not gagged) or until he sees that itis being effectively 
chewed. | 

In very many cases we have been successful single-handed in the 
short space of time that elapsed while waiting for an attendant to give 
assistance. 

Instead of operating in the stall in this way, some practitioners secure 
the animal to a tree, stand facing it, and with extended arms, placing 
the fingers behind the obstacle, contrive to pull the root into the mouth, 
from which it may drop out or be seized with the hand. For the operator 
this may be deemed the safer plan, but it is more troublesome, involves 
delay, demands assistance, and does not admit of the same amount of 
purchase on the obstruction. 

If the site be lower down, upward taxis is not advisable; but if the 
object is susceptible to manipulation downwards, it sometimes happens 


DISEASES OF THE SOPHAGUS : CATTLE 335 


that the travel is continued, as evidenced by the eructation of gas, dis- 
appearance of tympany, and ability to swallow. A continuation of its 
movement is encouraged by the administration of small quantities of 
raw linseed oil. One cannot, however, reasonably leave such a case 
without passing the probang, to insure that the obstruction has entered 
the rumen. 

3. Passage of the Probang.—This instrument, of which there are 
several varieties, and for which many things are substituted—e.g., whip- 
handles, pieces of cane, cart-rope, etc., has been responsible in impatient 
or incompetent hands for the sacrifice of the lives of many choking 
animals. The object in using the probang is to propel the obstruction 
into the rumen. The forceps and corkscrew patterns of the probang, 
designed for the extraction or disintegration of the offending body, are 
not to be recommended. Their use is fraught with danger to the gullet. 
The ideal probang is 6 feet long and hollow, being made of a spiral 
spring steel wire covered smoothly with leather or gum-elastic, and 
provided with a cup-shaped metallic mount at one end and an egg-shaped 
one with a flat face at the other end. 

We consider that the use of the probang for the relief of choking 
should be limited to those cases in which external taxis is impossible, 
inadvisable, or has been unsuccessful. In the latter case it must be used 
with extreme caution, for an obstruction that resists external taxis does 
not readily yield to a rational use of the probang. 

Before use the instrument should be smeared with oil, vaseline, or lard, 
etc. Itis usual to fix a wooden perforated gag in the mouth, provided with 
two arms, and secured by a strap round the base of the horns. This 
facilitates the passing of the instrument through the mouth and prevents 
crushing of it by the molar teeth, while its arms afford a ready means 
by which assistants may steady the head. It is to be remembered that 
in passing the probang through the unobstructed gullet in the ox some 
resistance is felt as soon as it enters the chest, and gives the impression 
that the organ is blocked; but this grip soon passes off, and further 
progress is easy. 

In all cases of choking in “aise it is suspected or known that empirics 
have been at work, the probang should be carefully passed down to the 
obstruction and withdrawn to see whether it is smeared with blood—a 
sure sign of injury to or rupture of the gullet. If this be the case, the 
practitioner had better establish his irresponsibility, and, if thought 
necessary, advise the salving of the carcass at once, for the flesh of the 
victim of a ruptured gullet is soon unfit for use if the animal is allowed to 
live for any time. 


336 SYSTEM OF VETERINARY MEDICINE 


If reassured by an examination of the probang that no lesion exists, 
it is again passed down to the offending body, a little oil is poured through 
it, and then the operator exerts a degree of steady pressure. Further, 
if a swollen and emphysematous condition of the neck is observed in 
a case of choking, this is a sure indication that the gullet has been 
ruptured, and the practitioner should on no account pass the probang, 
or he may be blamed for causing the lesion. If a somewhat easy onward 
movement of the sound seems to indicate propulsion of the obstacle, 
such is not to be taken for granted, as it may have slipped past it; so it 
is best to retract a few inches, when the tactile sense may determine 
that all is well, and the instrument is pushed on till it enters the rumen. 

If marked opposition to the passage of the probang indicates a firmly 
held obstruction which will not yield to judicious pressure or gentle 
tapping, patience is to be exercised, for the ease with which it is occasion- 
ally dislodged after a few minutes shows that the cesophagus tends to 
grasp the obstruction more firmly when pressure is first put on it. 

Any attempt on the part of the patient to rear is a signal to desist, 
and if this is repeated, the probang is to be abandoned, else rupture of 
the gullet will be produced and bruising of thoracic organs. When it 
is decided to leave the patient with the obstruction still in the gullet, 
the animal should be gagged with a piece of wood, the rumen should be 
punctured, or a trocar left with a responsible attendant to be used at 
once if tympany becomes marked. Deflation of the rumen relieves the 
upward pressure of gases on the obstruction, and so facilitates its passage 
towards the stomach. | 

The animal should then receive by very cautious administration gill 
doses alternately of the following: linseed oil, soapy water, solution of 
sugar, carbonate of potash or soda, etc. Extract of belladonna may be 
given with the hope of producing topical relaxation of spasm, or such 
alkaloids as pilocarpine, eserine, arecoline, or apomorphine, which directly 
influence the secretion of saliva or functions of the muscles of the gullet, 
may be administered hypodermically. 

If the offending body be a portion of a root, it gives way in most cases 
in the course of twelve to thirty-six hours. Occasionally a longer time 
elapses, but one should never be tempted to use the probang later on, 
for the swollen state of the gullet renders it more friable. 

Cases are on record in which the probang perforated or split the 
offending body, and the patient was able to swallow fluid food while 
the obstacle remained in the gullet. 

4. isophagotomy.—In cases of cervical obstruction this operation, 
complete or modified, may be performed (see p. 77). 


DISEASES OF THE CGESOPHAGUS: CATTLE 337 


(ESOPHAGITIS, GESOPHAGISMUS, PARALYSIS OF THE ESOPHAGUS, 
DILATATION AND CONSTRICTION OF THE GESOPHAGUS. 


These conditions also occur in cattle, and do not differ materially 
from similar affections in the horse (see p. 54). 


TRAUMATIC LESIONS OF THE CESOPHAGUS (PERFORATIONS 
AND RUPTURES). 


Lesions of the cervical portion of the gullet occasionally arise from 
horn-gores or accidents on hedges or other fences, gates, etc., the ceso- 
phagus being implicated in the serious wounds of the neck that result. 
But such cases are rare, and it is to the careless use of the probang 
that the great majority are attributable. The rupture may be partial 
or complete, one or both coats being involved in the lesion. 

(Esophageal obstructions that present angular, sharp, and rigid 
borders to the mucosa very readily produce a lesion, even under modified 
probang pressure, and if a slight lesion occurs, the end of the probang, 
under pressure, readily slips into the lesion pocket and completely per- 
forates the tube. In some cases of cervical choking it is quite apparent, 
on manipulation of the obstruction externally, that its anterior surface is 
so slanting that central pressure on the offending body is: not possible, 
When used with some force in these cases the end of the probang 
swerves and bears almost entirely on the cesophageal wall, which, if it 
be healthy and elastic, may accommodate the probang past the obstruction 
without material injury. But when, as is often the case, the cesophagus 
at the seat of stenosis is congested and swollen, so that its capacity and 
elasticity are diminished, the end of the sound diverted by the sloping 
surface of the root, readily bursts the friable walls of the gullet, while 
the obstruction remains in position. 

Perforation of the esophagus as a result of ulceration is very un- 
common, but certain pathological conditions, as well as structural 
defects in the organ, predispose to rupture when the probang is used, 
It is also possible to have an effectual lesion produced without the use 
of the probang when an animal is choked by a septic foreign body of 
unyielding consistence and possessed of sharp edges. 

We have already referred to the wisdom of making an exploratory 
passage of the probang before attempting removal of the obstruction 
when it is suspected that the animal has been empirically treated, and 
if blood is found on the end of the instrument when it is withdrawn the 
practitioner had better retain his reputation and advise slaughter. 

For symptoms and treatment of cesophageal lesions see pp. 82, 84. 

VoL. HU, 22 


338 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE STOMACHS. 
GENERAL REMARKS. 


Reference has already been made in a general way to the frequent 
incidence of gastric disorders in the ox, and how this is influenced by the 
habits of the animal, indiscreet changes of diet, and other factors. Our 
knowledge of the processes of bovine digestion is still so limited that we 
cannot consider our present-day conception of bovine gastric disorders 
as a matter approaching perfection. Indeed, it cannot be truly said 
that we possess clear ideas regarding the functions of the compartments, 
of their complex gastric apparatus and the modus operandi of their 
co-operation one with another, while in respect of the questions as to the 
disposal and movement of the aliment, rumination, etc., there is much 
tor future investigators to reveal. . 

Many enlightened farmers and cow-feeders have, to their own profit 
and the welfare of their animals, put into practice the methods of feeding 
which science and practical experience have shown to be best and most 
economical ; still, a great many owners pay too little or no attention to 
the maintenance of a proper food-ratio or the propriety of making any 
compulsory change of diet a gradual affair. 

Though it be true that the neuro-motor functions of the aliment- 
preparing compartments undergo modification, and the gastro-intestinal 
secretions vary according to the quality of the food consumed by the 
animal, this adaptive capacity is a process too gradual to enable them to 
meet the digestive demands of food-stuffs given in quantity, and materially 
different in quality, from what the animals have been accustomed to. 
The day-book of the country practitioner strikingly illustrates the 
almost absolute immunity from gastric disturbances which our herds 
enjoy during the grazing season. We therefore conclude that during a 
prolonged course of suitable and unchanging diet—e.g., when the animals 
are on all-sufficient, well-watered pastures, the processes of digestion and 
the gastro-intestinal secretions become so peculiarly suited by usage to the 
requirements of this simple bulky diet that the acme of digestion and 
assimilation is gained, and the objectionable features of the glutton, the 
saucy feeder, and the chronic dyspeptic are in great measure lost. 

But when, in the late autumn, declining growth in the pasture land 
renders supplementary feeding essential, gastric disorders become more 
common. Coincident with declining growth and the commencement of 
artificial feeding, exposure to colder weather and occasional wet and 
stormy nights during the last weeks of out-door life, plays a not unim- 


DISEASES OF THE STOMACHS: CATTLE 339 


portant part in revealing again the tender animals that require special 
consideration as to food and housing. 

It may be said of the functions of the digestive organs, as of those of 
the other systems, that nothing applies the brake more suddenly and 
effectively than a severe chill from exposure, and the period of inactivity 
and non-resistance that follows, enables latent factors to become exciting 
causes of disorder and disease. Further, chills so occurring shock the 
system the more profoundly because the fatigued animal stands list- 
lessly about, and fails to take its wonted amount of exercise. 

For these and other reasons it is true economy, with dairy herds in 
particular, to err on the side of early housing when the weather breaks ; 
and if the change from grass to the full menu of winter-feeding is wisely 
graded, the ox shows a remarkable adaptability to extremes of diet. 

It must also be borne in mind, in the stall-feeding of animals for flesh 
or milk, that the best results—including freedom from digestive troubles 
—can only be obtained when due regard is paid, not only to the quality 
of the food, but to an unfailing regularity in the meal-hours, and the 
work of the cattle-shed should be so planned that the animals may have 
the maximum period of quietness between meals. 

Intensive feeding, the royal road to beef- or milk-production, is beset 
with many dangers that make the dairying and feeding districts 
notorious for their crop of dyspeptic animals. 

Per contra, in the breeding and stock-raising fare where the animals 
lead a natural life with the maximum of days off the chain, and where they 
are almost entirely fed on home-grown crops, digestive derangements 
are almost unknown ; and though, under these conditions, their milk-yield 
compares unfavourably with that of the cow-feeder’s animals, they 
fulfil their own destiny by breeding surer and living healthily to a ripe 
old age. But the cult of the simple life may be carried too far, and on 
many upland farms during severe winter seasons there is an inexcusable 
death-rate among the stock from actual starvation and exposure. 

The fittest only survive, they are stunted in growth, and often become 
the hosts of internal parasites which produce pathological conditions of 
important organs—e.g., distomatosis of the liver—and thus lay the founda- 
tion of impaired digestion for the future. 

Rumination.—Regarding the physiology of this important process, 
the reader is referred to Smith’s “ Vetermary Physiology.” 

As we proceed in our consideration of the diseases of the digestive 
organs, reference will repeatedly be made to temporary or prolonged 
suspension of the process, and to its perfunctory or modified perform- 
ance, circumstances which have a symptomatic bearing on the case, 


340 SYSTEM OF VETERINARY MEDICINE 


assisting the practitioner in his daily prognosis. Our recognition and 
clinical estimate of the varying degrees of abnormal cud-chewing ob- 
served in sick animals is necessarily based on our conception of what 1s 
normal, and a few preliminary remarks on the latter may not be out of 
place. 

Perfect rumination requires that the ramen be moderately filled with 
rough food in need of remastication, as well as a considerable quantity 
of fluid. The rations of ruminants should therefore comprise a certain 
amount of long food, an abundant supply of water, and if the animals are 
stinted in either of these, derangement readily results. If the rumen be 
too empty, its flaccid walls are not effectively aided by the abdominal 
muscles ; while if the organ be overdistended, as in hoven, the walls are 
paralysed and rumination is impossible. Hand-fed or suckled calves that 
have access to other food begin to ruminate from the seventh to the 
twelfth day, or soon after they have taken to long food. 

Adults spend from six to seven hours per day ruminating. The 
majority of animals begin to ruminate within fifteen minutes after feed- 
ing, and though a minority of healthy beasts do not conform to this rule, 
the exceptions almost invariably include those that are the subjects of 
indisposition. If not grossly disturbed, the healthy animal will ruminate 
for forty-five minutes or more at a time, and with many the act will end 
in drowsiness or sleep if there is perfect quietness. During the longer 
intervals between meals—e.g., in the night time—the animals may have 
three periods of rumination, but the number of ruminating periods in 
twenty-four hours depends on the number of meals allowed and the 
absence of disturbance. 

Kach bolus takes from three to four seconds to reach the mouth after 
its disengagement at the stomach. As it passes under the soft palate 
it is subjected to pressure, and the return of expressed fluid is noticeable. 
Simultaneously the bolus is directed to one side of the mouth by a single 
movement, which may be from right to left, or vice versa ; thereafter the 
mastication of the bolus is accomplished by aseries of rhythmical strokes, 
all in an opposite direction to the initial one. 

If observations are taken over a number of days in a herd, it will be 
seen that the sum of those observed chewing from right to left is as 
nearly as possible equal to that of those operating from left to right; 
but the chosen direction is maintained in each case till the process ceases 
during any period of rumination, though the direction may be, and often 
is, changed by many of the animals when next they begin to chew the 
cud. According to the temperament of the animal the speed of the 
masticatory movements varies ; and since one may be seen to dispose of 


DISEASES OF THE STOMACHS: CATTLE 341 


five mouthfuls while another accomplishes four, each subjecting the cud 
to the normal number of cuts, it follows that the time spent in rumination 
by animals of equal appetite must vary. 

The normal number of strokes is from forty-five to seventy-five per 
bolus, the average being about sixty ; and though a few animals take a 
fraction over one second to each stroke, the majority accomplish sixty 
or more in about fifty seconds. The first bolus of each period is usually 
a small one, receiving less than forty strokes. The downward journey 
of the masticated mass is speedier than the upward, and this is doubtless 
due to the lesser resistance of its finely divided condition as well as the 
law of gravity. 

The thoroughly masticated bolus of normal rumination passes directly 
to the third stomach, taking with it any fluid material that may be in 
the cesophageal canal, and the effect of a period of rumination is seen in 
a considerable diminution of the size of the rumen. If mastication is 
perfunctory and incomplete, there is reason to believe that the bolus may 
wholly or in part again reach the rumen for further treatment, and the 
duty of selection in all probability rests with the modified sphincter 
which guards the entrance to the third compartment. | 

Rumination is readily modified if bulky food is withheld for a time, 
and any circumstance which disturbs an animal calmly chewing the cud 
causes a temporary suspension of the act. Repeated and needless or pro- 
longed interruption of the act of rumination may conceivably have an 
ulterior effect on digestion. Reasoning thus, it is easy to comprehend the 
deleterious effects of long, bustling journeys by road or rail, during which 
the animals have neither the opportunity nor the inclination to perform 
an act so essential to their well-being. 

Prescribed medicine should not be administered till an animal has 
ceased ruminating. 

Cattle attendants who know normal rumination when they see it, 
and can specify the animals under their charge that are slightly atypical 
in their cud-chewing, are in a position to recognise what is often the 
first sign of disorder—viz., abnormal rumination. But it is too often 
taken for granted that, because an animal has been seen recently to 
chew the cud, it may still be fed with a free hand. 7 

Rumination is to be deemed abnormal when the number of cuts 
each bolus receives is markedly decreased ; when the strokes of the 
molar teeth are hesitating, irregular, and deficient in force; when the 
interval between the fall of one bolus and the rise of another is pro- 
tracted ; when the whole period of rumination is curtailed, and it may 
be suspected when an animal, without cause, is unduly slow to commence 


342 SYSTEM OF VETERINARY MEDICINE 


the process after feeding. With increasing sickness the function becomes 
more and more perfunctory till it ceases altogether. 

Per contra, when recovery has begun, rumination, though at first per- 
formed in a listless way, gradually improves, mastication is more decisive, 
the strokes per bolus increase daily in number, and these features serve 
to guide us in our estimate of the case. 

Vomition.—In spite of the fact that the healthy ox voluntarily re- 
gurgitates from the stomach to the mouth several hundreds of food boli 
per day during rumination, actual vomition very seldom occurs, and that 
notwithstanding that the anatomy of the cesophagus and stomachs, and 
the relation of the rumen to the abdominal wall, seem to favour the easy 
accomplishment of the act. It would appear that the centre for vomition 
in the medulla is not easily roused, but when it does act the expulsion 
of food is very facile. 

Salutary vomition occasionally occurs when the rumen is becoming 
distended with rapidly fermenting ingesta. It may also happen during 
or after the consumption of putrid decomposing roots or of fermenting 
and irritant food materials, or in cases of rhododendron poisoning, 
etc. In such cases the amount vomited is usually considerable, and 
the act is not repeated. It is in rare instances noticed immediately 
after the withdrawal of the probang. With the exception of the 
conditions referred to, vomiting is to be reckoned a very serious 
symptom. 

The centre for vomition is readily roused and kept irritable by 
afferent messages arising from pathological conditions of the throat and 
cesophagus, and from the seat of choking, due to the obstruction of 
foreign bodies. In the latter the regurgitated materials only reach the 
obstruction, while in the former the reflex act 1s complete. Chronic 
vomition is usually an irremediable phenomenon, dependent on organic 
disease of the*lower third of the gullet, the growth of neoplasms, or 
diseased conditions of contiguous glands, etc., implicating the tube and 
prejudicing its capacity to transmit the food. The arrest of aliment at 
the site induces regurgitation, as in choking with a foreign body, but 
because the obstruction is easily overcome the act of vomition is 
completed, food being expelled. This is repeated as often as the patient 
partakes of food which fails to pass onward to the stomach. 

Inertia of the walls of the reticulum is sometimes the cause of vomi- 
tion. Bambauer in six cases found peritoneal adhesions caused by the 
passage of a foreign body through the walls of the reticulum, and in 
other three cases he found adhesions which resulted from an inflammation 
determined by accumulations of large quantities of sand in the retic- 


DISEASES OF THE STOMACHS: CATTLE 343 


ulum. These adhesions had the effect of annihilating the activity of 
the walls of the reticulum. 

On two occasions, when we were in the act of administering a drench 
composed of magnesium sulphate and sodium chloride to recumbent 
animals suffering from gastric engorgement associated with cerebral dis- 
turbance, forcible emesis occurred, and the delirious animals, being unable 
to control the copious vomit, at once died of asphyxia. 

True vomition—+.e., emesis direct from the abomasum—is, so far as 
we are aware, unrecorded. 

Dropping of the Cud ; Spewing of the Cud.—This is occasionally seen 
in bovines, and is usually due to diseased teeth, acute stomatitis, glossitis, 
or actinomycotic invasion of the jaws, mouth, or tongue, etc. These 
conditions render mastication difficult and painful, causing loss of control 
over the cud, which readily drops out of the open mouth. Dropping of the 
cud has also been observed when animals have been fed on decomposing 
vegetables, or roots, or unwholesome herbage of an acrid character. 
The affected animals, while ruminating, may chew and swallow some 
mouthfuls fairly well, but others, often very many, are discarded and 
fall to the ground. If the animal is recumbent, a heap of sour green 
material is accumulated, otherwise it is found scattered over the pasture- 
land. Appetite and secretion of milk are impaired, flesh is lost, and 
diarrhoea sets in. The symptom ceases when the cause is remedied. 
In cases due to improper food, the pasture should be changed, faulty 
roots withheld, and the patients should be purged and have a course of 
stomach tonics with alkalies. 


DISEASES OF THE RUMEN. 


GENERAL REMARKS.—The rumen or paunch in the adult is the largest 
dilatation of the alimentary canal. In non-pregnant animals it occupies 
three-fourths of the abdominal cavity, is seven times larger than the 
other three stomachal compartments combined, and has a capacity of 30 to 
50 gallons or more. It occupies the left side of the abdomen from the brim 
of the pelvis to the diaphragm, and its left hemisphere is in contact with 
the abdominal wall, excepting where the spleen is interposed. It is 
roughly divided into a large left and a shorter right hemisphere by two 
fissures, an anterior and a posterior, which are connected above and below 
by shallower depressions. The left hemisphere receives in front the 
terminal portion of the gullet and communicates with the reticulum. In 
the female, the uterus rests on the postero-superior aspect of the rumen, 
and since in pregnant animals a large part of the gravid womb is super- 


344 SYSTEM OF VETERINARY MEDICINE 


imposed on the rumen, it is easy to understand how gestation may be 
influenced by abnormal conditions of the rumen. 

The internal surface presents two large, fleshy pillars corresponding 
in disposition to the external fissures referred to, and from them trans- 
verse, but less developed, pillars run, dividing each hemisphere into 
two sacs. Where the external depressions are deepest, the internal 
pillars are best developed. 

Of the three coats which form the walls of the viscus the internal one 
only calls for remark. This cuticular mucous membrane is compara- 
tively smooth over the pillars, but elsewhere it is covered with papilla, 
which vary in number, shape, and size, being longest and most plentiful 
in the depth of the sacs. Some are leaf-shaped, others conical, and a 
few are fungiform. 

The strong and prominent fleshy pillars are mainly responsible for 
the vermicular movements that churn the food while it is undergoing 
maceration and fermentation in the presence of swallowed saliva, and 
on account of their prominence they are subject to greater attrition 
from the food than the less elevated and more passive parts of the organ. 
While this of itself would tend to check the growth of the rudimentary 
papilles found on the cuticular covering of the pillars, the comparative 
smoothness of the latter lessens the resistance which the partitions would 
otherwise offer to the shifting of the food from one sac to another when 
the organ rolls. 

The epithelium of the mucosa is squamous and stratified, and readily 
becomes detached in thin, broad flakes. Extensive removal of the 
epithelium is often seen as a post-mortem lesion. Of the two openings 
seen in the left anterior sac the cesophageal is superior to that which 
connects the cavity of the rumen with that of the reticulum. The former 
is funnel-shaped, and the latter is to some extent guarded by a valve 
formed by the pillars of the cesophageal groove. 

Being the receptacle for the sojourn of food, indiscriminate alike in 
quantity and quality, the rumen is pre-eminently liable to disorders of 
various kinds. Its functional activity is constantly at the mercy of its 
owner's unchaste appetite, and there is little wonder that a distensile 
organ of such enormous dimensions should, under the smallest systemic 
disturbance, have its innervation upset and its activity modified. The 
slightest loss of muscular tonicity of its walls, though it may not primarily 
be denoted by loss of appetite, causes imperfect rumination ; and if this 
passes unobserved—a common occurrence—and no precautions are 
taken, the loss of peristalsis increases, particularly if the appetite is 
maintained and indulged, other organs become implicated, and much 


DISEASES OF THE STOMACHS: CATTLE 345 


time, as well as value in milk and flesh, is lost before the animal recovers 
from this seemingly simple functional derangement. 

A slowly developing paresis of the walls of the rumen is one of the 
commonest harbingers of an attack of indigestion in animals that are 
strenuously fed day after day with the maximum of nutritious and 
stimulating artificial food-stufis. The insidious signs that readily escape 
notice are, slightly modified, or, it may be, perfunctory rumination, slight 
decrease in milk, occasional dryness of the muzzle, failure to lick the 
feeding trough quite clean, with a tendency to greater loss of appetite, 
and dryness of the feces ; while if attention is given to the movements 
of the rumen after food it will be seen that these are much less marked 
than those observed in a healthy neighbour. 


Impaction of the Rumen. 


Synonyms.—Plenalvia ; Mawbound ; Engorgement of the rumen; 
Overloaded rumen; Indigestion as a result of overeating. 

Derinition.—This condition signifies inordinate accumulation in the 
first stomach of food that has little tendency to undergo fermentation 
or putrefaction. The solidity of the aliment varies in different cases, 
and this is determined mainly by the nature of the food eaten. 

Our remarks will be chiefly directed to typical impaction—1.e., over- 
loading with material unnaturally deficient in sap. We cannot, how- 
ever, overlook the fact that occasionally we are called to treat aged milch 
cows suffering from gross distension of the rumen with semifluid fari- 
naceous aliment, mistakenly supplied to them by indulgent attendants, 
when, with digestion in abeyance and rumination suspended, the appetite 
for meal gruels sweetened with treacle or condimented has been main- 
tained for several,days after they had ceased taking food requiring 
mastication. Between these extremes we meet with cases in which the 
rumen is engorged with food of intermediate consistence, and such are 
usually amenable to simple treatment. 

It is worthy of remark the extent to which all the cows in a herd 
contrive to fill their paunches with grass in summer, during the period 
of most luxuriant growth, without ulterior result, after they have become 
accustomed to it. When housed at each milking period they look 
surfeited and oppressed, as they groan with the load in their well-filled 
stomachs. But it is the oppression of satisfaction, and the observable 
and active vermicular movement of the walls of the rumen allay our 
fears and foretell the early commencement of rumination, which soon 
distributes the aliment to other parts of the tract, and the laboured 
breathing subsides. Under no system of winter feeding have we noticed 


346 SYSTEM OF VETERINARY MEDICINE 


such repletion of the rumen that was not pathological or bordering on 
it. When discussing acute tympanites we shall refer to certain cases that 
arise suddenly and readily prove fatal, in which the rumen is greatly 
distended with fermenting food, the gases generated being so intimately 
mixed with the aliment that they are not free to be tapped by the trocar 
and cannula, This condition is included under impaction by some Con- 
tinental writers, but since the outstanding features of these cases are 
dependent on fermentation and retention of the evolved gases, and not 
on an inordinate accumulation of food actually swallowed, we preter to 
deem them special cases of tympany. 

The salient features of typical impaction are absolute repletion with 
food, flaccidity of the walls of the stomach, and an almost entire absence 
ot tympany ; but many true cases of plenalvia, during treatment or on 
account of it, or because some of the material is slowly fermentescible 
or turns putrefactive, become atypical and assume a more serious aspect 
from the development of hoven as a complication. 

Er1oLocy.—Under certain conditions consummate impaction of the 
rumen may be established in a short time—eg., when a gluttonous 
feeder accidentally or otherwise gains access to an unlimited or over- 
abundant supply of food—but in securely stalled animals the process is 
usually a gradual] affair, extending over several days. 

The avaricious glutton always devours more than its share of the 
double supply intended for itself and its neighbour, if attendants are 
careless in placing the rations, or the animal has too much freedom ; and 
when unequal feeders are stalled together it is not uncommon to find 
both animals doing badly, the rapid eater becoming surfeited and the 
other losing condition ; hence the necessity, in double-stalled byres, for 
pairing animals according to their feeding propensities. 

Marked dietetic errors, especially sudden changes of food, and notably 
from a low to a rich diet, as well as a continued insufficiency of water, 
lead directly to impaction, and under such conditions two or more cases 
may occur simultaneously in the same herd. Cases of excessive accumula- 
tion of semifluid material in the rumen may arise, as already explained, 
by giving an indisposed animal the only food it appreciates ; but similar 
cases result when an attempt is made to compensate for a shortage of 
long food or roots by giving an increased amount of meal gruels, brewer’s 
grains, etc. Animals so fed fail to ruminate on this finely comminuted 
material, and the contents of the rumen increase with each meal, till a 
crisis is reached. Any circumstance that interferes with rumination 
paves the way to impaction of the rumen. 

__ As in tympanites, so in plenalvia, the special condition of the 


DISEASES OF THE STOMACHS: CATTLE 347 


animal’s digestive organs at a time when it is exposed to the danger 
of a plentiful supply of food to which it is not accustomed is a potent 
factor—e.g., an atonic state of the walls of the rumen. This may 
be set up by a copious draught of icy-cold water; it may be due to 
a catarrhal state of the mucous membrane of the stomach, induced by 
irritant herbage or musty fodder, and a varying degree of such depressed 
functional activity is a common accompaniment of many post-parturi- 
tion ailments. 

Some newly-calved cows assume a peculiar idiosyncrasy, preserving 
an appetite for dry food, especially ill-gotten fodder prone to cause 
paresis of the stomach walls, while they persistently refuse an adequate 
supply of fluids; and if precautions are not taken, they become the victims 
of impaction in the course of a few days. 

Animals that have been starved, or whose appetites have just returned, 
after an attack of febrile disease, are especially liable to this complaint 
if too suddenly allowed to consume more than they can digest. 

Symproms.—Compared with tympanites, the onset of impaction is 
gradual, and the condition of the animal is less urgent. The symptoms 
vary greatly with the quality of material in the stomach and the degree 
of torpor of the viscus which predisposed the animal to develop plenalvia. 
The abdomen is unusually rotund, the hollow in the left flank is 
effaced, and in many cases the engorged stomach bulges the flank, 
creating a convexity in front of the ilium. 

Characteristic symptoms are the doughy, sodden feel of the swollen: 
stomach, which pits on pressure, and owing to loss of tonicity in the 
stomach walls the indentation remains for a time. 

The sounds emitted on percussion are not resonant. but dull; no 
sounds are heard on auscultation, and the flat hand applied to the flank 
detects no movement in the walls of the viscus. In some cases extreme 
pressure of the hand causes wincing and uneasiness. Appetite is in 
abeyance, and rumination is stopped. The animal is usually dull and 
listless, arches the back, and has a tendency to seek relief by standing 
with the hind-feet in the dung channel. 

Occasionally signs of colic are witnessed, as evidenced by restlessness 
and twitching of the tail, etc., when the sleepy countenance gives place 
to a more active and anxious expression. If down, the animal has most 
comfort on the right side, but it seldom goes off its feet for more than a 
few minutes. There is grinding of the teeth, occasional mimetic chewing, 
and moaning during expiration is more or less marked, especially when 
the patient is recumbent ; respiration is quickened, and if, later on, some 
degree of tympany supervenes, the difficulty in breathing is exaggerated 


348 SYSTEM OF VETERINARY MEDICINE 


and the urgency of the case is much increased. The condition of the 
bowels is variable, but they are often sluggish and constipated. 

While the animal stands listless the pulse is unaltered, but a period of 
restlessness accelerates it temporarily. No fever is present in the un- 
complicated case, and if a rise in temperature does occur, this usually 
indicates rumenitis (inflammation of the rumen). In most cases the 
visible mucous membranes are congested. 

Coursz.—Acute cases of plenalvia dependent on a gross dietetic 
error, though more prone to have tympany as a complication, and pre- 
senting more urgent symptoms than a slowly developed case, may 
recover spontaneously if food is withheld for a time ; and since in cases 
so caused the inactivity of the walls of the rumen is alike recent and 
resultant, the viscus readily resumes to some extent its muscular tonicity 
and natural movements, when, under suitable treatment, the escape of 
some of the material towards the bowels, by lessening the internal pressure, 
facilitates the restoration of circulation in the temporarily anemic 
stomach walls. ) 

The more chronic cases, which have torpor of the gastric walls as 
a primary condition, are slow in recovery, and often need strict attention 
for two or three weeks ; andif unduly neglected, some such cases gradually 
become oblivious of their surroundings, comatose, and moribund. 

In protracted cases serious complications sometimes arise—e.g., 
rumenitis, gastro-enteritis, rupture of the diaphragm, and, in pregnant 
animals, uterine disturbance and abortion. 

Draenosis.—This presents no difficulty in typical cases, The tardy 
development of the case, the heavy, sodden state of the stomach contents, 
dulness on percussion, and the absence of sounds on auscultation, are 
negative of tympany ; while the absence of fever differentiates plenalvia 
from rumenitis, pneumonia, gastro-enteritis, and other inflammatory or 
febrile conditions, with which it might be confounded on account of 
laboured respiration, etc. 

Proenosis.—This is grave, because the majority of cases do not 
readily respond to treatment; and when recovery is slow, complications 
may arise. 

PROPHYLAXIS.—Measures for the prevention of impaction are much 
the same as those applicable to tympany of the rumen. Avoid sudden 
changes of diet, irregular and overfeeding, allow a sufficiency of water, 
balance the diet both as to its albuminoid ratio and its bulkiness, remem- 
bering that rumimants must have a due proportion of rough food. The 
glutton should, if possible, be put in a single stall, where it can only 
reach the food given to it. 





DISEASES OF THE STOMACHS: CATTLE > 349 


(It is a “ golden rule’ with intensely fed cattle, at the first sign of 
disorder, to withhold three or four meals for every one they refuse, and 
meantime allow water only and apply medicinal correctives, after which 
the return to the usual rations should be gradual. Neglect of this 
precaution, and all attempts to maintain the milk-supply by giving 
choice food to the subject of incipient indigestion, can only end in 
disaster. ) 

TREATMENT.—Rational treatment is dominated. by the cause, 
symptoms, and complications. The main objectives are to rouse the 
flaccid rumen, soften the doughy material it contains, and prevent 
fermentation or putrefaction. ; 

Good results often follow the use of the time-honoured dose of 
Epsom salts combined with treacle or aloes in solution, followed by stimu- 
lants and nerve tonics such as: 


Kk Pulv. ammon. carb. 4 is. errs Vg 
Pulv. nucis vom. Ae = Siege Al Sa 
Pulv. gentian. .. e igi Pe an 


M, ft. pulv. Sig.: One powder every four hours in 1 pint of 
cold water till purging commences, after which bitter stomachics 
may be given in ale or in the form of electuary. The ad- 
ministration of the saline purge is sometimes followed by tym- 
pany, and, to prevent this, internal antiseptics may be given 
before the purge, such as formalin (3i.ss.) in 2 quarts of cold 
water. | 


If, after purgation, and some initial improvement, the animal reverts 
to its former state in spite of the use of stimulants, subsequent purgation 
has to be carefully carried out if we would avoid a fatal abomasitis. 

In all cases likely to prove stubborn, the judicious use of common 
salt in moderate and repeated doses, alternated with the use of ammonium 
carbonate and nux vomica, combined with the administration of warm, 
freshly made, strong coffee, is more likely to be successful. The first 
dose of salt (about 4 pound) should be made into an electuary with ginger 
and treacle, and used as recommended for hoven (see p. 363). 

Smeared on the back of the tongue, this dose causes increased secre- 
tion of saliva and induces thirst, so that the animal voluntarily takes the 
further doses of salt dissolved in drinking-water that are needed to cause 
purging, and not only is the state of the mass of food in the rumen 
favourably influenced by the saliva and water swallowed, but the salt 
has a high antiseptic and tonic value, while its aperient action is not so 
liable to be followed by the inertia of the alimentary tract that is so 
common after the use of Epsom salts, By using the salt in this way we 


350 SYSTEM OF VETERINARY MEDICINE 


avoid the danger that attaches to drenching, and we can easily control 
its action on the bowels, giving or withholding as occasion requires. 

Vigorous massage helps to rouse the rumen, and in special cases 
this may be followed by the use of hot-water blankets and securely bound 
clothing. When the wet rugs are discontinued, rub the animal dry, 
apply a little ammonia liniment or solution of mustard, and put on 
properly adjusted dry clothing. 7 

Pilocarpine, arecoline, physostigmine, and barium chloride have each 
been experimented with in the treatment of plenalvia ;. but in our hands 
these drugs, used hypodermically in moderate doses, did not materially 
influence the condition of the rumen, and recent reports go to show that 
the use of arecoline and eserine in full doses in cattle is not unattended 
by danger. American practitioners habitually practise, and with good 
results, irrigation of the rumen with large quantities of water, by means 
of a stomach-tube. 

When the peristaltic action of the rumen is in some degree restored, 
bitter stomachics combined with ale should be given twice or thrice 
daily, and the use of coffee continued, and the animal should be groomed 
well and exercised daily. When appetite returns, the food should be 
sparing and easy of digestion : bran gruels or mashes with boiled turnips, 
and very little good hay (to induce rumination), for the first seven days, 
when, if the animal does well, a gradual increase in the rations may be 
made. Hay tea, salted, may be given in the early stages of treatment. 

If treatment proves futile, and no marked improvement is apparent 
in the condition of the rumen, the long-imprisoned material may undergo 
putrefactive fermentation. This usually ushers in rumenitis and the 
animal becomes feverish. To avoid this, rwmenotomy should be performed 
as soon as it seems that medicinal treatment is not going to succeed and 
before the patient’s strength is too far reduced (see p. 358, Rumenotomy 
for Tympanites). Having removed the most objectionable portion of the 
contents of the rumen and examined the cesophageal canal, reticulum, 
etc., the stitches temporarily binding the rumen to the abdominal wall 
may be severed and the wounds thoroughly cleaned with perchloride 
of mercury or other antiseptic solution. The stomach lesion may then 
be closed with continuous sutures of carbolised catgut, so inserted that 
when drawn tight the edges of the wound are inverted, bringing the 
serous coats firmly together. Thereafter the muscle and skin wounds 
should be sutured, jointly or separately, with strong silk ligature, using 
interrupted sutures. 

A course of careful low diet is essential after the operation, so that the 
healing of the wounds may not be hindered by the occurrence of hoven. 


DISEASES OF THE STOMACHS: CATTLE ~ 351 


Carbonate or sulphate of iron and salts of potash should now be 
added to the bitter vegetable stomachics which the animal has been 
receiving. 

Tympanites of the Rumen. 

SyNonyMs.—Tympanitic indigestion ; Gaseous indigestion ; Hoven ; © 
Blown ; Fog-sickness ; Bloating, etc. 

Derinition.—An abnormal accumulation of gas in the rumen, causing 
distension of that organ, and associated with paralysis of its walls. The 
condition may be primary, as in those cases that immediately follow a 
dietetic error, or it may be secondary. | 

GENERAL REMARKS.—No symptom of disease is moreoften encountered 
by the cattle practitioner than tympanites. In practice it is of vast impor- 
tance, on account of the great number of diseased conditions, functional 
and organic, of which itis often the outstanding symptom. Whether itis 
acute, subacute, or chronic, primary or secondary, it is, apart from its 
cause, always momentous because of the displacement of organs, thoracic 
and abdominal, to which it gives rise. Hundreds of animals of all sorts 
and conditions which might be saved if the owner had some first-aid 
knowledge are lost yearly from suffocation through tympany, and while 
this result of the forward pressure of the distended viscus on the thoracic 
organs is its most serious aspect, we cannot overlook its often untoward 
effect on the gravid womb, on abscesses, on confined dropsical areas, on 
old-standing adhesions, etc. And however insignificant and easily 
removed the cause of tympany may be, it is certain that the walls of 
the rumen cannot with impunity withstand prolonged or repeated 
distension. 

The quantity of gas that is normally present in the rumen of healthy 

animals varies somewhat, and can be roughly estimated by placing the 
~ closed hand on the top of the left flank and exerting pressure downwards 
till the doughy mass of food is felt. 

The layer of gas which lies between the food and the superior wall of 
the rumen represents the surplus of the gases of fermentation that are 
constantly being generated in the food while it is undergoing treatment 
in the rumen. A little oxygen and nitrogen may be present, having 
been swallowed from the air, but the bulk of the gas consists of carbonic 
acid, sulphuretted hydrogen, and carburetted hydrogen. Reports re- 
garding the analyses of gases found in cases of tympany are variable. 
According to Lungwitz, carbonic acid predominates with all classes of 
food, although the quantity present varies with the food. Next in 
importance is marsh gas, the average quantity of this being from 20 to 
30 per cent. of the whole. 


352 SYSTEM OF VETERINARY MEDICINE 


During feeding and the process of rumination, considerable eructa- 
tion of gas goes on, and any obstruction of the gullet which interferes 
in the slightest degree with its free exit leads to its accumulation in the 
stomach, for the fermentation of food which gives rise to it proceeds. 

Tympanites may be acute or chronic, and we occasionally encounter 
cases of a subacute character that do not properly belong to the acute 
or chronic types. 

Acute Tympanites.—This signifies extreme gaseous distension of the 
rumen. Itis very often sudden in its onset, is always portentous to life, 
and its cause is seldom difficult to trace. Its clinical aspect in these 
outstanding particulars differs radically from that of the chronic type of 
tympany. 

Acute tympanites might also be subdivided into two forms, according 
as the gas is in a free state in the viscus on the top of the food contents, 
or intimately mixed up with the aliment, floating it up in a frothy, yeasty 
condition. 

EtroLocy.—The most rapid cases of tympany we have met have been 
due to a well-established cesophageal obstruction occurring when an 
animal had eaten a quantity of succulent roots or cabbages, and had 
failed to negotiate some awkwardly shaped and, it may be, hard portion. 
These cases usually occur singly, and in the tympany that ensues the gas 
is invariably free and easily tapped or eructated when the obstruction is 
removed. | 

Next in suddenness of onset, and perhaps more significant because 
the alarming symptom is seldom confined to one animal, are those cases 
that arise from turning out the cows to a soaking wet aftermath of 
clover. We have frequently seen 10 per cent. of a herd acutely tym- 
panitic (some in eaxtremis on our arrival) when the mistake of putting 
hungry cattle on such pasture for the first time was committed. The 
clover aftermath that succeeds the hay crop is usually of rank growth, 
through treatment of the land with soluble artificial manures, such as 
nitrate of soda; and probably the red clover is more potent to produce 
tympany than any of the others. Similar results often follow the sudden 
use of other kinds of pasture that are succulent, wet with rain or dew, or 
covered with hoar frost. The effect of the ingestion of such chilling food 
is to cause modification or suspension of the peristaltic action of the 
walls of the rumen, innervation having resulted from the anemia so 
induced. Acute tympany also results from the greedy devouring of large 
quantities of frozen roots or cabbages, particularly if the animal is in 
any way predisposed to indigestion. Indeed, any sudden change to green 
food, whether to clover, grass, or green corn, etc., is vexatious, and if these 


DISEASES OF THE STOMACHS: CATTLE 353 


be cut and given in a half-withered condition to cows or when heated by 
fermentation, their consumption is apt to be followed by acute tympany 
in predisposed animals, that find in them an appetising meal. In most 
of these cases the gas generated is not free to be tapped either by 
probang or trocar and cannula, but is intimately mixed with the food 
particles in such a frothy condition that when a handful is pressed the 
solid residue left would not fill a tablespoon. 

Among other food-stufis potent to produce tympany are vetches and 
green-cut bean or pea crop (especially when wet), turnip tops, dry bean 
straw, rotten, decomposing potatoes and turnips, and all kinds of fer- 
menting food. 

Tympanites, often of an acute and alarming character, occurs In cases 
of poisoning from eating the prunings of yew and rhododendron, etc., 
and such poisonous plants as hemlock, meadow safiron, deadly nightshade, 
and various members of the Ranunculaceew. In many of such cases 
rumenitis is associated with the tympany. 

In a minority of cases a severe chill from exposure to wind and storm 
has been the only traceable cause, Hoven may also follow the giving 
of good sound food in too great quantity or in a too concentrated state 
to fasting animals. Cases are produced by driving animals on a journey 
immediately after eating, rumination being thus interfered with. It 
also supervenes occasionally when dry-fed animals are allowed to drink 
a large quantity of very cold water without subsequent exercise. Some 
degree of tympany is often observed in milk fever, if the patient is 
allowed to lie flat on her side, and it often occurs as a secondary con- 
dition in other affections. 

It is important to remember that the Re | condition of the 
animal itself is a major factor in establishing those cases that are induced 
by the less potent causes of tympany. 

Symproms.—These may appear while the animal is yet feeding or 
immediately afterwards, the initial symptoms being unobserved. Very 
soon increased rotundity of the abdomen and manifest uneasiness of 
the animal are apparent. The pathognomonic symptom is the rapid 
ballooning of the left flank, which may be so marked that it reaches the 
level of the spinal column. The swelling rebounds when pressed, and 
when percussed emits a dull sound, being most drumlike when the gas 
is free. No attempt at rumination is made, there is loss of peristalsis, 
and no sounds on auscultation. The rectum is usually evacuated by 
repeated efforts, and slimy, blood-coloured material may trickle from 
the anus. The animal crouches and stamps, kicks at the abdomen, arches 
the spine, and twists the tail. | 

VOL. I. 23 


354 SYSTEM OF VETERINARY MEDICINE 


The increasing pressure on the lungs and heart, through the diaphragm, 
of the gradually enlarging rumen causes distressed and laboured respira- 
tion, and the animal moans and pants in pain, with widely dilated nostrils, 
open mouth, and protruding tongue. Salivation is present in most cases, 
but is most pronounced in those due to choking. 

Palpitation of the heart is very marked, and the pulse is frequent and 
wiry, becoming gradually uncountable and imperceptible. The great 
pressure of the distended rumen drives the blood from the central regions, 
and the consequent disturbance of the circulation is soon in evidence. 
The superficial veins of the head and neck are engorged, the visible 
mucous membranes cyanotic, and the extremities, are cold. The eyes 
are staring and blood-shot, and as suffocation becomes impending the 
victim reels and staggers and eventually falls insensible. Sometimes 
asphyxia is so advanced that the animal dies while the trocar and cannula 
is being inserted. Symptoms of vertigo and syncope may be exhibited 
after puncture, the rapid expulsion of gas inducing simultaneously 
cerebral anémia and congestion of abdominal organs. Animals advanced 
in pregnancy frequently abort a few days after an acute attack of 
tympany. 

Salutary vomition occasionally occurs, and the animal obtains a 
measure of relief, and may even recover on account of it ; but sometimes 
the retching induces rupture of the stomach and sudden collapse. 

Death results from carbonic acid poisoning, which is mainly due to 
impossibility of respiration, but the quantity of uneliminated carbonic 
acid may conceivably be increased by absorption of that gas from the 
distended rumen (intoxication). The immediate cause of death in some 
cases may be cardiac interference, or possibly nervous shock. 

Post-Mortem Lrsions.—There is enormous distension of the abdo- 
men, even when the animal is recently dead. So great is the tension force 
that if a knife be plunged through the abdominal wall into the rumen 
the first stream of aliment may be shot to a distance of twenty yards. If, 
on opening the carcass carefully, particles of food are found in the peri- 
toneal cavity, this indicates that the rumen has been ruptured. The 
rupture may have occurred ante or post mortem, but this lesion is not 
common. 

Rupture of the diaphragm is often revealed. We have occasionally 
seen evidence of some hemorrhage at the seat of old adhesions that 
have given way under the stress of increasing pressure. Rupture of the 
right auricle of the heart has been recorded. All the lesions of asphyxia 
are present—viz., oedema and hyperemia of the lungs, engorgement of 
veins with black, tarry blood, hemorrhage under the serous membranes, 


DISEASES OF THE STOMACHS: CATTLE 355 


etc. The contents of the rumen vary in character with the nature of the 
case. The gas may be free and the aliment doughy or partly fluid, or 
the whole contents may be a seething frothy mixture. 

DIFFERENTIAL D1acnosis.—Acute hoven may be differentiated from 
impaction of the rumen by the small amount of ingesta present, the 
intensity of fermentation, and the abundance of gas. 

CoursE.—If unrelieved, an acute case may die in thirty minutes, 
but the patient does not usually succumb for two or three hours. 

Proanosis.—This is always grave till the surgeon arrives, and even 
then it may continue so. If the animal is still on its feet, heroic treat- 
ment usually obviates death, though a perfect recovery may not ensue. 
If eructation of gas is established, recovery is the rule. Should the 
practitioner have only one patient to minister to, the results are better 
than when half a dozen are in need of prompt measures. 

As a sequel, abortion may result from the compression exerted on 
the uterus by the distended rumen, and eversion of the rectum may 
also occur. 

PROPHYLAXIS.—See Cisophageal Obstruction, p. 333. 

To obviate the danger arising from grazing animals on an aftermath 
of quickly grown clover or other succulent herbage, certain precautions 
are necessary. For the first two days the animals should be fed with 
dry rations before being turned out, they should not be allowed to remain 
longer on the field than one hour, and they should be herded so as to 
detect incipient tympany. These precautions insure only a moderate 
consumption of the growing crop. For the first day or two it is essential 
that the clover is not wet when the animals are put out. The risk of 
disaster is greatly increased if the growth is laden with moisture, but it 
is remarkable that, after the first day or two, the animals can consume 
large quantities of it, wet or dry, with impunity. 

When animals are watered in the stall in frosty weather, a sufficiency 
of warm water should be added to slightly raise the temperature of each 
bucketful. If the cows are turned out to a pond to drink, even when 
the ice has to be broken, the exercise of walking to and from the pond 
seems to neutralise the chilling effect of the icy-cold water. 

Frozen turnips or other roots should never be given to cows if this 
can be avoided, and, if given at all, only very few should be allowed. 
When all the stored roots are frozen, the supply for each day may be 
defrosted by being stored in an empty stall in the cowshed for twenty- 
four hours or longer. Though the consumption of rotten and decompos- 
ing turnips and other roots is occasionally the cause of acute hoven and 
other gastro-intestinal disturbances, it is remarkable at times how some 


306 SYSTEM OF VETERINARY MEDICINE 


herds relish and consume with impunity large quantities of roots that 
have gone bad. It would seem that decay in stored roots is not always 
dependent on the same putrefactive agents. Changes of rations, especi- 
ally to green food, should always be gradual, and if the latter is hand-fed, 
it should, as far as possible, be fresh cut and dry. | 

To avoid tympany caused by eating poisonous plants and prunings 
of irritant shrubs the prophylactic measures are obvious. When any 
course of feeding is adopted that is liable to lead to tympany, a probang 
or trocar and cannula, or, in default of these, asharp-pointed knife, should 
be at hand in case of accident. Every stockowner should possess a 
suitable trocar and cannula, and know how to use it in emergency, so that 
when the veterinary surgeon arrives he may have a live patient to deal 
with. It is the duty of cattle practitioners to press home this truth, 
especially to their distant clients. 

TREATMENT.—Active measures must at once be adopted when the 
animal’s life is threatened, and the practitioner’s first concern is to avert 
a sudden collapse. He is to be guided in what he advises and does by 
the necessities of the case, the bodily condition of the animal, her stage 
of lactation, and whether she is pregnant; and if it is apparent that the 
minimum of loss would be secured by sending her to the butcher, this 
should be done at once. 

In all acute cases of tympany removal of the gases is the first con- 
sideration. When the distension is extreme, it is often impossible to 
determine whether the gas is quite free for tapping, only partly free, or 
in that state of intimacy with the food that renders the use of the trocar 
of no avail. When one gets a well-marked, drum-like tympanitic sound 
on percussion, indicating that the gas is free, steady, strong, and con- 
tinued, pressure on the left flank sometimes succeeds in setting up some 
degree of peristalsis in the walls of the viscus, followed by eructation of 
wind. This operation is occasionally completely successful, when we 
may proceed to treat the animal medicinally ; but it may need repetition 
pending the fruition of the latter treatment. It is sometimes possible 
to tap the wind by passing a hollow probang, but very often the end of 
the tube is at once blocked by food when it reaches the stomach, and no 
gas escapes. 

If the animal is restless and suffering from dyspnoea, the passing of 
the cesophageal tube is both difficult and dangerous. When attempted 
under these circumstances, there should be as little fuss made as possible. 
The patient need not be loosened, as is usually done in passing the pro- 
bang, and no gag need be employed. An assistant steadies the head 
by holding the horns, while the surgeon passes one hand over the face 


DISEASES OF THE STOMACHS: CATTLE — 357 


and with it opens the mouth on the off-side. He then deftly passes the 
well-oiled probang with the other hand, and during its passage towards 
the stomach the behaviour of the animal will indicate whether he should 
desist and adopt other measures. Should the contents of the rumen 
be in a seething state when the tube is passed, some of it is forced into 
the tube, the calibre of which is too small to admit the passage of aliment 
of the consistence of that usually present, and so, beyond a little bubbling 
of gas, nothing reaches the external air. In such cases we have occasion- 
ally seen vomition follow the withdrawal of the probang with signally 
good results, but some animals are so sick when vomition occurs that 
they fail to control the quantities of semi-fluid frothy ingesta forced 
through the pharynx, and it may happen that some of it finds its way 
into the trachea, choking the animal, or setting up traumatic broncho- 
pneumonia, according as the amount of strayed material is great or small. 

If failure follows palpation or the use of the probang, the stomach 
must at once be punctured at the height of the swelling—z.e., at a spot 
equidistant from the last rib, the external angle of the iltum, and the 
transverse lumbar processes. If the cannula used be less than 4 inches 
long, a steady pressure must be exerted on its shield while the tapping 
proceeds, for it usually happens that, as soon as the swelling is somewhat 
relieved, violent peristaltic movements of the rumen walls set in, evidenced 
by the tilting of and forcible dragging on the cannula; and if the tube is 
not sufficiently long to jockey the receding stomach, it slips out of that 
viscus and rides over its peritoneal covering. Then its reinsertion into the 
organ necessitates a new puncture, for it is seldom that the two original 
apertures are in apposition after the bulk has been somewhat reduced. 
Indeed, if it is intended to leave the cannula in position for a day or two, 
it is sometimes wise, when the organ has regained its normal size and 
position, and we find the cannula is much tilted, to puncture the stomach 
anew exactly opposite the lesion in the abdominal wall. 

When puncture of the rumen has to be done with a knife in default 
of a better instrument, it sometimes happens that the escape of gas is 
aborted through recession of the stomach. There is then a great lia- 
bility of the escaping gas finding its way into the subcutaneous tissue of 
the abdominal wall, and it would seem that this venue is a comparatively 
easy one, for we have often seen well-marked, widespread, and persistent 
emphysema result. We have even seen some degree of this emphysema 
follow the use of the trocar and cannula when the force of the escaping 
wind was great. It often persists for a week or two without much evil 
result, and may be mitigated by puncturing the skin and massaging the 
gas towards the puncture. 


358 SYSTEM OF VETERINARY MEDICINE 


If it be evident, when the instrument has been plunged into the rumen 
and the trocar withdrawn, that relief is not thus to be obtained, as evi- 
denced by the passage of very little free gas, followed by a bubbling of 
semi-fluid material in the cannula, the surgeon must proceed a step 
farther and perform rumenotomy, if the patient exhibits urgent symptoms. 
Standing with his back towards the patient’s left shoulder, he removes 
the cannula, and inserts a sharp, long-bladed, blunt-pointed bistoury, and 
makes a vertical incision at least 34 inches long, severing simultaneously 
the abdominal and rumenal walls. Immediately this is done, the con- 
tents issue forth more or less forcibly, according to the consistence of the 
layer of aliment next the seat of operation, and the tension pressure. By 
means of a strong needle and a piece of string, from one to three 
sutures are inserted, binding the stomach walls securely to the parietes. 
This is to prevent escape of aliment into the peritoneal cavity when the 
tension slackens, and to keep the stomach puncture patent with that in 
the abdominal wall. Manual retraction of the lips of the wound is now 
followed by a forcible belching forth of the stomach contents. If caught 
in a receptacle, this may need to be placed three or four yards back from 
the patient during the first two minutes. Should the flow slacken 
through plugging of the orifice with more solid material, this should be 
levered out with a strong iron spatula or spoon.. Very soon, owing to 
relief of pressure, renewed circulation and innervation induce a return 
of peristalsis, the viscus contracts forcibly, and materially assists and 
hastens the further removal of its contents. The flow may be further 
promoted by assistants exerting pressure on the abdominal walls by 
means of a strong sheet passed under the abdomen. When the aliment 
is too coarse to escape in this mechanical way, the iron spoon is repeatedly 
used, and it may be necessary to enlarge the opening in an upward direc- 
tion to permit the use of the hand in its removal. We have often taken 
away from five to eight pailfuls before we were satisfied that the organ 
was sufficiently emptied, and it is well always to leave one-third behind. 
The operator should then bare his arm to the shoulder, and make a 
thorough examination of the remaining food in the rumen, and remove 
any foreign bodies that may be found, and which may not have been 
innocent as a predisposing cause of the indigestion. In most cases one 
can also ascertain the state of the reticulum, which is the predilection 
location of the smaller and metallic foreign bodies. 

It is now a moot point whether it is advisable in such cases to close 
the wounds in the orthodox manner, even though arrangements are 
made for drainage. In a clean rumenotomy for removal of a foreign 
body, stitching is advisable, and is usually completely successful, except 


DISEASES OF THE STOMACHS: CATTLE 359 


that the rumen forms a localised attachment to the abdominal wall. But 
when performed as a dernier ressort in the rough-and-ready manner 
indicated in the cases referred to, a considerable experience has forced 
us to conclude that the best practical results are got by leaving the wound 
open, and swabbing it daily with an antiseptic solution. 

After operation, the cow should be placed with her left side next to 
the wall, so that her neighbours or attendants may not be soiled with 
the aliment that is sometimes ejected from the stomach when the animal 
coughs. She should then be warmly clothed, but only a thin sheet should 
cover the seat of operation. 

If, after rumenotomy, there is evidence of abdominal pain, apply 
hot-water rugs, followed by a thin sinapism, to the abdominal walls, and 
clothe securely. The animal should now receive per os a moderate saline 
purge, followed by stimulants, nerve tonics, and bitter stomachics. 

We have often been satisfied that good results follow the use of a daily 
dose of formaldehyde (2 drachms), largely diluted, and poured directly 
into the rumen through the lesion. <A course of low diet should then be 
ordered, and if the patient 1s in fair condition and not too old, a justifiable 
and uneventful recovery is almost certain, and the wound heals up in 
about five weeks, leaving a hollow puckered scar, the rumen being, of 
course, firmly attached to the abdominal wall. The advantage of the 
open wound as a safety-valve while the state of indigestion is being 
corrected medicinally is not to be forgotten. When called to a clover 
field where several animals are i extremis from acute tympany, the 
practitioner should not hesitate to plunge a sharp knife into the rumen 
of each animal, and make a wound large enough that the foaming ingesta 
may to some extent escape of itself or by the help of an assistant holding 
the lips of the wound apart. Fatal asphyxia in many simultaneous 
cases may thus be averted, and further treatment can be carried out at 
leisure. 

In those cases in which danger is averted by means short of rumen- 
otomy, the course of medicinal treatment is often more elaborate and 
longer continued. Purgatives and stimulants may need to be repeated 
before the peristaltic action of the rumen is properly restored, and the 
slightest dietetic indiscretion may precipitate the need for surgical 
interference. 

For medicinal treatment of cases that do not require operation, see 
Treatment of Chronic Tympany. 

Chronic Tympany.—Chronic tympany signifies habitually intermittent 
or persistent gaseous distension of the rumen. Under this head, espe- 
cially as regards treatment, we will also refer to those subacute cases of 


360 SYSTEM OF VETERINARY MEDICINE 


tympany which differ from the acute in the degree of hoven present, and 
from the chronic type in their short duration and aptitude to recover. 

ErroLocy.—Many and varied are the causes of chronic tympany, and 
their diagnosis is not an easy matter. Any of the causes that are pro- 
ductive of acute tympany may serve to effectually establish such atony 
of the walls of the rumen as predisposes the animal to subsequent accu- 
mulation of gas in that organ, and renders impossible the carrying on of 
the intensive feeding necessary for fattening or milk production. 

Mechanically produced atony is usually associated with a degree of 
chronic gastric catarrh set up by the increased fermentation and the 
sudden changes in the visceral circulation. Though gastric catarrh is 
induced in this way, it constitutes of itself, when established, a strong 
factor in propagating the tympanitic state. 

Many animals suffer more or less from chronic tympany daily, when, 
_the store of roots being exhausted, the food given is too finely commi- 
nuted—e.g., watery gruels of the various cereal meals unmixed with 
rougher material. This cause is all the more potent if the fodder ration 
is deficient in quantity or of inferior quality. The animal that becomes 
ballooned soon after drinking greedily a. bucketful of meal gruel may 
remain swelled for some hours, but if the hay or straw ration is given 
soon after the gruel, the accumulation of gas is less evident, and we have 
often seen an immediate reduction of the swelling when the first few 
mouthfuls of the long food had been swallowed. This would seem to 
indicate that eructation of gas proceeds when an animal is swallowing 
roughly-masticated food, each bolus producing a considerable distension 
of the gullet as it passes towards and into the stomach. But post- 
mortem examinations of inveterate cases of chronic tympany reveal that 
the great majority are not due to functional derangement of the rumen 
or of the accessory organs of digestion. It1is more usual to find some tangi- 
ble morbid organic diseased condition that is obviously neither remediable 
nor capable of accurate diagnosis. 

Implication of the esophagus by enlarged glands, tumours, abscesses, 
etc., is of all causes the most common. A frequent cause of stenosis of 
the gullet is disease of the mediastinal lymphatic glands, which may be 
enormously enlarged from being the seat of tuberculosis, actinomycosis, 
or sarcoma. Tumours pressing on the cesophagus, or surrounding it, 
that have been met with, include sarcoma, fibroma and papilloma ; while 
abscesses which interfere with the gullet have usually been caused by the 
passage of a foreign body from the reticulum. Such traumatic abscesses 
are usually at once apparent when the cadaver is opened behind the 
sternum, and are found to implicate the anterior wall of the reticulum, 


DISEASES OF THE STOMACHS: CATTLE 361 


the adjacent wall of the rumen, the terminal portion of the gullet and 
surrounding tissues. These causes operate by mechanically impeding 
rumination and eructation of gas, which, as a result, accumulates in the 
stomach. 

The painful localised peritonitis that indicates traumatism from the 
stomach is often associated with a resolute type of tympany, lasting for 
a day or two. Large irritating foreign bodies in the rumen readily give 
rise to hoven, especially if located near the cesophageal groove, and 
accumulation of sand from the use of meals manufactured from very 
dirty cereals hampers peristalsis by its weight, and leads to tympany. 
Adhesions of the rumen to other organs and the parietes as a result of 
peritonitis (often tubercular), and any other condition of its walls that 
limits its contractile power, are also potent and persistent causes. 

A badly accomplished puncture of the rumen in acute tympany, with 
soiling of the peritoneum, produces a peritonitis that has a paralysing 
effect on its walls ; and when the puncture is no longer patent, the animal 
swells up daily, and the need for puncture is renewed. In young animals 
hair-balls in the rumen often set up indigestion and tympany. 

Tympanites occurs as a secondary condition to inflammation of the 
abomasum, advanced disease of the liver (cancer, diastomatosis, ecchi- 
nococcus disease, etc.), and certain septic states of the womb. 

Symproms.—The victims of incipient chronic tympany are usually 
alternately hoven and collapsed, according as they have been fed recently 
or have been for a time without food ; but if no corrective measures are 
adopted, the hoven period lengthens out till it spans the time between 
meals. Even then it is only moderate, though its degree varies. 

Peristaltic movement of the walls of the viscus are much modified— 
it may be almost to inertness—and very little rumbling is heard ; but the 
symptoms are not urgent as in acute cases, the discomfort being in pro- 
portion to the degree of hoven present. It is invariably evident that the 
accumulated gas is free to tap. Rumination is very irregular, and is 
always in abeyance when the tension of the stomach is very marked. 
When the tension falls, some degree of activity returns and rumination 
is resumed, though it may be very imperfect in many respects. The 
animal hesitates between the acts, and each bolus that is sent up may 
receive only a fraction of the usual number of strokes (sixty or more) 
that obtain in healthy animals. The appetite is also more or less irregular, 
and, in many cases, depraved. The patient gradually loses condition, 
and, when diarrhoea is present, emaciation is fairly rapid. The presence 
or absence of fever is usually dependent on the determining cause of 
the tympany, or it may result when a catarrhal state of the rumen has 


362 SYSTEM OF VETERINARY MEDICINE 


arisen through persistence of the hoven state; but it guides us little in 
prognosis. 

In contradistinction to equine gaseous indigestion, we have never 
noticed escape of flatus by the anus in tympanitic cattle. 

Lrstons.—Many of these have already been described under etiology. 
The rumen is usually one-half larger than normal, and when emptied 
may measure 12 inches more than that of a healthy animal in any direc- 
tion. Its mucous membrane is often in a catarrhal state, and if the 
case has continued long, and has been associated with persistent diarrhea, 
as is often the case, lesions of muco-enteritis are present, and the carcass 
is very emaciated, the kidney fat has almost disappeared, and the quantity 
of blood in the carcass is limited. 

DIFFERENTIAL DiaGNnosts.—This is always easy, if any care is exercised. 
It might be confounded with the ascites of chronic peritonitis, with 
abdominal dropsy, or with hydrops uteri. The high, left-sided character 
of the swelling in tympany, and the absence of any wave movement on 
percussion, differentiate it from dropsical conditions. 

We once visited a cow, and found on arrival that the owner had just 
punctured at the usual seat for tympany, because he thought the patient 
—a pregnant cow—was sufficiently uneasy to warrant it. We were 
astonished to see issuing from the cannula a forcible stream of normal 
uterine fluid. In this case the position of the rumen was usurped by an 
enormously distended womb. | 

In cases of impaction, the solidity of the rumen leaves no room for 
doubt. A large hernia of the rumen gives a marked left-sided swelling, 
but no veterinary surgeon could confound this with tympany on account 
of the sagging character of the swelling and the abnormal hollow in the 
left flank. 

Proenosis.—In chronic tympany prognosis is distinctly unfavourable. 

TREATMENT.—This may be attempted in every case where it is not 
certain that the cause is irremovable. 

If the animal is obviously tubercular, treatment should not be 
attempted, and the use of tuberculin helps to decide. In no case should 
essential oils be administered till the owner has decided against sending 
the animal to the slaughter-house. Indeed, if medicinal treatment of 
any kind is begun, it should be to a finish. 

Since tympany is but an objective symptom, our efforts should 
always be directed against the suspected determining cause, though we 
must always bear in mind the baneful effects of long-continued distension 
on the rumenal walls. 

The exhibition of “ gas absorbents ”’ is of little avail, and any benefit 


DISEASES OF THE STOMACHS: CATTLE 363 


obtained is temporary. The same remarks are in some measure true of 
antiseptic treatment, unless this is combined with the use of stimulants 
potent to promote peristalsis of the rumen, etc. Of antiseptics, sodium 
hyposulphite, sodium bicarbonate, hydrochloric acid, creolin, chinosol, 
wood-tar, and formalin, are worth a trial. The latter is probably the 
best of these, given in 2-drachm doses largely diluted with water. 

Oil of turpentine (2 ounces), given in raw linseed oil, is held in high 
repute by many, and to this may be added 15 minims of oil of pepper- 
mint. Thisis both a stimulant and antiseptic. Butif the tympany has not 
yet become chronic and persistent, and the state of the bowels warrant 
it, nothing is better calculated to remove the atony of the stomach and get 
rid of its vitiated contents than a moderate saline purge combined with 
aloes. This should be followed by three doses of ammonia carbonate 
(6 drachms) in a quart of cold water at intervals of four hours, the animal 
being warmly clothed. After the bowels have responded (severe purga- 
tion is to be avoided), nerve tonics and bitter stomachics with alkalies 
should be prescribed. Of the former, nux vomica is the sheet-anchor, 
and may be given in the form of tincture in 2-drachm doses, combined 
with tincture of ginger, etc., or in powder. 


B Pulv. nucis vom. ig an cg DIB on DORE 
Pulv. zingib. - at ra acs} 
Pulv. gentian. ke " HPS ivE 
Pulv. pot. nit. i” ex: MALS 


M. ft. pulv. Sig.: One every twelve hours in a bottle of ale or 
eruel. 3 


Or an electuary may be used, and this obviates any danger from 
choking in animals difficult to drench. 


RK Sod. chlor. ol a sss 2 Oat 
Pulv. nucis vom. #3, uh tf Oar 
Pulv. zingib. $43 i% ae nd Bil: 
Pulv. gentian. ne Bi by Ae SN, 
Theriac. se SENT RE 


M. ft. electuar. Sig.: This quantity to be smeared on the back of 
the tongue with a flat spoon or piece of wood two or three times 
a day. The electuary may be made in bulk and dispensed in 
tins containing six or twelve doses. 


Instead of giving a saline purge when aperients are indicated, an 
electuary containing a larger proportion of salt may be used, and advan- 
tage may be taken of the thirst it induces to give repeated doses of 
common salt in drinking-water, a halt being called as soon as the faeces 


364 SYSTEM OF VETERINARY MEDICINE 


are slightly watery. Drenches frequently cause immediate asphyxia in 
severe tympany. 

Cadéac advises the use of a drench composed of alcohol, hydrochloric 
acid, naphthol, decoction of gentian, etc. He also recommends eserine or 
veratrine, or apomorphine. Electricity is recommended by some authors 
to rouse the inert walls of the rumen. 

If treatment is attempted in advanced cases associated with diar- 
rhoea, hydrochloric acid may be given in 2-drachm doses twice a day in 
drinking-water. 

Puncture of the rumen is seldom indicated in chronic tympany, but 
as in many cases the gas can be tapped by the simple expedient of passing 
the hollow probang, this should be done before a drench is given. Occa- 
sionally, however, the use of a permanent cannula is imperative. An 
exploratory rumenotomy is often advisable, and the operator is occasion- 
ally rewarded by finding in the rumen large foreign bodies or other 
deleterious material, the removal of which is followed by the best 
results. 

Food should be sparing in quantity, and of a quality easy of digestion : 
bran mashes, demulcent drinks, boiled turnips, etc., and a moderate 
quantity of good hay or straw. If diarrhoea is marked, give gruels of 
boiled flour, milk, and starch. No bean or pea meal should be allowed 
till the tympany is completely removed. 


Rumenitis. 


Synonyms.—Alvitis; Inflammation of the rumen; Catarrh of the 
rumen. 

GENERAL REMARKS.—In a large proportion of the cases of rumenitis 
met with in practice, the pathological state is limited to a general catarrhal 
inflammation of the internal coat, though sometimes we find inflam- 
matory patches involving all the coats of the viscus, and occasionally 
ulceration is seen. As a primary affection in bovines rumenitis is com- 
paratively rare. When a catarrhal condition of the mucosa is set up, 
it gives rise to such marked functional disturbance, leading to tympany 
or plenalvia, that the practitioner has some difficulty in divining the 
incidence of these conditions. Reticulitis is usually associated with 
rumenitis. 

ErroLogy.—Rumenitis of a profound character is not seldom en- 
countered in certain specific diseases—e.g., malignant catarrh, anthrax, 
foot and mouth disease, rinderpest, Texas fever, etc. (see Vol. I.). 

Many of the usual and familiar routine cases are due to the animal’s 
indiscretion in feeding, the swallowing of foreign bodies capable of 


DISEASES OF THE STOMACHS: CATTLE > 365 


irritating the mucosa, the consumption of irritant herbage, badly got 
fodder, ete. 

Overhot fluids and chemical irritants mistakenly administered are 
occasional causes, as well as the swallowing of powdered lime when this 
has been left within reach of animals that have a taste for it. But the 
majority of cases occur as a secondary condition to prolonged tympany 
or plenalvia. 

Morsip Anatomy.—When the rumen is opened, it is observed that 
the epithelium has been shed in patches, and adheres to the adjacent solid 
masses of food on the viscus, the denuded papille presenting a red, 
angry appearance; and where the papille are only rudimentary—over 
the partitions which divide the interior into four sacs—the surface 
presents a distinctly red, raw, weeping appearance when the adherent 
mucus isremoved. Dark-coloured, circumscribed, and swollen patches of 
more advanced inflammation may be seen, and sometimes actual ulceration. 

Symptroms.—According to the gravity of the case, appetite is lost or 
only very little food is taken, and rumination is irregular or altogether 
suspended. 

Tympany more or less marked usually follows the consumption of 
even very little food, as the congestion of the mucosa inhibits the peristaltic 
action of the organ. There is a varying degree of fever and acceleration 
of the pulse, the muzzle is dry, and the horns and ears are hot, or one 
horn may be hot and the other cold. The animal resents palpation, 
as in peritonitis, 1s disinclined to move, and, when recumbent, respiration 
is catching, and a grunt accompanies expiration. Vomiting and saliva- 
tion may occur, while paralysis of the limbs and evidences of cerebral 
disturbance are not uncommon. 

The bowels are irregular, and putrefactive fermentation of the 
contents of the rumen is usually announced by profuse diarrhcea, as 
well as tympany. 

Course.—The trend of the case greatly depends on the etiological 
factors. Partial preservation of appetite is a favourable symptom, 
but if this be unduly indulged, complications readily arise. Favourable 
cases recover with proper nursing in a week, whereas neglected animals 
readily become the subjects of chronic tympany or impaction, and rapidly 
lose condition. If symptoms suggestive of meningitis supervene, or 
acute tympany with intractable diarrhcea sets in, the case is likely to be 
speedily fatal. 

Diacnosis.—A knowledge of the early history of the case is advan- 
tageous. The presence of fever, tenderness on palpation, and intense 
signs of gaseous indigestion, are outstanding features. 


366 SYSTEM OF VETERINARY MEDICINE 


Prognosis.—This must always be guarded, for an indiscreet nurse 
may effectually mar the most hopeful of cases. 

TREATMENT.—If there is reason to suspect the presence of foreign 
bodies in the rumen, rumenotomy should be performed for their removal, 
and the operation is always advisable in acute cases dependant on the 
consumption of large quantities of irritant herbage, since the likelihood 
of having a good result from medicinal measures only in such cases 1s 
remote. When rumenitis is directly due to the swallowing of acids or 
caustic alkalies, neutralismg agents must be administered, dilute alkalies 
for the former—e.g., lime-water or magnesia, which may be given along 
with linseed oil—and weak acids for the latter—e.g., vinegar or dilute 
acetic acid. In cases caused by the swallowing of a quantity of slaked 
lime the advantage offered by a rumenotomy should be considered. 

In all cases of rumenitis (or other stomach disorder) associated with 
oppressed respiration, grunting, and marked tenderness on palpation, 
much relief follows steaming of the abdomen with hot water. A dry 
woollen rug should be put on the patient’s back, and a tub of hot water 
placed on the floor below the abdomen. An assistant then stands on 
each side of the animal holding the ends of a woollen rug extending below 
the abdomen. This they periodically dip into the hot water, and carry 
it up against the abdominal wall. The temperature of the water is 
maintained at the proper degree by adding occasional small quantities 
of boiling water, and the process is kept up for the space of an hour, 
or until the symptoms are abated. The wet surface is then vigorously 
rubbed dry by means of an absorbent sack drawn backwards and forwards 
on the abdomen by the two assistants. 

A thin solution of mustard is then applied, and the abdomen bound 
securely with comfortable dry clothing. The process may be repeated 
once or twice if necessary. 

Aperient medicines should be given with discretion. Some rely on 
small doses of raw linseed oil and lime-water combined with tinctures 
of nux vomica and gentian. ; 

Sulphate of magnesium in repeated doses of 4 ounces with nitrate 
of potash, acts as a febrifuge and mild aperient. If there is engorge- 
ment and marked atony of the rumen, recourse may be had to larger 
aperient doses, either of sulphate of magnesium, common salt, or 
sulphate of sodium, followed by a course of stomachics and nerve- 
tonics. | | 

In all acute cases food is inadmissible for the first day or two, and 
only a little cold water or cold hay tea should be allowed. Afterwards 
small quantities of cooked food may be given, such as boiled turnip and 


_DISEASES OF THE STOMACHS: CATTLE — 367 


cut hay with steamed bran and linseed. This mixture is nutritious and 
easy of digestion. | 

As the animal improves, the quantities are increased, and other 
materials substituted, including hay of good quality. 


Tumours of the Rumen. 


These are said by Cadéac to be extremely rare. Sarcomata furnish 
the largest number of cases. Epitheliomata and chondromata have also 
been observed. 


DISEASES OF THE RETICULUM. 


The reticulum or honeycomb, the second and smallest gastric com- 
partment, is situated in front of the left anterior cul-de-sac of the rumen, 
and between it and the diaphragm, to both of which it is adherent. So 
far as its participation in gastric derangements is concerned, this viscus 
might reasonably be deemed an additional sac of the rumen, while its 
co-partnership with the larger organ in the process of rumination, and 
the freedom of their communication, likewise support such a view. Its 
claim to be considered a special compartment rests on the peculiar dis- 
position of its mucous membrane and the constant fluidity of its contents. 

Its internal surface is characteristically mapped out into numerous 
polyhedral alveoli or cells by raised folds of mucous membrane studded 
over with small papilla, and having serrated edges. Examined closely, 
we find that the serrations correspond to the minute and evenly-formed 
ridges and furrows seen on the broad sides of the folds that run straight 
from the fixed’to their free border, giving the appearance in miniature 
of the proglottides of some bovine tapeworms. 

In the depth of the alveoli smaller and more delicate partitions of 
mucous membrane are thrown up, subdividing them into three, four, or 
more secondary cells. Further, a remarkable structure, the cesophageal 
canal—a, continuation of the cesophagus—which passes along the roof of 
the organ, enables it to communicate with the gullet and the omasum and 
serves on occasion, by approximation of its lips, to directly connect the 
two latter. At the opening of the cavity of the reticulum into the rumen 
the special mucosa of the one merges into that of the other. 

Thus it will be seen that in all derangements of the paunch the reticu- 
lum is readily involved, and while it is usually the primary seat of 
traumatic indigestion, this is explained by the fact that it les directly 
below the termination of the wsophagus, so that, as soon as they are 
freed from the oesophagus, the natural fall of swallowed foreign bodies of 


368 SYSTEM OF VETERINARY MEDICINE 


greater density than the aliment is into the floor of the reticulum. (See 
Traumatic Indigestion, below.) 

The walls of the reticulum are not rarely the seat of actinomycosis. 
A. M. Trotter, of Glasgow Abattoirs, has preserved several specimens 
showing extensive thickening of the walls of the reticulum. It is likely 
that the excoriation of the mucosa by retained metallic bodies accounts 
for the implantation of the elements of the ray fungus from infected food 
materials. | 

We have no means of diagnosing this condition, though if, during a 
manual examination of the interior of the organ for foreign bodies by 
means of an exploratory rumenotomy, some degree of rigidity of its walls 
or the presence of a tumour was discovered, actinomycosis should be 
suspected, especially if the animal presented some superficial lesions of 
this infection. 

The dispersal of the internal as well as the external lesions will follow 
the use of iodine and iodide of potassium, or iodide of mercury and 
iodide of potassium. 

Tumours of the reticulum have been observed by Continental authors. 
The neoplasms include papillomata, sarcomata, and carcinomata. 
Papillomata may be very numerous, and sometimes attain such a size 
that they obliterate the opening between the reticulum and the omasum, 
and give rise to serious digestive troubles. 


Traumatic Indigestion. 


SynonyM.—Indigestion due to foreign bodies in the rumen and 
reticulum. 

GENERAL ReEMARKS.—The presence of various kinds of foreign bodies 
in the rumen and reticulum is exceedingly common in bovines. The 
latter organ is so much the predilection receptacle for the smaller, 
heavier, and sometimes pointed, metallic substances swallowed by the 
animal that, in some instances, when opened it presents the appear- 
ance of a “ hardware curiosity shop.” 

Though the variety of non-alimentary materials so often found here 
is amazing, it is remarkable in how many cases their presence has not 
been betrayed by signs of indisposition before slaughter. But this is not 
always so, and their presence in either stomach is a constant menace to 
digestion and health, for they are liable at any time to produce impor- | 
tant pathological conditions, varying from a more or less severe irritation 
of the mucosa to the more serious stomachal and extra-stomachal lesions 
so often caused by the peregrinations of sharp foreign bodies, which 
readily become fixed in the gastric walls, and gradually emerge, to produce 


DISEASES OF THE STOMACHS: CATTLE - 369 


in contiguous and remote organs and structures inflammatory trau- 
matisms, usually of a markedly septic character. 

In this section our remarks will be confined chiefly to the baneful 
effects of these foreign bodies on the digestive organs ; elsewhere, under 
Traumatic Pericarditis and Pneumonia, etc., the ultimate intrathoracic 
lesions caused by the visitation of penetrating substances will be con- 
sidered. 

Et1roLocy.—From what has already been said regarding the unfor- 
tunate inclination which cattle have to prehend and swallow without 
discretion non-alimentary substances that may chance to be mixed 
with their food, to lick at and pick up objects within reach in byre or 
field, and their natural habit of swallowing all kinds of rough food with 
but little mastication, it will be seen that these indiscretions ‘constitute 
their outstanding predisposition to traumatic indigestion. The exciting 
causes—t.e., the foreign substances swallowed—are readily divisible into 
two distinct groups —(1) Penetrating, and (2) Non-penetrating sub- 
stances. These two groups merit separate consideration, because of the 
marked contrast portrayed when we attempt an estimate of their effects 
on the animal’s economy. 

1. Penetrating or Pointed Foreign Bodies.—These are of two kinds, 
V1Z.— 

(a) Those possessed of a head, or so shaped at their non-penetrating 
end that their egress from the stomach is for a time at least delayed—e.y., 
nails, hairpins, pins, long tacks, pieces of wire with one end hooked or 
bent, etc. 

(b) Those which in shape present no material impediment to their 
passage through the tissues—e.g., needles, pieces of wire of all kinds, 
including paling wire, knitting wires, portions of umbrella-ribs, broken 
nails, broken hairpins, sharp pieces of iron, knives, forks, sharp flint 
stones, and spicule of glass, wood, or bone. 

The influences are many that play a part in determining the im- 
plantation in the gastric walls of a pointed foreign body which has been 
swallowed and lies free in the cavity of the reticulum. 

Certain favourable conditions attach to the stomach itself. Its 
capacity is small and its contents semi-fluid, and for these reasons 
materials of greater density than the aliment are in almost continuous 
contact with the walls of the viscus. 

Again, its peculiar internal surface is a factor, being composed of 
numerous polyhedral cells, the thin walls of which consist of raised folds 
of mucous membrane, so that each cell constitutes a possible mechanical 
trap for the extremities of foreign bodies moving or lying in contact with 

VOL. I, 24 


370 SYSTEM OF VETERINARY MEDICINE 


the mucosa, in the same fashion as the depressions in a thimble when in 
use arrest the end of a tailor’s needle. 

Further, because the reticulum is closely related to the diaphragm 
and the more sodden rumen and omasum, it is often, under certain con- 
ditions, subjected to considerable compression in more than one direc- 
tion. To this its flaccid walls readily yield, and the resistance which 
these more solid structures afford to pointed objects lying athwart the 
cavity of the compressed viscus in a position favourable for puncture is a 
special factor in determining their penetration of the walls of the organ. 
Moreover, it is possible that vigorous contractions of the organ itself may 
account for the fixation of the longer pointed metal objects. Culpable 
compression of the reticulum may be due to the influence of the expanding 
womb in the later stages of pregnancy on the relative positions of the 
internal organs. Violent straining from whatever cause arising (in- 
cluding labour and after-labour pains) is a potent factor. To such we 
may reasonably attribute the frequent occurrence of exudative traumatic 
pericarditis within a few weeks after parturition. 

Other influences worthy of mention are violent exercise, especially in 
a downhill direction, and long, tiresome journeys on foot, because they 
induce laboured respiration, during which the forcible action of the 
diaphragm and abdominal muscles, etc., exert an undue pressure on the 
abdominal organs. 

Again, if the stall slopes markedly in the wrong direction, the heavier 
organs press the collapsible reticulum against the diaphragm, and make 
the penetration of the contained foreign body more easy. Under certain 
conditions, more than one of these factors may operate simultaneously 
in the production of a traumatism. 

Morpip ANATOMy.—On examining the interior of the reticulum, we 
may find the penetrating body transfixed in its walls anteriorly, the 
fistula being too small to allow the passage of an awkwardly shaped 
extremity. In most cases the sharp body has escaped from the viscus, 
leaving a fistula with indurated, discoloured edges, surrounded by a 
radiating patch of inflammation. The canal itself is purulent, and, if very 
patent, may contain particles of aliment. But if the animal survives for 
a time after the escape of the foreign body, the fistula readily heals up. 
In that case the point of escape is denoted by a smooth central scar on 
the mucosa, towards which the folds of mucous membrane forming the 
walls of the polyhedral cells gradually taper down to nothing. The 
modification of the mucosa caused by the traumatism fades at the dis- 
tance of fully 1 inch from the scar. 

The peritoneal surface of the organ is more or less firmly adherent to the 


DISEASES OF THE STOMACHS: CATTLE 371 


diaphragm. Occasionally the inflammatory exudate is abundant and 
strong, and the evidence of surrounding peritonitis causing adhesion of 
the rumen to the diaphragm and abdominal wall is considerable. 

Sometimes the foreign body is found safely encapsuled in exudate. 
Abscesses, however, often form at the seat of the traumatism, and when 
the cadaver is opened behind the sternum a large quantity of pus—often 
very footid—escapes, and we discover the presence of a good deal of 
adventitious granulation tissue. According to the direction taken by 
the migrating body, we encounter lesions of the diaphragm, heart, lungs, 
pleura, thoracic or abdominal wall, liver, spleen, or peritoneum, etc.; but 
its trail is usually easy to trace, though it is not always possible to recover 
the foreign body. 

Symproms.—Outstanding features of the case are sudden and’ un- 
accountable gastric disorder, associated with distinct evidence of ab- 
dominal pain, with a tendency to periodic exacerbation when the animal 
rises or lies down. Though restless, groaning, and otherwise manifesting 
colicky symptoms, all movements are stiffly and carefully performed. 
The increase of pain that sometimes results when the animal attempts to lie 
down often aborts the act, and the’animal may stand up for long periods. 
During quieter periods the animal’s expression is dull, but is wildly 
anxious when the pain appears lancinating and uncontrollable. 

If suddenly seized behind the withers, the patient winces and groans, 
as in pleurisy, and palpation of the abdominal wall behind the ensiform 
cartilage causes marked grunting. Its pose during defecation and 
urination is imperfect, and these acts are often delayed and incompletely 
performed, and because of the prolonged retention of feeces in the rectum 
there is evident constipation. 

Gastric disturbance is at once well marked when a foreign body has 
punctured the reticulum or rumen and set up localised peritonitis. 
Rumination is impaired and the peristaltic movements of these organs are 
in abeyance. Appetite is usually suppressed, but if any food is consumed 
an increase of pain results. 

Respiration is increased during pain, and is considerably disturbed when 
the diaphragm is punctured. After a time the symptoms may become 
modified, and the apparent improvement may cause us to doubt our diag- 
nosis, pending the onset of the symptoms of such serious sequels as peri- 
carditis or pneumonia, etc. In the early stages the pulse is little altered, 
though its frequency is increased during restlessness, and there is little or 
no fever. Afterwards, the general symptoms vary with the complica- 
tions, and there may be a marked and persistent rise in temperature and 
significant changes in the character of the pulse. 


372 SYSTEM OF VETERINARY MEDICINE 


In the more fortunate cases in which the foreign body becomes 
encapsuled or falls back into the stomach, improvement is gradual and 
lasting. In many cases in which the foreign body, after puncturing the 
diaphragm, traverses the left chest wall and eventually punctures an 
intercostal space, causing an abscess, the animals seem to suffer little 
inconvenience. We have put on record a case in which a piece of 
wire unfortunately punctured the intercostal muscles opposite to and at 
the level of the left elbow-joint, which it penetrated, causing disintegra- 
tion of the articulation, and the animal had to be slaughtered. The seat 
of lameness was occult till swelling appeared inside the elbow, and the 
cause was mysterious till a post-mortem examination had been held. 

In some cases it 1s possible that the gastric fistula permits escape of 
fluid material, and perhaps also of gas, into the chest or abdominal 
cavity. — 

Arnold of Idstein* has drawn attention to a pneumatic state of 
the abdominal cavity met with in this complaint. He says: “ Upon 
manipulation of the left flank, either an atonic condition of the 
abdominal wall is noticed, or an intermediate space filled with gas 
is found between the abdominal wall and the rumen, the rumen being 
then only perceptible by pressure upon the abdominal wall (which 
is elevated by gas), and often being a hand’s-breadth away from it. 
The rumen itself is solid, and thus contains no gases. There is, therefore, 
no tympany, in the accustomed sense of the word, but a collection of gases 
in the abdominal cavity above the rumen.” He considers this collection 
of gas to be diagnostic of traumatic indigestion. Since the publication 
of Arnold’s discovery of this classic symptom we have had no opportunity 
of testing its accuracy, and while believing that his observations are 
likely to be true of some cases, we cannot concede its constant occurrence 
in all. Arnold asserts that the gases of digestion escape through the 
fistula and collect in the peritoneal cavity. 

Such an occurrence may be possible, but the escape of gas from a small 
fistula in a liquid-containing viscus like the reticulum, communicating 
with the rumen and lying at a lower level than the bulk of that organ, 
cannot be an easy affair. Free gas, obeying the law of gravity in the 
stomachs, as elsewhere, rises as it is formed to the top of the aliment in the 
rumen. On the other hand, the percolation of fluid from the stomach 
through a patent fistula into the peritoneal cavity is a feasible proposition, 
while its decomposition there would naturally give rise to a certain 
amount of gas, which would rise to the highest point of the abdominal 
cavity, and might be recognisable over the rumen at the left flank. It 


* Berliner Tier. Woch. 


DISEASES OF THE STOMACHS: CATTLE 373 


may be said that visceral peristalsis accounts for the escape of digestion 
gases; even so we would expect the escape of fluids to occur more 
readily. 

Further, in contrast to his views, we have many times seen true tym- 
pany of the rumen associated with traumatic indigestion, and have often 
temporarily modified the animal’s distress by tapping the rumen with a 
small trocar and cannula, thus relieving the pressure which the distended 
rumen exerted on the seat of mischief and pain. 

DIFFERENTIAL Dtacnosis.—To diagnose traumatic indigestion with 
certainty, even in acute cases is a matter of great difficulty, and it may 
readily be confounded with gastro-enteritis, peritonitis, pleurisy, or 
sudden, serious, and accidental disturbance in the pregnant womb. The 
difficulty experienced at first in differentiating between the symptoms 
of these diseases and the complaint we are considering is usually removed 
when an estimate is made after a second examination twenty-four hours 
later. Signs in favour of traumatic indigestion are primary absence of 
fever, the apparently causeless occurrence of periodic shallow, catching 
respiration associated with grunting, both of which are made more mani- 
fest on pressing the abdominal wall behind the ensiform cartilage, together 
with colicky pains, restlessness, careful and stiff movements, a tendency 
to keep standing, and an inability to obtain comfort when recumbent. 
Arnold considers the presence of gas in the peritoneal cavity a pathogno- 
monic symptom (see Symptoms). 

The ErtotogicaL Diagnosis of lesions caused by a migratory foreign 
body in other organs than the stomach, diaphragm, and heart, is beset 
with much difficulty. It may be said that a developed traumatic peri- 
carditis can be diagnosed by a novice, but in the early stage, before 
exudation is pronounced, it may baffle the experienced clinician, and we 
have met with cases so suddenly fatal when the heart was punctured as to 
suggest anthrax as the cause of death. 

Neidinger considers the presence of albumin in the urine, demon- 
strable by the nitric acid test, a fairly sure sign of peritonitis, and since, 
in bovines peritonitis is in the great majority of cases either due to a 
stomach traumatism or uterine mischief, a positive reaction, in the absence 
of any history of metritis, assists the diagnosis to the extent of the 
reliability of his conclusions. | 

ProGnosis.—This is always grave. The occurrence of serious sequelee 
may follow on the heels of the gastric disturbance, or it may be delayed for 
weeks or months. In the latter case the initial gastric symptoms gradu- 
ally subside, and the patient regains a fair measure of health, which sud- 
denly declines with the implication of some important organ. In other 


374 SYSTEM OF VETERINARY MEDICINE 


cases the recovery is permanent, indicating encapsulation of the object 
or its return to the interior of the stomach. 

TREATMENT.—Prophylaxis dictates that female attendants should 
wear caps or hair-nets to prevent the loss of hair-pins. Nails and odd 
pieces of wire lying about in and around the byre and fodder-shed should 
be collected and stowed safely away. The dressing of pasture and hay- 
land with city refuse polluted with dangerous metal substances should 
be avoided, and for the same reason farmers should be careful as to 
what rubbish they cast into the dungstead. Stalls should be so con- 
structed as to give a slight fall from the feeding-trough to the dung- 
channel. 

If satisfied with his diagnosis, the practitioner must consider the ad- 
visability of salving the carcass. If there is considerable doubt, the treat- 
ment should be, during the first twenty-four hours, that recommended for 
rumenitis, taking care to avoid the use of anything internally or ex- 
ternally that would prejudice the flesh in the event of a decision to 
slaughter on the second or third day. 

In addition to this, the animal should be made to stand with the 
hind-feet at least 12 inches lower than the fore-feet. This has the effect 
of materially altering the relation of the stomachs to the diaphragm and 
heart, and may cause a partially escaped foreign body to fall back into 
the stomach, when the effects of its puncture may subside and the fistula 
heal up. 

The animal should be sparingly fed with liquid food or bran mashes 
for a day or two, till the specific gravity of the contents of the rumen is 
reduced. ‘To assist in this and promote digestion, small doses of linseed 
oil and lime-water with carminatives should be given. 

To obtain backward displacement of the foreign body into the reticu- 
lum, Schoberl advises that the animal be turned’ on its back with its 
head uphill and the application of forcible, repeated pressure with the foot 
in the region of the ensiform cartilage. He claims for this treatment 
fifty-eight recoveries out of sixty cases; and though we may be sceptical 
of his diagnosis in so many cases, the turning up of the animal and the 
kneading are not unlikely to influence the position of the object, and the 
treatment is worthy of a trial before conducting an exploratory operation. 
If the milder measures fail, too much time should not be put off before 
performing an exploratory rumenotomy in a clearly-defined case. Having 
opened the rumen at the usual seat, the hand and arm are passed through 
till the hand reaches the reticulum, which is at once explored for loose or 
implanted foreign bodies. After their removal the wounds in the 
rumen and abdominal wall are stitched in the orthodox manner. This 


DISEASES OF THE STOMACHS: CATTLE 375 


operation is often practised in Scotland for the removal of foreign bodies 
in both ante-stomachs. 

_ Friedberger and Fréhner quote it as Obich’s method, and state that he 
had four successes in thirteen cases. Mr. W. Dummock, Ames, Iowa, 
U.S.A., resident secretary for the A.V.M.A., in his report to the forty- 
seventh annual meeting of that society, relates that one of the best dairy 
cows in the State was saved by the removal through the rumen and 
reticulum of a nail that was penetrating the pericardium. Obviously, 
this operation can only be successful if performed early, and before the 
object has escaped and caused serious damage. 

2. Non-penetrating or Blunt Foreign Bodies.—These may be soft or 
hard, light or heavy. Of soft substances, some are capable of disintegra- 
tion in the stomachs; others, including pieces of garments, woollen 
materials, sacking, etc., are not so, and produce obstructive indigestion. 
The harder and heavier materials, including stones, gravel, sand, blunt 
pieces of iron, bolts, nuts, etc., being quite indigestible, fall into the 
deeper recesses of the rumen and the reticulum, and interfere radically 
with the functions of the stomachs, if present in quantity. 

Symproms.—Though gastric disturbance of an acute or chronic type is 
often well marked, the symptoms presented differ little from those 
observed in indigestion arising irom other causes. ‘There is impairment 
of appetite and rumination, loss of peristalsis, and a tendency to hoven, 
occasional salivation, and usually constipation, followed by diarrhea in 
the later stages of serious cases. 

On one occasion a cow-feeder fed eight dairy cows three times a 
day, always in the same rotation from a common cooler, with a mess 
containing pea-meal that must have been grossly adulterated with 
sand. 

The eighth cow, which always got the last bucketful of the cooler fell 
ill from profound and intractable indigestion, followed by sluggishness, 
marasmus, and death, and it was only when a post-mortem examination 
revealed a large quantity of sand in the rumen and reticulum that the 
owner recollected that the last pailful on each occasion had been very 
heavy, and that some grit had been found in the bottom of the cooler when 
cleaning it. 

DIFFERENTIAL Dracnosis.—The etiology of these cases can only be 
surmised if there is no definite history as to what the animal has swallowed. 
If symptoms of indigestion are intractable, the complaint we are discuss- 
ing may be suspected. 

PROGNosIs is essentially bad. 

TREATMENT.—As to prophylaxis. the above cases indicate the need 


376 SYSTEM OF VETERINARY MEDICINE 


for cleansing cereals before grinding, and for testing every consignment 
of artificial meal for the presence of sand, etc. 

If fortified with a true history, an operation for the removal of the 
offending material from the stomachs is the only admissible treatment. 


DISEASES OF THE OMASUM. 


The omasum, or manyplies, the third gastric compartment, is situated 
in front of the right anterior sac of the rumen, and, like the reticulum, 
is attached by cellular tissue to the diaphragm. Its greater curvature 
is fixed above to the liver by the gastro-hepatic omentum, and its lesser 
curvature is related to the reticulum; with the latter it communicates 
by a small opening, compared with which its entrance into the abomasum 
is twice as large. 

It is ovoid in shape, like a typical stomach, and its contents are natur- 
ally in a doughy condition. The arrangement of its mucous membrane 
is remarkable. It presents numerous deep folds or leaves, covering a 
framework of muscular fibres. These are attached by one border to its 
greater curvature, and, extending the full length of the viscus, hang 
down into its interior, while between them smaller leaves are interposed. 
These leaves are studded with papille, long and short, which serve the 
dual purpose of retaining and triturating the aliment. While assisting in 
this work, it is conceivable that the less-developed leaves situated between 
each full-sized pair operate in tongue-like fashion to disturb and favour- 
ably place the ingesta under the action of the deeper and more powerful 
leaves. 

But the physiological functions of this organ are in great need of 
investigation. Its elaborate design, as well as the obvious unprepared- 
ness of its crude contents for entrance into the true digestive apparatus 
indicate circumstantially its detective and milling functions. In passing 
through the omasum, the cruder particles of food are waylaid, in all likeli- 
hood by the combined suction and waving motion of the borders of the 
deeper folds. Between these the material is pressed and detained for 
trituration, and the expressed fluid joins the flow of other liquid pabulum, 
which carries along the available free and finely comminuted material 
that has undergone treatment in the viscus. 

It is generally admitted that the omasum is not exercised, like the 
rumen and reticulum, by electrical stimulation of the vagus, but that it is 
influenced by stimulation of the spinal cord and the branches of the sym- 
pathetic system connected to the numerous ganglia in the walls of the 
organ. Its independent innervation would seem to favour the views 


DISEASES OF THE STOMACHS: CATTLE 877 


of those who believe the organ to be a common and primary seat of diges- 
tive disorder; moreover, if it be possible that its activity is maintained 
when that of the rumen and reticulum is in abeyance, its contents, being 
unrenewed, would be unduly pressed, dried, and triturated, and, in the 
absence of the normal flow of liquid from the inert rumen and reticulum, 
the removal of the dried material would fail to be accomplished. 

This possible theory of the drying of the omasal contents may be 
worthy of notice, but we cannot think it is the usual factor, and consider 
that the complex structure and function of the organ are sufficient 
warrant for the need of a special nerve-supply. 

Knigmatical as its physiology is, its pathology is no less obscure. 
Whether impaction of the omasum, otherwise designated “ fardel-bound ” 
(like an oat-cake), “dry murrain,” “ clew-bound,” “ vertigo,’ “‘ stomach 
staggers,” “ grass staggers,” etc.), occurs as a disease per se, is a problem 
about which veterinarians hold extremely opposite views. 

While it would seem arrogant to assert that, under no conditions, 
digestive disorder can originate in the omasum, it is tolerably certain 
that indigestion resulting from dietetic error is invariably manifest in 
the first instance in the rumen in the case of bulky material, while indis- 
cretions with food that can be swallowed without chewing are more prone 
to upset the true digestive apparatus as well as the rumen. 

The involvement of the omasum, as we shall see when discussing 
chronic indigestion, is, we believe, at all times a secondary affair; and, 
notwithstanding what has been written by many authors and spoken 
by many practitioners, we are unable to say we have ever encountered 
impaction of the omasum as a primary disease. 

The symptoms usually set forth as characteristic of this so-called dis- 
order are exactly those of profound dyspepsia, and we have made 
numerous post-mortem examinations of animals that in life illustrated 
the description given, and died delirious, and yet we failed to find any 
abnormal condition of the omasum worthy of note. 

The fallacy is, we believe, in great measure based on a en aN 
of the factors giving rise to desiccation of the contents of the viscus in 
animals subjected to what was at one time a universally adopted line of 
treatment for indigestion. Until recent years it was the custom of 
owners and practitioners alike to treat all cases of dyspepsia with large 
and repeated doses of purgative medicine, especially hydragogues like 
magnesium sulphate, etc. The purgation that ensued was often fol- 
lowed by an absence of feces for a time, and this or the tardy appearance 
of a little dry material (dry because of its long travel over an actively 
absorbent surface) served as an excuse for repeating the purge over and 


99 66 


378 SYSTEM OF VETERINARY MEDICINE 


over again. This treatment effectively outraged the digestive canal, 
inducing gastro-enteritis; and since the omasum itself is but little influ- 
enced by purgatives of any kind to part with its contents during neuro- 
motor dyspepsia, it 1s not to be wondered at that the ingesta between its 
leaves was found in many instances on autopsy to be so dry and caked 
as to suggest the term “ fardel-bound.” The devotees of this cult, forgetful 
of the effect on the omasum of repeated hydragogue depletion, a febrile 
state of the system, and the contiguity of the organ to the inflamed 
abomasum, never failed to find in the revealed dry state of the omasal 
contents a full justification of their diagnosis and treatment, and an 
illustration of the need for more heroic doses in future cases. 

Again, while the ingesta of the omasum is liable to alter in character 
under the conditions referred to, and though the dimensions of this organ, 
as of the other compartments, varies within certain limits in animals 
of like age, breed, and size, we have never seen it impacted to twice or 
thrice its normal size. 

It is never suggested that fermentation with gas formation occurs to 
any extent in the omasum, and it is certain that gas never accumulates 
in it, producing inertia of its walls, as is so often the case with the rumen. 

Again, if we admit the possibility of great engorgement of the viscus 
with food during the development of dyspeptic conditions, or at any other 
time, we must concede either that it receives its contents in the same 
passive way as do the other compartments, which are devoid of such im- 
pediments as it possesses in its well-developed folds, or that under some 
inexplicable stimulus these folds become perversely active in the stowing 
away of food into the depths of the organ without any corresponding 
increase in its output of prepared material. 

Hither hypothesis is untenable, for there is reason to believe that not 
only is its functional activity early and readily disturbed and reduced 
in an attack of indigestion, but, owing to the fact that during a protracted 
state of stomach derangement its contents are undisturbed and undergo 
little change excepting a loss of sap, the organ experiences on that account 
comparatively greater difficulty than the other compartments in 
assuming again its normal activity. 

In chronic neuro-motor dyspepsia the loss of moisture from the 
omasal contents is attributable, not only to the paralysis of the organs — 
and the consequent absence of removal of the material, but also to the: 
curtailment of the natural flow of fluids from the rumen and the 
reticulum. 3 

But, whatever influence this awkward sequel may have on the animal’s 
recovery, its presence is not easily determined, and in most cases can only 


DISEASES OF THE STOMACHS: CATTLE | 379 


be presumed from the lengthened period during which visceral peristalsis 
has been in abeyance, and the obstinacy of the case to remedial measures, 
while in some cases the flaccid state of the abdominal wall enables us 
by palpation to locate the organ and measure with some accuracy its 
condition. 

It is worthy of note that in autopsies made on animals that have died 
after a long illness, the symptoms of which provoked a diagnosis of impac- 
tion of the omasum, the appearance of the organ has been found to differ 
little, if at all, from that of the omasum of prime animals slaughtered 
for beef. In the past, the natural doughy state of the omasum, offering 
as it does a marked contrast to that of the other stomachs, has been too 
often represented by the expert clinician as a diseased condition confirming 
his diagnosis. 

Note sy Eprror.—Impaction of the omasum is not described as a 
disease per se by Hutyra and Marek, but under the heading of “ Atony of 
the Fore-Stomachs ” they draw attention to “a slowly developing weak- 
ness of contractions of these organs (rumen, reticulum, and omasum), 
depending upon a diminution of irritability and energy of contraction. 
The removal of the normal, or even subnormal, amount of food becomes 
more or less retarded, and digestion disturbed.” The affection is said to 
be due usually to prolonged improper feeding. A secondary atony of the 
fore-stomachs is recognised, and is observed in the course of traumatic 
gastritis and other forms of inflammation of the rumen, reticulum, and 
omasum, or of the abomasum. 

One of the results is desiccation of the gastric contents. Owing to 
the functional interrelation of the individual sections of the stomach, 
stoppage of movements in one section causes a similar effect in the other 
sections. These authors do not deny that occasionally the omasum alone 
is the seat of the obstruction, and explain this by the fact that in the 
normal condition the contents of this viscus are comparatively firm, its 
muscular tissue weak, and finely divided food may occasionally get 
directly into the omasum without rumination. “Such cases, however, are 
said to be rare, and their differentiation from other forms of atony appears 
impossible, as disease of the omasum at once leads to disturbance of the 
functions of the other sections of the stomach. | . 

The post-mortem appearances described are a dilatation, more or less 
marked, of the rumen and omasum, the increase in size of the latter being 
particularly obvious. ‘‘ The contents of the omasum are unusually dry, 
almost rock-like, but they can be ground up into a fine powder between the 
fingers; they completely fill the organ.” The rumen usually contains 
desiccated foetid masses of food, and usually also gases. Occasionally, 


330 +~=« SYSTEM OF VETERINARY MEDICINE 


in cases of atony, the omasum may not be obstructed. Desiccation of 
ingesta in this viscus without dilatation of the organ is common in severe 
febrile general diseases or other affections in which the movements of 
the fore-stomachs have been diminished for a considerable time. 
According to the same authors, the omasum appears to be the 
favourite seat of neoplasms. Polypoid tumours have been observed, 
which obstructed the opening between the reticulum and the omasum. 
Cases of sarcomata of the omasum have also been recorded. 
Inflammation of the omasum is described by Cadéac. It is said to 
be generally a secondary affection, associated with chronic gastro- 
enteritis, malignant catarrh, rinderpest, foot and mouth disease, etc. 
The condition is sometimes primary, and is said to depend on external 
injuries, such as those inflicted by the horns of other animals, or by kicks 
given by the attendant. Chronic inflammation of the organ is believed 
to occur when animals are fed for a long period on dry food. Irritant 
toxic agents, such as arsenic and mercurials, may also set up omasitis, 
associated with inflammatory changes in the other divisions of the 
stomach. 
The symptoms described are by no means characteristic, and we 
doubt very much if a differential diagnosis of the condition is possible. 
Tuberculous ulcers of the omasum have been described by Johne 
and Weiser. 


DISEASES OF THE ABOMASUM. 


The abomasum is the fourth or true digestive stomach. It is pyri- 
form in shape, slightly curved upon itself; its left side is in contact with 
the rumen, and its right side is related to the diaphragm in the epigastric 
region. To its greater curvature the great omentum is attached, while 
its lesser curvature is connected to the greater curvature of the omasum 
by serous membrane, and looks upwards. Anteriorly the base of the 
viscus is in contact with the reticulum, while its constricted posterior 
extremity is continuous with the duodenum at the pylorus. The interior 
communicates in front with the omasum, and behind with the small 
intestine. From the day of birth, and so long as the calf is milk-fed, 
this is the largest stomach, but it is soon superseded in size by the rumen 
when the animal begins to take solid food. 

Its highly vascular mucous membrane is thrown into a number of 
folds (twenty or more), which run spirally from its anterior extremity, 
and become lost posteriorly in the area of plain mucosa which exists in 
the organ for a few inches in front of the pylorus. 

In the adult the space between the bases of the folds is about 1 inch, 


DISEASES OF THE STOMACHS: CATTLE ~' 381 


and many of the folds measure 4 inches in depth at their broadest part, 
so that the arrangement of the mucosa enormously increases the secreting 
area which contacts the aliment. In calves the folds are little over 
linch in depth. They differ from the leaves of the omasum in having no 
groundwork of muscular tissue. The ingesta, when it reaches the omasum, 
is in a finely comminuted condition, and is normally semi-fluid. Here 
it is at once subjected to the action of the gastric juice secreted by the 
numerous glands and follicles present in the mucosa. The gastric juice 
contains the specific ferment “rennin,” which has the power of coagu- 
lating milk. 

It cannot be said that abomasal indigestion, catarrh of the mucous 
membrane, or actual abomasitis, though each may be of primary occur- 
rence, can exist as diseases per se for any length of time. 

The vascular mucosa of the organ is, however, so delicate that its struc- 
ture is easily prejudiced by the ingestion of irritants of any kind; and 
though the abomasum may suffer primarily, and continue to confer on 
the case its main features—for which reason its disorders demand special 
consideration—the other compartments, as well as the intestines, are 
usually implicated to some extent. Per contra, disease of the abomasum 
is very common as a complication in digestive cases in which the evidence 
of disturbance of the anterior stomachs or of the intestines is paramount. 


Abomasitis. 


Synonyms.—Catarrh of the abomasum; Gastritis; Gastro-enteritis. 

Derinition.—Inflammation of the abomasum. 

GENERAL REMARKS.—When the inflammation is limited to the super- 
ficial layers of the mucosa, it is spoken of as gastric catarrh, which may 
be mild, chronic, or acute, the last merging into “ gastritis,” which 
signifies involvement of the deeper structures, the cortum, and the gastric 
glands. - 

In degree and character gastritis also varies, and may be acute, 
chronic, phlegmonous, or ulcerative. Classified according to etiology, 
gastritis may be semple, toxic, or mycotic. 

The more common term gastro-enteritis is applied to all cases in 
which the bowel as well as the abomasum is implicated. In choosing the 
term that is applicable to a given case, our only guides are the severity of 
the symptoms and whatever knowledge of the cause is procurable. We 
cannot otherwise differentiate the forms and stages of the disease. 

Er1oLocy.—The effect of chill as a contributory cause of gastritis 
cannot be overlooked in the initiation of the original catarrh, producing 
as it does a low state of vitality favourable to microbic infection and auto- 


389 SYSTEM OF VETERINARY MEDICINE 


intoxication, or, if experienced later, in facilitating the development of 
the graver stages of the disease. It has been our experience that when 
the system of animals suffering from prolonged dyspepsia sustains a 
shock from undue exposure, the symptoms at once increase in gravity 
on account of gastritis supervening. 

Exciting causes are exceedingly numerous, though many of them are 
so obscure that it is often impossible to determine them satisfactorily, 
even when, with a succession of fatal cases obviously dependent on a 
common cause, we have every opportunity for research. 

Predisposed by its vascularity and delicate structure, the sensitive 
mucosa of the abomasum is more liable to inflammatory changes than 
that of the other stomachs when an animal has partaken of irritant food. 
Even though it be allowed that the ante-stomachs police the rougher 
particles of obnoxious and irritant herbs which an animal may have eaten, 
the effect of mastication and maceration with saliva is to free much of 
the irritant juices of the plants, some of which may pass directly to the 
abomasum in concentrated form, while more dilute solutions manufac- 
tured in the rumen will continue to flow towards the abomasum, 

According to the efficacy of the essential juices of the herbs as irri- 
tants, the mucosa of the abomasum as well as of the intestine is impinged 
and betrayed to bacteria, which, though pathogenically held in check by 
normal mucous membrane, are capable of attacking it when it is enfeebled 
by the action of irritant ingesta. In like manner, the mucosa is suscep- 
tible to the scalding effect of hot drinks (often seen in calves), the irritant 
action of mineral and vegetable poisons administered purposely or in 
error, and, as already explained, the administration of too large or re- 
peated doses of drastic purgatives is one of the commonst causes of 
gastritis in bovines. Other causes are draughts of icy-cold water given 
to unexercised stalled animals, frozen roots, mouldy and fermented food- 
stuffs, decomposing roots and potatoes, badly got fodder, etc. 

Among dairy cows intensively fed with artificial meal made from 
foreign cereals, we have repeatedly experienced alarming outbreaks of 
gastro-enteritis when sudden changes had been made from a well-balanced 
food to one in which the nitrogenous ratio was greatly increased. In 
1908, when Soya beans were imported as a substitute for the more 
expensive Egyptian beans, Indian peas, etc., hitherto in universal use, 
sporadic outbreaks involving from one to six animals occurred in every 
dairying district in Scotland. | 

These cases were sudden in onset, very often proved fatal, and usually 
occurred a day or two after a marked increase had been made in the 
Soya ration; and the post-mortem examinations showed such typical 


DISHASES OF THE STOMACHS: CATTLE - 383 


lesions of gastro-enteritis as might have been induced by feeding a hungry, 
exposed animal on rancid, decomposing turnips. 

In marked contrast, the other animals whose digestive powers were 
equal to the rich food produced milk in such quantities as they never did 
before on any other ration. 

In most of the outbreaks the freshness of all the food-stufts was beyond 
suspicion, and we were inclined to attribute the illnesses to nothing else 
than the baneful effects of a diet so over-rich in proteid as to be unfit for 
digestion by some animals in whose abomasum and intestines it would act 
the part of an irritant, prejudice the mucosa, and make it susceptible to 
the perverted pathogenic action of the ordinary saprophytic flora of the 
digestive organs. Or is it possible that the same cereal grown in different 
foreign parts may vary in value as a food-stuff—though its analysis 
remains constant—according as it has been grown in dry heat or in regions 
fairly well watered? If so, the eccentric effects of feeding with Soya 
meal is explained. Moreover, it has been shown that the natural amides 
of plants are deficient when they are grown under unduly dry conditions. 

Morsip AnAatomy.—In the milder cases of catarrh of the abomasum 
there is a simple congestion and redness of the mucosa, with slight thicken- 

ing and follicular catarrh, the mucous folds being twice their normal 
thickness. On opening the cadaver of animals dead from acute gastro- 
enteritis, there is revealed extensive ecchymoses of the serous membranes 
suggestive of a septiceemic infection like anthrax; but the spleen is normal, 
and smears made from an incised red patch and stained show multitudes 
of putrefactive bacilli. The conténts of the abomasum are found to be 
changed in colour from admixture of blood and inflammatory exudate, 
and the liquid material in the intestines is also sanguinolent. An exam- 
ination of the mucosa shows the folds to be greatly thickened by exuda- 
tion, and of a dull red colour; in many places the epithelium is desqua- 
mated, and capillary hemorrhage has occurred from the raw surface. In 
some cases necrotic patches are seen, with here and there typical round 
ulcers denoting where a dead portion of the mucous membrane has been 
exfoliated. In exceptional cases an ulcer deepens to actual perforation 
of the wall of the viscus, allowing oozing of fluid into the abdominal 
cavity. 

In cases caused by corrosive poisons there is often ate destruction, 
and portions of the mucous folds may be exfoliated, leaving a raw heemor- 
rhagic surface; while in cases arising from drastic purgation the lesions 
of the mucous membrane in the abomasum are often so extensive that 
hemorrhage to the extent of sausaging a portion of the bowel with coagu- 
lated blood has occurred. In the small bowels we find the usual lesions 


384 SYSTEM OF VETERINARY MEDICINE 


of enteritis. In the omasum hemorrhagic spots are sometimes observ- 
able on the leaves, and the ingesta near to the abomasum may be stained 
through back-washing of material from that organ. In rapidly fatal 
cases the omasal contents are otherwise little altered, but in protracted 
cases the ingesta is very often much drier than normal, and is occasionally 
firm and consolidated between the leaves, simulating portions of linseed 
cake. 

Symproms.—The signs of catarrh of the abomasum are indistinguish- 
able from those of derangement of the ante-stomachs; indeed, these con- 
ditions are often associated. A slight irregularity in temperature would 
favour a diagnosis of catarrh. 

The majority of cases of acute gastritis come on suddenly, and are 
already serious when we are called in. The appetite at once fails, though 
thirst may be present, and rumination ceases. The animal is often found 
shivering with a temperature over 105° F., and we have seen 109° F. 
registered. The pulse is at first frequent, full, and bounding, but gradually 
loses volume, and becomes small, feeble, and difficult to count. At first 
the bowels are, in many cases, constipated, but this usually gives way 
in time to profuse foetid, dark, tarry, or chocolate-coloured diarrhea. 
The animal is uneasy, sometimes evinces colicky pains, and palpation 
of the right hypochondriac region shows tenderness, and causes grunting, 
and in the later stages groaning accompanies each expiration, especially 
if the animal is disturbed. Some degree of tympany may be present. 
In exceptional cases constipation is persistent in spite of large doses of 
purgative medicine given by the owner, or a small amount of watery 
feeces may be ejected, and leads to some deception, for it is often followed 
again by constipation. In fatal cases death usually occurs within four 
days, and this may happen without the exhibition of any signs of in- 
toxication. But this is not always so, and in the later stages marked 
symptoms of cerebral disturbance are common, and when they occur 
they are predominant. The animal assumes a wild appearance, the 
eyes being congested and the pupils dilated. Vision seems gone, the 
patient heedlessly abuses itself, strains at its binding, and sometimes 
gets astride the stall partition. If approached and handled, the animal 
bellows and lashes its head about regardlessly, often dislodging the horns, 
and kicks out with its feet. During the excitement there are muscular 
tremors and some degree of dampness over the body. Eventually the 
animal wears itself out, the extreme exhaustion greatly hastening the 
end. 

If the animal survives for five or six days, and the pulse and tempera- 
ture remain favourable, recovery may be looked for, but the patient often 


DISEASES OF THE STOMACHS: CATTLE 385 


remains a dyspeptic ill-doer—doubtless the result of trophic changes in 
the gastric glands and follicles. 

DIFFERENTIAL Dracnosis.—It is only by judging the gravity of the 
symptoms that we can attempt differentiation between the milder catarrh 
and the more serious inflammation of a well-developed gastritis. The 
presence of a well-developed febrile condition, marked changes in the 
rate and quality of the pulse, and the altered state of visible mucous 
membranes, distinguish abomasitis from ordinary indigestion, however 
profound and intractable, and notwithstanding the fact that many of the 
signs of acute dyspepsia without inflammation are similar to those of 
gastritis. From enteritis it may be distinguished by the character of 
the feces and the absence of tenderness in the right flank, but this is 
not always easy, as the small bowel is often simultaneously affected, 
though perhaps to a lesser extent than the abomasum. 

Proenosis.—This is always grave. Catarrhal conditions, if not care- 
fully treated and nursed, are apt to run on to acute gastritis, and when 
this is established most cases are fatal. The symptoms of pain are rather 
deceptive for prognosis, and reliance must be placed on the temperature 
chart, the quality of the pulse, and the character of the faeces. The 
absence of feeces for a time, followed by the evacuation of dark-coloured, 
bloody, often tarry-looking material, and signs of collapse, are significant 
Symptoms. 

TREATMENT.—Prophylactic measures comprise the breaking-up of 
pasture-land notorious for noxious irritant weeds. Trimmings of shrubs 
should always be destroyed by fire. If thrown carelessly over the hedge 
into the grazing-field, cattle are prone to devour them, and suffer in 
consequence. ‘The diet of stall-fed animals should be well balanced, and 
such as is justified by good results in practice. When changes are made 
from one concentrated food-stuff to another, they should be gradual, and 
the results closely watched. Soya bean meal is an invaluable food-stuft 
when given in moderation to animals plentifully supplied with roots and 
other rough bulky materials. When trouble has followed its use, it 
was usual to find that upwards of 8 pounds per head per day had been 
allowed, and that the supply of coarser food was deficient. 

Victims of the milder forms of indigestion should at once receive 
proper medicinal treatment and nursing as to food, clothing, housing, 
etc., if the onset of inflammatory conditions is to be avoided. 

For curative treatment, a mild purge is only admissible in cases due 
to dietetic error or irritant food materials. For this purpose, 1 pound 
of magnesium sulphate or 1 pound of sodium sulphate in solution, with 
from 1 to 3 pounds of treacle, may be given according to the size and 

VOL. IL. 25 


386 SYSTEM OF VETERINARY MEDICINE 

age of the animal. Or the same purpose may safely be accomplished 
without drenching by giving doses of electuary of common salt, and, 
when the animal is thirsty, allowing it to drink salt water in moderation 
till the bowels respond. Some practitioners recommend large doses 
of linseed oil, followed by plenty of fluids containing treacle and stimu- 
lants, such as No. 1 ale, ete. | 

Toxic gastritis is to be combated by the use of suitable antidotes and 
the administration of mucilaginous materials. In cases set up by the 
use of drastic purgatives, measures must be taken to inhibit their action, 
and for this purpose chlorodyne is to be recommended, or small doses of 
powdered opium along with chalk, tannic acid, or powdered catechu, to 
be given in a quart of gruel made with boiled milk, flour, starch, and 
water. Doses of sodium bicarbonate or hyposulphite may be given, to 
counteract acidity and limit fermentation. If pain is marked and con- 
tinuous, extract of belladonna may be given, followed by nux vomica, 
gentian, and alkalies. 

The great depression that follows abstraction of blood puts that 
treatment out of court unless the case is seen early, when the pulse is 
full and bounding, or the animal is showing signs of intoxication. In 
all cases the application of moist heat for a time, to be followed by a 
sinapism over the seat of the abomasum and comfortable clothing, is 
of distinct advantage. When fever is extreme, full doses of antifebrin, 
antipyrin, or aceto-salicylic acid, may be placed on the tongue and 
washed over with a little water containing a dose of tincture of aconite. 
Chloral hydrate is the best agent to combat delirium, and may be given 
in from 1 to 2 ounce doses, the smaller dose to be given if phlebotomy 
has been practised. If the animal survives for four or five days, its 
strength should be maintained by giving milk, eggs, linseed gruel, boiled 
oatmeal gruel, hay tea, etc., and, later on, cooked mashes of bran, boiled 
turnips, and cut hay, as well as a little fodder of good quality.: Mean- 
time, bitter stomachics, combined with carbonate of iron, may be pre- 
scribed. : 

If the bowels are sluggish, a daily dose of linseed oil, lime-water, and 
tincture of ginger, may be given, and the more concentrated cereal meals 
should be withheld till the patient is well on the way to recovery. 

Ulcer of the Abomasum.—This is a very rare condition in adult cattle. 
Cases have been recorded by Gotteswinter, Kitt, Kohlhepp, and Plate. 
In some instances profuse hemorrhage, leading to profound anemia, was 
observed. In Kohlhepp’s case, the animal (a cow) showed extensive 
emphysema of the skin, due to the gases from the stomach finding their 
way through the ulcer into the subcutaneous tissues. In Plate’s case, a 


DISEASES OF THE STOMACHS: CATTLE 387 


tuberculous ulcer in the abomasum caused a fatal hemorrhage. Joest 
found multiple peptic ulcers in a cow suffering from lympho-sarcoma of 
the abomasum. | 

According to Ostertag, Kitt, and Ramussen, gastric ulcer is seen most © 
frequently in the abomasum of calves, and is due to catarrh of the mucosa. 
Johne holds that the cause is an injury to the abdominal region, which 
leads to hemorrhage into the gastric mucosa. 

Tumours of the Abomasum.—<According to Hutyra and Marek, 
tumours are common in this viscus. The varieties include adenomata, 
adeno-carclnomata, and alveolar carcinomata. A tuberculous tumour 
was found by Joest in the abomasum of a cow suffering from generalised 
tuberculosis. 

Torsion of the Abomasum.—According to Hutyra and Marek, torsion 
of the abomasum is a lesion that occurs exceptionally in cattle. A case 
of this affection was reported in a calf eight days old by Carougeau and 
Prestat. The abomasum was twisted towards the right, both orifices 
were closed, its walls were congested, and peritonitis was also present. 
Death took place in one and a half days. The animal protruded its 
~ tongue, showed colicky pains and marked weakness. Pressure on the 
abdomen elicited splashing sounds. 

Parasitic Gastritis—The abomasum is often the seat of parasitic 
invasion. For a description of this the reader is referred to the section 
on Parasites. 7 


DYSPEPSIA. 


Synonym.—Indigestion. 

Derinition.—A lack of digestive power. 

GENERAL REMARKS.—Here it is our intention to refer to those con- 
ditions dependent on a more or less generalised aberration of the func- 
tions of the digestive organs in which the morbid phenomena are not 
confined to a single compartment or section of the alimentary canal, but 
are found involving the entire digestive system as well as the accessory 
organs of digestion. Such a general state of indigestion is rather common 
in milch stock, but the severity of the catarrhal condition engendered in 
any one viscus is not constant, so that, even in simultaneous cases 
occurring in the same herd, we find not only dissimilarity in the symp- 
toms exhibited, but in fatal cases autopsies show much variation in the 
site, character, and extent of the lesions, as well as in the amount and 
condition of the ingesta contained in particular compartments. 

It may be urged that the use of the term “ dyspepsia,” or “ indiges- 
tion,” is an admission of ignorance, and an evidence of our limited powers 


388 SYSTEM OF VETERINARY MEDICINE 


of topical diagnosis. In some measure this is true, but the difficulty 
we experience in referring certain trains of symptoms with accuracy to 
the occurrence of lesions at specific locations is often exceedingly great, — 
and many conclusions arrived at when an analytical attempt is made 
are correspondingly hypothetical. 

The great bulk of the bovine digestive apparatus, the remoteness of 
some important parts that we would fain handle and examine, and the 
comparative tardiness of the usually stolid bovine temperament to show, 
in altered symptoms, the slighter gradations in the progress of internal 
disorders, render the task of making a topical diagnosis extremely diffi- 
cult, and force us, in the absence of symptoms characteristic of specialised 
visceral disorder, to adopt the more comprehensive term “ dyspepsia,” 
or “indigestion.” Animals suffering from indigestion, however pro- 
found, and whether it -be acute, subacute, or chronic, may maintain 
throughout the entire course of their illness such a non-topical train of 
symptoms that we cannot at any time suggest the predominance of dis- 
order in any compartment. The etiological factors in many such cases 
are to be found in a vitiated state of the blood, resulting in depressed 
innervation from malnutrition of the nerve centres and the independent 
visceral ganglia, due to the products of imperfect digestion in the blood, 
and our line of treatment should be based on our knowledge of these 
factors and the gravity of the case. 

Nevertheless, it commonly happens, and particularly in cases arising 
from dietetic error, that for one reason or another the morbid phenomena 
become so concentrated in one particular compartment that its condi- 
tion demands special attention, apart from the general line of treatment. 

In our consideration of the special disorders of the various portions 
of the alimentary tract, it will be seen that, though the symptoms are 
sufficiently distinctive for a topical diagnosis to be made, the arrange- 
ment and direct communication in sequence of the organs make it im- 
possible for one compartment to suffer acutely or for any length of time 
without the participation in some degree of the other organs. Speaking 
generally, it has been our experience that the tendency in the great 
majority of cases is towards special implication of one to two compart- 
ments. Milch cows, which normally run the gauntlet of one period of 
gestation per annum, are liable to special ante- and post-partum in- 
fluences inducing secondary forms of digestive disorder, and to these 
must be added those cases occurring in all bovines which are the result 
of malignant or other chronic disease of important accessory organs, or 
are secondary to progressive organic disease of the organs of other 
systems. 


DISEASES OF THE STOMACHS: CATTLE 389 


Errotocy.—While gross dietetic errors and other factors capable of 
suddenly upsetting digestion almost invariably result in marked derange- 
ment of special compartments (see pp. 343-381), the same causes, when 
less pronounced, may act gradually over a period of days, and culminate 
in a well-developed and persistent general dyspepsia. This occurs most 
readily in winter-time, when the animals get little or no exercise, and 
probably an insufficiency of fresh air, when, in order to maintain the 
milk supply or to hasten the fattening process, they are plied with rich 
food to the limit of their appetite and digestive power. If the animal 
falters in appetite and is enticed with condimented or sweetened food- 
stuffs, it very readily assumes a condition of ‘ digestion stasis,” spoken 
of in the West of Scotland as “ stawed,” appetite, digestion and rumina- 
tion being in almost complete abeyance. 

The extent to which animals possessed of healthy organs and untainted 
blood may be pressed with intensive feeding without inducing disorder 
varles according to sex, breed, temperament, age, and size, and the 
practical feeder soon discerns the limitations he must put on the menu 
of the animals under his charge. It is, however, proverbial that milch 
cows, for a period of a few weeks after calving—the danger decreasing 
from the third week—are exceedingly prone to become satiated, and 
exhibit signs of nervous disorder when fed with materials that they can 
consume with the best results during the later stages of lactation. Those 
most prone to “slack” are the matured, highly strung, well-developed 
milkers—the “milk fever” type of animal. The danger involved in giving 
such animals concentrated artificial food-stuffs too soon after calving— 
and while their economy is still in a parturient state—is one of the greatest 
bugbears of the dairying industry, and one which is being daily accen- 
tuated by the culpable tendency of the cattlemen to “ freely give in food 
where they freely receive in milk.” 

Younger, immature cows are much less susceptible, but we occasionally 
encounter in those begot of milk-record parents modified symptoms of 
post-parturient dyspepsia. It is not an easy matter to explain satisfac- 
torily the predisposition of the recently calved deep milker to impaired 
digestion and its attendant sequele when being artificially fed. The 
liability thereto is practically absent when they are at grass, and is greatly 
minimised even in winter if the rations are easy of digestion and some- 
what deficient in proteids for the first fortnight, the subsequent altera- 
tions in quality being gradually made. Doubtless the nervous system 
- of the impressionable descendant of a line of deep milkers is more pro- 
foundly affected by the trials of the parturition period than that of the 
less gifted moderate milker. 


390 SYSTEM OF VETERINARY MEDICINE 


When they reach maturity, we experience that these animals are 
eminently the victims of milk fever, and until the cause of that affection 
has been precised as clearly as its curative treatment is now eflective, the 
actual influences that depress the digestive processes for a period after 
calving will continue to mystify us. Stockowners, not without reason, 
associate the cases occurring in their herds with retention of the “ second 
cleansing ’’—.e., the lochia—and many practitioners are disposed to 
attribute the digestive disorder, as well as all post-parturient nervous 
phenomena (apart from typical milk fever), to a toxemia resulting from 
the absorption from the womb of pernicious elements elaborated in the 
débris of the uterine cotyledons, when, from want of tone, the uterine 
walls are slow to contract and the lochia is late in appearing. Whether 
this is the whole truth is problematical, but it is conceivable that the 
blood may be prejudiced by the absorption of such products, even though 
the lochia is admittedly non-septic. But, in determining the factor 
giving rise to the initial loss of tone throughout the system, our 
experience leads us to indict the unknown etiological entity of milk 
fever. 

We know to what extent this affection varies in degree in different 
animals, and that in some the symptoms are so very mild that they can 
only be appreciated by the trained observer. An acute attack of milk 
fever, if proper treatment is at hand to insure a speedy recovery, is 
preferable to the slow, ill-developed, and often chronic type that baffles 
diagnosis and engenders indecision, for in the former the animals, very 
often within two days, spring into full tone and utility. Per contra, the 
mildly-developed case may show no symptoms commonly regarded as 
pathognomonic of milk fever; she may even retain the use of her limbs; 
but under the pernicious influence of this hidden agency there is produced 
a more or less well marked and persistent loss of tone throughout the 
economy. The effect on the womb is to retard contraction, thus favour- 
ing retention and absorption of its contents, the secretion of milk is 
reduced, the digestive functions are aberrated, and it is the evidence of 
digestive disorder that confers on the case its predominant primary 
features. 

Oft-times we have known animals that in previous years held first- 
class records as feeders and milk producers assume this pensive non- 
febrile state immediately after calving, and, even when safely guided 
during the dangerous period of the first two or three weeks, they failed 
for a season to attain their former excellence. To some extent we were - 
led to attribute the general lassitude of such cases to the milk-fever agent 

by the undoubted good results of udder inflation when the food-refusing 


DISEASES OF THE STOMACHS: CATTLE 391 


dyspeptic animal became the victim of nervous disorder—so-called 
“ staggers ’—that had materially resisted other treatment. 

Though somewhat atypical on account of the accompanying dyspepsia, 
we latterly considered as “‘ deferred milk fever ”’ all such cases occurring 
for some weeks after calving, and precipitated by the careless over- 
feeding of predisposed animals. 

It is not suggested that in such cases udder treatment miraculously 
disperses their complicated features, as it does every trace of typical 
milk fever, but even in cases occurring up to and beyond two months 
after calving the beneficial results of the inflation is unquestionable, 
pacifying and restoring the senses of the animal, and making her sus- — 
ceptible to the action of medicines for the restoration of her digestive 
functions. It may be objected that a consideration of these cases is 
misplaced in this section. Our justification is the undeniable influence 
of over-rich food and indigestion in their production. 

Those chronic forms of indigestion which are commonly unassociated 
with nervous phenomena and characterised by no special symptoms but 
persistent refusal of most kinds of food and the signs of impaired visceral 
peristalsis, are usually referable to undiagnosed and often incurable 
organic disease of the liver, or to neoplasms of one kind or another im- 
plicating some part of the alimentary tract. 

In rare cases of “ hunger strike ” in cattle an autopsy discloses no 
tangible lesion that can be considered culpable, and we are forced to 
suspect a condition of morbid exhaustion or degeneration of the con- 
trolling nerve centres. 

Morpip Anatomy.—The post-mortem appearances vary. The rumen 
may contain much or little food, but it is usually drier than normal, 
clings to the walls of the viscus, and, when removed, carries with it very 
readily a layer of epithelium. A certain amount of gas is usually present. 
The reticulum may contain, and is sometimes filled with, coarse food, 
like that in the rumen, instead of liquid ingesta. 

In long-continued cases there is often well-marked dryness of the 
contents of the omasum. The material often becomes caked between the 
leaves, being almost devoid of moisture. The tendency of this viscus to 
assume this condition in protracted states of indigestion is often well 
marked, and has caused many observers to believe that this organ is the 
primary seat of many attacks of indigestion, as well as gastric catarrh 
and gastritis, whereas its condition is but a secondary result of these 
affections. 

In many cases the contents of the abomasum are much coarser than 
normal, and simulating in appearance that in the rumen. The mucosa 


392 SYSTEM OF VETERINARY MEDICINE 


may be congested and irritable looking, and in cases associated with 
violent symptoms before death there is usually some degree of gastritis. 
This, as well as the appearance of the bowels and the state of their con- 
tents, is much influenced by the medicines administered. 

When death has been preceded by tetanic seizures or epileptiform 
attacks, we may find cerebral hamorrhage or meningeal congestion, as 
well as venous congestion of the lungs, kidneys, and other organs. The 
liver is often slightly enlarged, and its substance abnormally soft and 
friable, paler than usual, or slightly yellowish in colour, the condition 
being akin to the “ cloudy swelling ” of pyrexial diseases. 

In cows recently calved, the capacity of the womb is greater than it 
ought to be, and it may contain lochia which would have been voided 
earlier if the organ had contracted normally. 

Symptoms.—The first symptoms are dulness, loss of appetite, im- 
perfect rumination, constipation, flaccidity of the rumen, and compara- 
tive absence of eructations. The milk supply is short, the skin loses its 
bloom, tends to cling, and becomes dirty, and the surface temperature is 
uneven, although the internal temperature is often subnormal. The 
pulse is soft and sluggish, and the respirations slow and shallow. The 
buccal mucosa is pasty, and often has a sour odour. 

In the case of animals recently calved, and sometimes while their 
appetite is but slightly capricious, the whole body seems permeated with 
a characteristic sickly parturient odour. Exhaled by the breath and the 
skin, the odour is appreciable on entering the byre if ventilation is defec- 
tive, but it is more felt when one stands near to the cow. 

The milk, when warm, carries the odour intensely. In cold milk it 
is less apparent to the sense of smell, but, when tasted, the heat of the 
mouth discloses the mawkish taste, which is also easily detected in hot 
tea, coffee, etc., to which the milk or cream has been added. The sickly 
odour usually remains with the animal for some time, and gradually 
fades with a return of tone and more perfect digestion. 

If the primary symptoms are unheeded, and the animal is injudici- 
ously tempted with rich food, serious developments are liable to occur. 

The special condition of one viscus or another may attract our atten- 
tion, and call for specific measures of treatment, but it is more usual for 
nervous phenomena to appear, especially in recently calved cows. In 
some cases the dull animal becomes more listless, though she may stand 
persistently leaning against the stall partition and resting her head on the 
front wall as if semi-comatose. Some animals remain in this state for a 
day or two, staggering when asked to move, and taking only an occasional 
drink of fluids offered, with very slow swallowing efforts. Often this 


DISEASES OF THE STOMACHS: CATTLE 393 


stage of dulness gives place to excitement, while in others excitability is 
the first evidence of nervous disturbance. 

It is a common experience to see the animal go down in a convulsive 
fit for the first time when an attempt is made to raise the head prepara- 
tory todrenching. In others the nervous tension is shown by exaggerated 
grinding of teeth and salivation, by standing back in the binding and 
bellowing, as if there was an object to be feared in front of them. Some 
cows stretch through their binding, and hysterically lick at the walls 
high up in front, while others will persistently lick one of their own legs 
or feet for many minutes on end. 

We have occasionally seen an animal take a fit while on her feet and 
secured by the chain. But fora rapid flopping of the ears, this phenomenon 
might have been missed, though the animal stood back with rigid limbs, 
straining on, but steadied by, the chain. In one such case the chain 
exerted pressure on the larynx, and the patient would have gone down 
asphyxiated, but this was avoided by two attendants tilting her body 
slightly forward, thus relieving the strangulation for two or three minutes 
till the fit passed off, and she never fell down. 

An improper attitude of body or limbs is always a suspicious circum- 
stance, betraying disordered innervation. In some cases—developed, it 
may be, four or five weeks after parturition—the animal, which has been 
indisposed and refusing food for a few days, will begin to paddle behind, 
and show the stringhalt movements characteristic of the early stages 
of milk fever. Sometimes the spasm affecting a hind-limb is uncon- 
trollable, exceeding that of a pronounced equine shiverer, and, in the 
absence of a support on the other side, the animal falls heavily on her 
broadside, and is convulsed for a short time. Again, in other cases the 
animal will simply be found down and unable, though willing, to try 
to get up, showing no cerebral disturbance, and continuing her other 
functions almost as well as she had been doing for a day or two before. 

It often happens, however, that when the victim of parturient indi- 
gestion goes off her feet, she is more excitable than a typical milk-fever 
case, and has not the same tendency to close her eyelids and become 
dull and semi-comatose. She is liable to great exacerbations and 
remissions of the nervous phenomena, is more resentful of interference, 
more difficult to nurse, and in fatal cases one fit succeeds the other, with 
gradually shortening periods of comparative quiet, till she becomes 
permanently convulsed and tetanic, and dies of exhaustion, or, if un- 
attended, dies of suffocation. 

Often in profound cases of dyspepsia unassociated with excitable 
nervous disorder the animal perseveres in her almost complete “ hunger 


394 SYSTEM OF VETERINARY MEDICINE 


strike,” baffling all our efforts to restore her appetite, and the state of 
her digestive organs becomes excessively morbid; condition is gradually 
lost, and the animal dies of inanition. 

CoursE.—With early treatment and judicious after-feeding many 
cases make an uneventful recovery in a few days. Very many animals 
predisposed by the inertia of the muscles of deglutition, are choked dead 
during drenching, while others, not quite drowned, suffer the agonies of 
traumatic broncho-pneumonia, set up by smaller quantities of strayed 
irritant medicaments—e.g., solutions of salines, treacle, and aloes with 
singer, etc. 

When lung trouble follows drenching, the patient should at once be 
sent to a slaughter-house, alike on the grounds of humanity and economy. 
If slaughter is delayed, the flesh becomes unfit for use. 

In many cases the digestive functions remain below par for some weeks, 
in spite of good treatment, while those due to organic disease exhibit 
such a gradually increasing lack of appetite, digestive power, and loss 
of condition, as compels a diagnosis of hopelessness. 

Nervous symptoms, when they appear, constitute the climax of the 
ease, and if the animal weathers the storm, the yoke of dyspepsia is not 
uncommonly at once cast off. If the animal suffers neglect, and is inju- 
diciously pampered with food up till the hour that sudden and violent 
symptoms of so-called “ staggers’ appear, the delirious animal may die 
in a few hours, or, if improperly guided and secured, it may so strain and 
injure 1ts hind-imbs by awkward falls or lying with them in malpositions 
which an animal compos mentis could not suffer, that, when consciousness 
is regained, the patient may be unable to rise, and, if lifted to its feet, it 
often fails to grip the ground. Even if able to stand, the strained limb 
at the first movement may slide helplessly forward or sideways, and the 
animal falls on its buttock, and settles down on the helpless limb, aggra- 
vating the injury. Such cases are usually quite hopeless, and should be 
slaughtered early, even though appetite and digestion are restored, for 
the tumefaction of the limb almost invariably increases, so that, after 
some days of hard nursing, the animal has to be killed, and her flesh is 
then useless. 

Dracnosis.—This presents little difficulty, though it must be ad- 
mitted that no sharp line can be drawn between the general dyspepsia 
which we have been discussing, and many other digestive disorders | 
which, because of some degree of concentration of the morbid phenomena 
in some special compartment, are dealt with in the list of topical digestive 
diseases. The differentiation of parturient dyspepsia from typical milk 
fever rests chiefly on the history of the case, the knowledge that several 


DISEASES OF THE STOMACHS: CATTLE  —_ 95 


days or weeks have elapsed since parturition, the want of appetite and 
signs of indigestion for a period before marked nervous phenomena set 
in, the periodic and often epileptiform character of the latter, and the 
tendency of the patient to become febrile. 

Prognosts.—This varies much, according as the cause is functional 
disorder or organic disease. In the former, prognosis is influenced by © 
the stage in which we find the animal when called in, as well as by its 
history, age, temperament, and bodily condition. It is usually grave 
when nervous phenomena are present, and particularly if there is great 
excitability. 

At all times loss of appetite is of more serious import in neurotic, 
deep-milking cows that have recently calved than in others less sus- 
ceptible to the development of dangerous nervous sequela. 

TREATMENT.—In all animals, prophylaxis comprises the avoidance of 
dietetic errors, and, for individual animals, such modifications of the 
common rations of the herd as are calculated to suit their special tempera- 
ment and bodily state. Any evidence of reluctance to feed, failure to 
properly and quickly clean the feeding-trough or to finish the hay ration, 
awkward attitudes of body or limbs, or of slight constipation, denoting 
peristaltic paresis, is to be taken as a hint by attendants to reduce, 
simplify, or entirely withhold food for a time, to carefully watch the 
animal, and have it so bound that, in the event of its losing control and 
going down, it- may be easily released. The dung-channel should be 
filled to the stall level, and an iron binding-chain should have a string 
link put in. 

Note.—An animal that has lost or is likely to lose control of its move- 
ments should have, during the period of danger, a binding that is capable 
of being cut by anyone without help if the animal falls awkwardly back- 
ward and is in danger of strangulation. If the neck-binding cannot 
be cut at once, the patient is likely to die before help can be got to lift 
her forward and relieve the pressure on the trachea or larynx. 

With very few exceptions, deep-milking cows should be kept on light 
and easily digested rations for at least a fortnight after calving, and 
the approach to full, rich food should be made gradually. Intensive 
feeding is less likely to upset animals if they have the advantage of a well- 
ventilated and clean byre to live in, and are thoroughly groomed over the 
whole body daily. 

In the early stages of dyspepsia a mild saline purge of sulphate of 
magnesia, or sulphate of soda, with some treacle added, followed by 
stimulants and nerve tonics every four hours till the bowels respond, has 
very often a salutary effect, the patient being suitably clothed. Some 


396 . SYSTEM OF VETERINARY MEDICINE 


practitioners habitually prescribe 4 or 5 pounds of treacle in solution, along 
with half a bottle of whisky (about 12 ounces). This is rather a bulky 
drench for an animal that has any difficulty in swallowing, but it is a 
very useful and effectual combination. The use of common salt in 
electuary, and allowing repeated drinks of salt water thereafter till the 
bowels respond, can be recommended. 

Linseed or castor oil, so often administered in indigestion, because 
considered safe aperients, are uncertain in effect and destructive of appe- 
tite. It is common practice to prescribe aloes, from 1 to 2 ounces in 
solution, along with salines, when torpidity of the liver is suspected. 

When the chosen aperient has acted, bitter stomachics and nerve 
tonics in electuary or powder, as recommended for the after-treatment 
of tympany, should be perseveringly administered. Sometimes full 
doses of sodium bicarbonate have an excellent effect, while, for other 
cases, dilute acids are beneficial. Sulphate of quinine (2 drachms) either 
in powder or electuary, placed on the tongue, is worthy of a trial. 

To overcome the sickly odour that emanates from the subjects of 
parturient dyspepsia, 14 to 2 drachms of formaldehyde, largely diluted 
with water, two or three times a day, often give good results; and, if the 
weather is suitable, the patient should be turned out for a bite of green 
food. The formaldehyde doubtless inhibits putrefactive decomposition 
of the ingesta. 

The response made by an animal to the action of a moderate purga- 
tive is at all times suggestive of the degree of atony present in the digestive 
organs. When the latter is well marked, there is often considerable delay ; 
still, it is safer to insure the action of an ordinary dose by rousing the 
animal with repeated doses of stimulants—e.g., carbonate of ammonia, 
whisky, or quantities of freshly made coffee—by energetic massaging of the 
body, exercise, if practicable, and a liberal allowance of fluids, than to 
repeat too soon, or give a double dose of purgative medicine. Nor, after 
the aperient action is over, should the often subsequent inactivity of the 
bowels be met by additional purgation, unless in very exceptional cases, 
for such treatment readily gives rise to a fatal gastro-enteritis. 

In administering bulky medicines to a half-intoxicated animal, we must 
always remember the danger of improper swallowing—viz., asphyxia by 
choking, and traumatic broncho-pneumonia. It should be done slowly, 
giving small mouthfuls, releasing the head if the animal coughs, and, 
applying the ear at times to the trachea to detect whether any has gone 
the wrong way. If liquid sounds are heard, the administration should 
at once be stopped, and recourse made to the use of common salt electuary, 
etc. Flaccidity of the tongue during drenching indicates aberration of 


DISEASES OF THE STOMACHS: CATTLE 397 


taste, and is a danger-signal, so also is the failure of a dry muzzle to 
become moist during the process. 

When a recently calved dyspeptic cow fails to recuperate under stimu- 
lating treatment in a day or two, and has a tendency to relapse into deeper 
lassitude, and particularly if she shows signs of nervousness, the udder 
should be inflated. This often relieves the incubus within a few hours, | 
and, under the use of tonics and stimulants, light food, and good nursing, 
the animal gradually recovers; but she must be sparingly fed for many 
days. 

If the animal is discovered in a very excited state, efforts should first 
be made to control the nervous symptoms, and for this purpose, besides 
inflation of the udder, full doses of chleral hydrate are to be recommended, 
along with tincture of aconite. 

If the pulse is full and bounding, venesection is of value, though some- 
times not easily performed, and the depletion materially lessens the 
amount of sedative medicine required. When the patient regains con- 
sciousness, recourse may be had to a moderate purge to remove from the 
digestive organs obnoxious material, which, if longer retained, may con- 
tinue to tax the said organs, and delay recovery. 

If, during the state of peristaltic paresis, putrefactive changes occur in 
the ingesta, this, later on, gives rise to diarrhoea, which should not at once 
be checked. When the recovering animal shows an inclination for food, 
she should be allowed only small quantities of bran mash, with boiled or 
pulped turnips, cabbage leaves, and a little good hay or part of a corn- 
sheaf. Animals that have no natural relish for bran may get brewers’ 
grains, hay tea, etc. 

If appetite is slow to return, the rations should be correspondingly 
kept short, while an attempt is made to restore the functions by means of 
stimulants, tonics, stomachics, and acids or alkalies, as the practitioner 
thinks fit. Fluids should always be allowed ad lib., unless when diarrhoea 
is present. 


PICA. 


SynonyM.—Depraved appetite. 

DEFINITION AND GENERAL RemarKs.—Pica signifies that morbid 
state of the animal economy which is characterised by a tendency to lick 
at anything within reach—the walls, boarding, manger, or floor of the 
stall, soiled litter, trees, posts, earth, sand, lime, the bodies of other 
animals, etc. 

In dealing with other affections we have already referred to the 
natural inclination of some bovines to make play with and swallow non- 


398 SYSTEM OF VETERINARY MEDICINE 


dietetic materials. Occasionally we meet with ill-doing animals in which 
the depraved appetite is so developed and inveterate that the matter 
deserves special consideration; besides, the emaciation that oiten 
results is of serious import. 

Errotogy.—The causes are numerous, and often obscure. In our ex- 
perience pica, when established, is usually associated with some form of 
debility, and is an evidence of nervous irritability originating therefrom. 
The debility may be due to dyspeptic conditions, and in old animals this 
is rather common. On late upland farms pica is commonly seen during 
the winter following a bad season, when the animals are being constantly 
fed with ill-gotten fodder which has been rendered innutritious and fibrous 
from undue exposure to rains and wind. 

It is often thought to be due to insanitary, dark, and ill-ventilated 
byres, and the licking habit is not seldom shown for the first time when 
animals are released after a long period of life in the stall. Occasionally, as 
in the human subject, pregnant animals show inordinate desire for certain 
food-materials, which they devour to excess if at liberty, and their choice 
is frequently for articles eschewed by them at other times. Some have 
sought the cause of pica in a deficiency of soda or phosphates in the 
animal’s rations, and for this reason the geological formation of a district 
in which it is common is held accountable. Again, from overcropping, 
the land may be exhausted of certain elements of potash, lime, sodium, 
or phosphates, and it has been shown that crops grown on such soil give 
an analysis at variance with that of the same crops grown on rich land. 
Deep milkers are lable to debility if their “ dry ” period is too short year 
after year, and they readily become the victims of depraved appetite. 
From whatever cause arising, it would seem as if in all cases there was 
some elemental deficiency in the system which the animal was endeavour- 
ing to supply. Primarily, this may be set up by a qualitative deficiency 
in the food; it may result from the tax which the growing foetus imposes 
on the mother’s economy; or it may be due to some degree of exhaustion 
of certain tissue elements during the morbid changes which occur in the 
course of wasting diseases. 

Morpip ANATOMy.—There is usually a catarrhal state of the mucous 
membranes of the stomachs and bowels, and general emaciation. Hair- 
balls in young stock, and all sorts of foreign materials, are met with in 
the stomachs of animals subject to the habit. The carcass is anemic, the 
muscles soft and pale, and any fat remaining about the kidneys and else- 
where is soft and oily looking. 

SYMPTOMS.—Pica itself is but a symptom. When first noticed, the 
animal may otherwise be in the bloom of health, and it is difficult to 


DISHASES OF THE STOMACHS: CATTLE - 399 


believe that the animal which caressingly licks the arms or clothing of an 
attendant when supplying it with food is showing the initial signs of the 
habit. In petted animals this is without significance; in others it is a 
suspicious sign. For a time after the animal has begun to lick walls, 
posts, earth, or other materials, it may continue to do well, but this much 
depends on what is swallowed (see Traumatic Indigestion, p. 368, etc.). ° 
If no alarming sequel results, there is little systemic disturbance; but soon, 
the constant swallowing of even such materials as earth, sand, lime, hair, 
pieces of cloth, etc., produces slowly-developing complications from the 
pernicious effects of their presence in the digestive organs. Indigestion 
and acute catarrh of the stomachs result, when the patient will show the 
special symptoms of these complaints, and the future history depends on 
the gravity of these complications. 

In many cases the depravity of taste is extreme. Pure water and 
food of good quality are refused, though the animals may greedily drink 
polluted, stagnant water, and eat, with apparent relish, bedding saturated 
with urine or soiled with dung, as well as earth, clay, lime, etc. Appetite 
gradually decreases, and rumination is perfunctorily performed. With 
increasing emaciation the animals become hide-bound, with hair erect, and 
the skin scaly and dirty. A low form of fever sets in, and any movements 
made are stiffly performed; the animal crouches when standing, and 
often grinds the teeth. The bowels become torpid and constipated, 
visceral peristalsis ceases, the appetite fails entirely, and the patient 
slowly succumbs. 

Diacnosis.—This is easy, but the determination of the influences 
giving rise to the depraved appetite is another matter. 

Procnosis.—This is grave, because the swallowing of the substances 
referred to produces serious complications in the digestive organs, and 
the case is all the more serious if the depravity is due to the debilitating 
effects of such wasting diseases as tuberculosis, etc. 

TREATMENT.—This depends on the etiological diagnosis. Animals 
showing signs of pica when at grass should have a change of pasture, and 
be allowed a certain amount of artificial feeding. ‘If occurring during 
stall-feeding periods, the rations should be changed or supplemented by 
food-stufis rich in salts of potash, sodium, calcium, and phosphates— 
e.g., bean and pea meals, clover, and other leguminous plants. 

Common salt should be given with each meal, and if a lump of rock 
salt is placed in the feeding-trough, the animal may assist its recovery 
while displaying its morbid habits. 

If housed under insanitary conditions, the patient should be removed 
to healthier surroundings, and be turned out with other animals for a 


400 SYSTEM OF VETERINARY MEDICINE 


time on suitable days. Symptoms of indigestion should be treated on 
their merits by salines, alkalies, acids, or bitter stomachics. Lemcke 
claims that the tendency to pica disappears and the condition of the 
animal improves when apomorphine, in doses of from 2 to 3 grains, 18 
administered subcutaneously, and repeated three times, at intervals 
of from one to seven days. 

We have, in a few cases, seen good results follow daily doses of 
2, drachms of formalin in a quart of cold water, and consider this treatment 
worthy of further trial. 

For the treatment of serious sequelee caused by the swallowing of gross 
foreign substances, see Traumatic Indigestion, p. 374. 


DYSPEPSIA IN CALVES. 


Synonyms.—Milk indigestion; Abomasal indigestion of sucklings; 
Gastro-intestinal catarrh of calves. 

Derinition.—A non-infectious catarrh of the abomasum of calves, 
usually associated with some degree of intestinal catarrh. 

GENERAL RemArKs.—Though often confounded with “ white scour,” 
especially when several cases occur simultaneously in the same shed, 
milk indigestion differs in many respects from that of infectious gastro- 
enteritis, and so deserves special consideration. 

We have already referred to the paramount importance of the abo- 
masum in young animals. We have seen that, until the calf begins to 
partake of solid food, the ante-stomachs are practically functionless and 
ill-developed, while the abomasum is well developed and wholly performs 
the same duties as the stomach of monogastric animals. 

It is to this fact that the frequency of abomasal indigestion in young 
animals is attributable. The milk or milk substitutes swallowed pass 
direct to this viscus, whereas the great bulk of the food of the adult 
sojourns for a time in the ante-stomachs, where it is subjected to treat- 
ment that fits 1t for entrance into the abomasum. 

Hriotogy.—The progeny of healthy mothers living under natural 
conditions are practically immune from milk indigestion, if they have 
from birth, and at all times, free access to their own parents, and provided 
they are never so exposed to inclement weather as to be subject to chills. 
Dyspepsia, however, readily arises under the following conditions, viz.: 

1. When the Meconium is retaaned.—The laxative effect of the colos- 
trum, or first milk, of the mother effectually rids the intestines of this dark 
green excretion of the liver, and if for any reason this natural régime is 
denied the young animal, it very soon sickens, peristalsis is retarded, and 


DISEASES OF THE STOMACHS: CATTLE 401 


the unduly retained intestinal contents undergo decomposition, and 
become intensely irritant to the mucosa of the alimentary canal. 

2. Unhealthy Conditions of the Mother —The health of the suckling 
materially depends on that of its mother, since the physical state of the 
nurse directly influences the quantity, quality, and wholesomeness, of the 
secretion upon which the young animal entirely depends. 

Microbic infection of one or more quarters of the udder is a potent 
cause, even when the milk, while showing an abnormal bacterial count, 
appears unchanged when newly drawn; but when the infection is further 
advanced and mastitis is set up, the altered product of the inflamed 
quarter often gives rise to gastro-intestinal catarrh. Tubercular disease 
_ of the udder, and all acute febrile diseases of the mother, apart from udder 
disease—e.g., septic metro-peritonitis, and particularly specific diseases 
such as acute generalised tuberculosis, foot and mouth disease, etc.— 
render the milk specially dangerous, while digestive disorders of the 
mother, and cachectic and debilitated states of her system, unfavourably 
influence the quality and digestibility of the milk she secretes. In a 
similar way the milk is prejudiced by undue excitement of the mother, 
by fatigue and over-exertion, and irregular and improper feeding. Bad 
results also follow when the intervals between feeding or suckling of the 
calf are too long. The hungry calf gorges itself with too much milk, 
the functions of the distended stomach are impaired, and marked 
disorder results. The pail-fed calf is specially liable, and the greedily 
swallowed milk, after curdling, lies solid in the abomasum as an 
impaction. 

Quite apart from the natural proclivity of certain animals to give 
milk excessively rich in solids, or the reverse, improper feeding, whether 
with over-rich concentrated diet or material greatly deficient in albumi- 
noids, as well as with unsuitable food-stufts, or such as are rendered irritant 
through decomposition, exerts a direct influence on the digestibility of 
the nurse’s milk. 

Symproms.—The calf loses spirit and stands about in a half-sleepy 
fashion, with little inclination to suckle. Borborygmi and eructations 
are present, with evidences of abdominal pain and costiveness, succeeded 
by diarrhoea. The faces gradually lose consistence, and become watery 
and yellowish-white, changing to a green, foetid, frothy condition, and 
ultimately become sanguineous. The irritating discharge, at first ex- 
pelled with force, is, later on, passed involuntarily, soiling the limbs, etc., 
and depilating the hair. The patient lies a good deal, moans occasionally, 
and may get up and down in restless fashion. The abdomen is usually 
swollen, and slightly resonant, pain being evinced on applying pressure 

VOL. II. 26 


402 SYSTEM OF VETERINARY MEDICINE 


over the right side. The muzzle is dry and the mouth sour and clammy. 
If vomition occurs, improvement is at once apparent; the abdominal 
tension lessens, the bowels become normal again, and appetite and 
sportiveness are reasserted. But if unrelieved by the act of vomition 
or other means, there is always the risk of a fatal gastro-enteritis. In . 
some cases the catarrhal and atonic condition of the abomasum con- 
tinues, indigestion becomes chronic, the animal stands with arched back, 
diarrhoea is persistent, and the appetite very capricious. The patient 
becomes pot-bellied from putrid decomposition of the ingesta and accu- 
mulation of gas in the rumen, etc. 

Course.—If attended to early, or if salutary vomition occurs, the ani- 
mal may recover in two days. On the other hand, many cases are fatal 
in that time, while others become chronic, and the animals fail to grow, 
and thrive badly. 

Lestons.—In fatal cases we find in the stomach large, firm, some- 
times hard, sour, and often foetid masses of curdled milk. The mucous 
membrane is congested and irritable-looking, and ulceration may be 
present. A similar state of the mucosa of the bowels also exists, and 
in the lumen are to be found small, firm masses of caseous ingesta, which 
have become separated from the gastric mass and escaped digestion. 
Signs of aneemia are present, and marked emaciation. 

Diacnosis.—This is easy. The sporadic nature of the cases and the 
course which they follow differentiate them from the infectious “ white 
scour.” 

Procnosis.—This entirely depends on the cause, and may be good 
or bad. It is always the latter if the animal is already tympanitic and has 
suffered for a time from diarrhoea. When the stomach contains many 
hard masses of curdled milk the case is hopeless. 

PROPHYLAXIS.—Every newly born calf should have its mother’s milk 
for the greater part of a week at least, before being allowed mixed milk or 
that of a foster-mother. 

The indispensable colostrum, or “ beastings,” differs mainly from 
ordinary milk in its richness in albumin, while the fat it contains is more 
like to body-fat than the fat of milk. The amount of albumin in the 
udder secretion immediately after calving may be as high as 15 per cent., 
and though it usually falls to the normal of 0-5 per cent. in three days, 
the calf should have the advantage of the gradual and natural tapering off 
which its mother’s daily secretion affords. 

The mother should be fed rationally on easily digested food, and the 
young animal should not be exposed to chills. If hand-fed, sucklings 
should only get a little milk at a time, and often repeated, so as to avoid 


DISEASES OF THE STOMACHS: CATTLE > 403 


gorging and over-distension of the stomach, and lime-water given with 
the milk acts as a preventative. 

TREATMENT.—If the causal factor is directly traceable to the cow, a 
foster-mother should be substituted. When the first signs of disorder 
appear, an aperient should be given, and for this purpose the following 
is useful: 


RK Magnesii sulph. sé oe Re Ab 
Sodii bicarb. ae aa mm Nee Aa 
Potass. nit. ot ie re Bee als 
Puly. zingib. pe ay, ot ae bes. 


M. ft. pulv.i. One powder to be given in half a pint of tepid water, 
and repeated once or twice at intervals of twenty-four hours. 


For the same purpose 1 ounce of Glauber’s salts may be given, or 
linseed or castor oil, from 1 to 2 ounces. 

If there is active fermentation, small doses of hyposulphite or bicar- 
bonate of soda may be given, formaldehyde (20 minims), well diluted with 
cold water, chinosol (15 grains), or creolin (1 drachm); while other useful 
agents are salicylic acid, carbonate of bismuth, chalk, lysol, turpentine, 
etc. 

To check diarrhoea and fermentation, the followig can be recom- 
mended: 


Onto ten. a a. 4) a MPA ZAND 
Tinct. opi = te ar eo ATT 
Whisky .. ae i he eras 


M. ft. haustus. To be given in a little warm milk that has been 
boiled, and, if thought necessary, from 1 to 2 ounces of linseed oil 
may be added. 


Dover’s powder may be used in 2-drachm doses. If it 1s necessary 
to give stronger astringents or styptics, catechu may be given, combined 
with chalk, opium, and ginger—e.g. : ; 


RK Pulv. catechu oe ag es ey 31, 
Cretee preep. a as 7s ey ale 
Pulv. opii a Re ar See ALY: 
Puly. zingib. ee if ho eee 
Aquee menth. pip. .. * $e MMEOE. 


M. ft. mistura. Sig.: From 1 to 2 ounces to be given morning and 
evening in a little warm milk that has been boiled. 


Other astringents recommended are tannin and the newer prepara- 
tions—tannopin, tannoform, and tannalbin—in 30-grain doses, 


404 SYSTEM OF VETERINARY MEDICINE 


To assist digestion, Law advises the use of rennet. ‘‘ One-eighth of 
a calf’s rennet is steeped in a bottle of sherry wine; and the liquid is given 
in tablespoonful doses with each drink. This facilitates proteid digestion 
and checks fermentation, thereby hindering the formation of the offensive 
products which maintain the irritation and disorder.” 

Lime-water is also of distinct advantage when given with each drink 
of milk. 

Dyspepsia of Recently Weaned Calves. 

This differs but little from the infantile disorder we have just con- 
sidered. Its foundation may have been laid while the animal was still a 
suckling, but it is usually due to too early weaning or sudden change from 
a simple milk diet to over-rich milk substitutes. Sometimes, when the 
oradations from the simple diet to materials rich in carbo-hydrates and 
the coarser food-stuffs, are made too quickly the digestion of which the 
young animal can only accomplish when the functions of the ante- 
stomachs are developed into activity, the animals fall victim, as foals do 
(see p. 106), to engorgement of the true stomach with material which it 
cannot digest. This undergoes fermentation, and gives rise to gastro- 
enteritis, accompanied by dangerous and often fatal nervous phenomena, 
though the post-mortem lesions are by no means so well marked as in 
adults. 

During teething such animals are prone to chew and swallow foreign 
substances, and suffer therefrom, and since they are frequently sub- 
jected to greater exposure than younger calves, they often contract chills 
which prejudice their digestion. 

The treatment of such cases comprises careful nursing, comfortable 
surroundings, a return to simple diet, the free use of aperient medicine, 
followed by tonics, antacids, and, if necessary, stimulants. 


DISEASES OF THE INTESTINES. 
GENERAL REMARKS. 


The small intestine of the ox measures about 147 feet in length, being 
twice as long as that of the horse, though it is much less in diameter. 
In other respects the small intestines of both animals agree very closely 
in structure. The large intestine, measuring about 35 feet, exceeds that 
of the horse in length, but is not nearly so capacious, and neither the 
cecum nor colon have longitudinal bands or transverse furrows, 


DISEASES OF THE INTESTINES: CATTLE 405 


As already stated, while diseases of the intestines of the horse pre- 
dominate and transcend in importance and variety the gastric disorders 
met with in that animal, the opposite obtains in bovines, for in them the 
importance of the many disorders of their complex gastric apparatus is 
paramount. In further contradistinction it may be said that, having 
dealt with the stomach disorders, we have concluded all that is to be 
considered of food engorgement and flatulent indigestion occurring in 
bovines, since their intestines are but rarely the seat of impaction, and 
practically never of flatulence. 

Another noteworthy contrast is that though both species are subject 
to acute diarrhoea as well as superpurgation, these complaints are much 
more rapidly fatal in equines, while cattle are more prone to suffer from 
chronic diarrheic conditions, which may be functional or dependent on 
specific infections—e.g., tuberculosis, Johne’s disease, etc. It will be 
seen, however, that many intestinal affections of cattle present patho- 
logical features similar to those met with in horses, so that, to avoid 
needless repetition, the reader will often be referred to the equine section. 


COLIC. 


This term, so loosely applied by common consent to signify the 
evidences of pain which accompany the many abdominal affections of 
the horse, is of comparatively little significance in bovines, because of 
their immunity from painful obstructive and flatulent conditions of the 
intestines. The signs of pain that accompany tympany and engorge- 
ment of the rumen, dysentery, etc., are not spoken of as colic, and as 
a matter of fact the term in cattle practice is usually only employed to 
signify the evidences of pain manifested in those painful conditions that 
puzzle us in diagnosis—e.g., certain stages of traumatic indigestion, such 
rare affections as invagination and volvulus of the bowel, undue quicken- 
ing of the foetus, and other ill-defined uterine disturbances in pregnant 
animals. 

Spasmodic Colic. 

This is a rare affection in cattle, and it cannot be said that they are 
liable to neuralgic conditions of the bowels. Occasionally, however, one 
encounters an animal that periodically exhibits for a more or less pro- 
longed time the violent symptoms of spasmodic colic, and we find it 
impossible to discover the cause or satisfactorily diagnose the seat of 
pain. Acute colicky symptoms may be shown at once when an animal, 
heated by exercise and thirsty, has free access to and drinks a quantity 
of very cold water. In most of the other cases the cause is very obscure. 

Symptoms.—lIncessant restlessness, crouching, stamping, and kicking 


406 SYSTEM OF VETERINARY MEDICINE 


at the abdomen, switching of the tail, getting up and down, an anxious 
expression, and looking towards the flank, and there may be salivation 
and repeated defecation. The symptoms are transient; they gradually 
subside, and recovery is spontaneous. 

TREATMENT.—To adult animals 5 grains of morphine should be given 
subcutaneously, the abdomen should be well rubbed, and exercise may 
be expedient. If pain persists beyond one hour, the case may be viewed 
more seriously, and hot-water rugs should be applied for a time, followed, 
if necessary, by counter-irritants, while antispasmodics are to be given in 
combination with laxatives, such as either linseed or castor oil. If these 
are not to hand, 2 or 3 pounds of treacle in solution with 8 ounces of 
whisky is safe treatment, but drastic purgatives should not be given 
without good reason. : 


INVAGINATION OF THE INTESTINES. 


This is probably the most common cause of colic in catile. 

Kt1ioLogy.—Any circumstance that produces deranged or increased 
intestinal peristalsis may cause one portion of bowel to slip into another 
—é.g., excessive purgation, diarrhcea, gluttonous swallowing of rich meal 
gruels, intestinal worms, or imbibition of icy-cold water when the 
animal is heated, etc. The condition very often occurs in animals 
suffering from disease of the liver and jaundice. 

Morsip ANAToMy.—T he small intestine is the usual seat of the lesion, 
though it may also occur in the cecum, colon, or rectum. The lesions 
are similar to those observed in equines (see p. 259). When the small 
intestine is telescoped, we find the part tumefied and dark in colour, 
sausage-like and firm in consistence, and a transverse section discloses 
three intestinal cylinders firmly united and occluding. the lumen of the 
bowel. The mucosa of the internal cylinder is usually very dark red. 
The extent of invagination may be from 6 to 12 inches or more. There 
is localised peritonitis, and adhesions with abundant fibrinous exudate. 
In many cases we find advanced disease of the liver, such as degeneration 
or abscesses, with great distension of the gall-bladder. 

Invagination of the cecum is usually into the commencing portion 
of the colon, accompanied by a part of the mesentery, but the lesion 
is very rare. “ Johnk* observed a case in a heifer seven months old. 
The animal showed spasmodic tremors and manifestations of feverish 
hemorrhagic gastro-enteritis, with the discharge of a great quantity of 
blood-red dirty coagulated material, containing, besides blood, fibrin-like 
accumulations. The post-mortem showed the cecum inverted into the 

* Miinchener Tier. Woch. 


DISEASES OF THE INTESTINES: CATTLE ~ 407 


colon, and the mesentery drawn in like a cord with the invagination. 
Analwards, by palpation through the walls of the colon, the conical ter- 
mination of the invaginated cecum could be demonstrated. The whole 
colon contained mucus, coagulated blood, and dirty-coloured fibrinous 
exudate, which consisted of a framework of very fine threads and numer- 
ous round cells.” 

Symproms.—Marked signs of pain may be present from the first, or 
the patient may simply be dull and listless, and showing but little 
evidence of pain. In the latter case the animal lies a good deal, and is 
disinclined to rise. There is usually salivation, foetid breath, want of 
appetite, dry muzzle, anxious expression of countenance, and staring 
coat. Defecation is often repeated till the posterior bowel is emptied, 
but the efforts are continued, and blood-stained mucus only is passed. 
There is an absence of the normal sounds of digestion, the animal hangs 
back in her binding, and stands with hind-feet in the dung-channel. At 
first the pulse may be full and bounding, and the temperature only 
slightly increased. When colicky symptoms are present—and this 1s 
the rule—they usually continue almost unabated for many hours, accom- 
panied by muscular tremors; and if they suddenly disappear, and the 
surface of the body becomes cold, and the animal profoundly apathetic, 
with a faltering pulse, we may conclude the onset of mortification of the — 
telescoped bowel. It is sometimes possible to demonstrate tenderness 
and the presence of the swelling on palpation of the right side of the 
abdominal wall, or this may be effected by rectal examination. 

The rotundity of the abdomen is usually increased, and vomition and 
retching generally precede death. If the animal survives a few days, 
there is a complete absence of faeces, owing to occlusion of the bowel, and 
if purgative medicine has been given, quantities of bloody material may 
be evacuated. In many cases the invaginated portion of bowel has been 
voided, and the animals recovered. 

CoursE.—Animals are known to have lived two weeks after having 
shown the first signs of invagination, but the majority of cases die in 
about seven days. After the first stage is passed, it is not often that the 
exhibition of pain is marked. The animals usually become stolid, and 
eventually comatose. As already stated, the telescoped portion of bowel 
may be safely cast off after it has undergone necrosis, and may be found 
in the feeces. 

DIFFERENTIAL Dr1agNnosis.—In many cases this presents little diffi- 
culty. If there has been persistent colic for many hours, followed by 
calm and stolidity, an absence of feces, the evacuation of blood-stained 
mucus, and a gradually failing pulse, and especially if a tender tumour 


408 SYSTEM OF VETERINARY MEDICINE 


can be demonstrated by abdominal palpation or rectal exploration, the 
diagnosis is fairly conclusive. The duration and course of the case clinch 
the matter. 

Perplexity may arise in such cases as, e.g.— 

1. The early stage of traumatic pericarditis. There the sudden 
exhibition of pain and restlessness for the first day or so is very similar 
to the phenomena shown by the victims of bowel invagination, but very 
soon the evidences of pericardial effusion and altered cardiac sounds 
decide the diagnosis. 

2. In torsion of the cervix uteri in animals well advanced in preg- 
nancy, very confusing colicky symptoms are manifested, but manual 
examination of the vagina discloses the spiral twist. 

3. Extensive separation of the foetal and maternal cotyledons, with 
hemorrhage accidentally caused, often gives rise to a continuous exhibi- 
tion of pain, but the succeeding features of the case soon serve to differ 
entiate the conditions. 

4. Some cases of anthrax show signs of colic, though these are often 
of a duller character than those accompanying invagination. The 
passage of blood from the anus may give rise to doubt, but in anthrax 
there is frequently also some appearance of blood at the vagina, mouth, 
and nostrils, while the great increase of temperature that obtains until 
an hour or so before death and the quick demise of the animal are charac- 
teristic. 

Proenosis.—This is very grave. Death is inevitable in all cases 
unless a successful laparotomy is performed, or the necrosed portion of 
bowel is safely cast off and discharged. 

TREATMENT.—All attempts to reduce the obstruction by physical 
means are likely to fail, and few of us are bold enough to attempt the 
only rational treatment—a laparotomy. For the technique of this opera. 
tion the reader is referred to textbooks on veterinary surgery. 


VOLVULUS. 


This is a very rare condition in the ox. The freedom of cattle from 
this lesion is doubtless attributable to the flexuous arrangement of the 
small intestine at the end of the mesentery, while the coils of the colon 
spirally arranged between the layers of the mesentery make ‘rotatory 
strangulation practically impossible. The colon and rectum are not so 
favourably placed to resist the occurrence of volvulus, but we have to 
remember that the ox is almost never affected with tympany of the 
bowels, which is one of the chief causes of “ twist ” in equines. 


DISEASES OF THE INTESTINES: CATTLE 409 


J.N. Ries, Government Veterinary Surgeon at Clervaux, Grand Duchy 
of Luxemburg, records the case of a cow* in which the usual symptoms 
of intestinal stenosis were present, but he was able to determine by 
rectal exploration the presence of a round fleshy body about the size of 
two fists floating in the abdominal cavity in the midst of the small intes- 
tines. This gave him confidence to operate. He found that the swelling 
consisted of a loop of small intestine, congested and distended and twisted 
on itself at its base, the mesentery forming a sort of hard, tight cord. 
Reduction was easy; the wound in the right flank was closed with sixteen 
sutures, and the animal made a good recovery. The operation was per- 
formed in the standing position, the animal being supported on sheets 
by six assistants. 

Symproms.—The symptoms of volvulus are those of acute abdominal 
pain as met with in intussusception of the bowel, and are in no way 
characteristic. 


STRANGULATION OF THE INTESTINE. 


In very rare cases portions of bowel have become strangulated by 
passing through perforations in the diaphragm, the mesentery, or the 
broad uterine ligaments. In some tubercular animals the growth of the 
tubercular mass around the intestines is enormous, and causes some degree 
of strangulation of the bowel. The most cominon form of bowel strangu- 
lation met with in bovines is known as “ gut-tie.”’ 


GUT-TIE. 


Synonyms.—Pelvic hernia; “‘ Bound.” 

GENERAL Remarks AND Etiotogy.—This condition is met with in 
bullocks only, usually from one to two years old, and in districts where 
the barbarous “ tearing operation ” of castration is commonly practised. 
By this method gelders, after exposing the testicle, simply seize it and 
pull till the spermatic cord gives way. In some cases the non-vascular 
portion is severed before applying traction in order to reduce the force 
necessary for the breaking of the cord. This forcible straightening of the 
spermatic cord alters its-relation to the wall of the pelvis, and the divorced 
cord carries with it its fold of peritoneum which bridges the space be- 
tween them. The backward pressure of a loop of intestine bulges this 
delicate curtain, forming a pocket, or ruptures it; the loop then passes 
through and becomes strangulated. 

In other cases the severed end of the cord becomes adherent to the 


* Translated by Dollar (see Veterinary Record, November 19, 1892). 


410 SYSTEM OF VETERINARY MEDICINE 


intestines, and, according to Williams, as the animal grows the cord 
remnant draws the adherent gut towards the margin of the pelvis, the 
fold of peritoneum separating the cavity of the pelvis from the abdominal 
cavity is pressed upon and ruptured by the gut, while the sac so formed 
incarcerates the gut and causes symptoms similar to those of strangulated 
hernia. 

Some authors say that when the cord recoils after breaking suddenly 
during the tearing operation, it winds round the intestine, becomes 
attached to it, and eventually causes strangulation. Again, it often 
happens that the stump becomes attached to the abdominal wall and 
the bowel passes between them as into a sling. 

Symptoms.—T he external symptoms differ little from those of obstruc- 
tion of the bowels due to invagination or volvulus, etc. There is want of 
appetite, almost complete absence of feces, discharge of bloody mucus, 
colicky pains, etc., and the bullock hangs back in his binding, stretches 
out his limbs, or crosses his hind-legs. The discovery by rectal explora- 
tion of a painful doughy swelling at the brim of the pelvis and midway 
between the sacrum and the internal abdominal ring is conclusive. 

TREATMENT.—Relief is sometimes obtained by running the animal 
downhill, and causing him to leap from a height; or by turning him on 
his back the imprisoned gut may escape. If these means are unsuccess- 
ful, an attempt should be made to reduce the hernia by upward and 
forward pressure on it through the rectum, or by breaking down the 
attachment of the spermatic cord by manipulation. If this is impossible, 
an incision is to be made in the right flank, through which the operatior 
introduces his hand, and having reached the imprisoned gut, he en- 
deavours to free it by taxis, or by means of a probe-pointed bistoury he 
severs the cord; and gives the animal permanent relief. This operation 
should be performed in the standing position. The animal should 
receive a full dose of chloral hydrate, then clip the hair from the seat of 
operation in the right flank, and paint with tincture of iodine. The 
incision made should be about 5 inches long and vertical, and when the 
hernia has been reduced by severing the cord, the abdominal wound is 
to be closed in the usual way. Soon thereafter the functions of the bowels 
are restored, and the animal recovers. 


IMPACTION OF THE COLON. 
This signifies obstruction of the colon, and distension of some part of | 

it with ingesta. 
ErtoLogy.—This condition is never seen in cattle properly fed, 
unless when, owing to the presence of a gradually growing tumour or 


DISEASES OF THE INTESTINES: CATTLE 411 


enormous tubercular deposit in the mesenteric glands, there is a pro- 
gressive interference with the passage of the ingesta at a given point, so 
that the more solid portions of it tend to-accumulate and distend the 
bowel in front of the obstruction. Even under other circumstances it is 
an exceedingly rare affection, and the few cases met with have been due to 
improper diet, prolonged dry feeding, the presence of astringent plants 
in the fodder, the consumption of badly harvested, smutty, innutritious 
hay, or hay that has been left uncut till it became over ripe and lignified, 
and an insufficiency of water. Similar results are likely to follow when 
young growing stock are turned out in spring to rough pasture-land in 
which the rank and dead overgrowth of coarse grass of former years is 
but sparsely mixed with green blades, and.the water-supply is deficient. 

When so fed, the debilitated members of the herd, suffering from 
want of tone and diminished peristalsis, are most liable to become affected, 
for the inactivity of the bowels predisposes to an accumulation of the 
indigestible material in them. 

Symptoms.—T here is constipation, straining, and difficulty in defeeca- 

tion, and the feces passed are mucus-coated and hard. Unthriftiness 
and signs of indigestion are present, loss of appetite, cessation of rumina- 
tion, some degree of tympany, dulness, and loss of flesh. There may be 
sight uneasiness at times, but rarely any marked signs of colic. Ex- 
ploration per rectum is the only means of arriving at a satisfactory diag- 
nosis. : 
TREATMENT.—Prophylaxis consists in a change of diet when it is seen 
that constipation results from the food given to or gathered by the 
animals. If hand-fed, the change should be to mashes of bran and 
linseed, with turnips pulped or whole, or to green food; while if the 
pasture is rough and indigestible, and water is scarce, the animals should 
be put for at least several hours per day to fresher grazing where water 
is plentiful. 

These measures are sufficient to improve the functional derangement 
that leads on to impaction, but if necessary they can be supplemented 
in individual cases by giving common salt and plenty of fluids, followed 
by a course of nerve tonics. In advanced cases, copious enemata of 
tepid soapy solutions should be given frequently. Repeated doses of 
linseed or castor oil are likely to prove beneficial. Some authors 
recommend 8 grains of eserine hypodermically, or 7 grains of barium 
chloride intravenously, and while these may be tried in cases that do not. 
yield to common salt, oil, nux vomica, water, and enemata, the owner 
should be advised that their use is not free from danger. 


412 _ SYSTEM OF VETERINARY MEDICINE 


RUPTURE OF THE INTESTINE. 


Rupture of the bowel from distension in ruminants is, we believe, 
unrecorded, and never met with. In such cases as are seen in practice, 
the lesion is invariably due to injury from horn-gores, impalement on 
fences, etc., and the rectum may be lacerated during an ill-managed 
parturition. The writer also recalls the case of an emaciated young 
cow which, when lying on her left side, had her flaccid abdomen trampled 
on by a heavy neighbour that was being turned out from the double 
stall. She died in two days, and the post-mortem showed mortification 
of a part of the small intestine, which was so bruised and lacerated that 
some ingesta had escaped and set up peritonitis. 

Symptoms.—The symptoms are those of acute septic peritonitis 
ending in death. 

T'REATMENT.—T'reatment is not likely to be of any avail in most cases, 
though an animal that has received a direct puncture of the intestine 
lying near to the abdominal wall may survive with the formation of an 
artificial anus, 

Injuries of the rectum during parturition are not necessarily fatal if 
there is no communication with the peritoneal cavity. In such cases 
antiseptic enemata are advisable. 


ENTERITIS. 


SynonyM.—Inflammation of the intestines. 

GENERAL Remarxs.—When we compare enteritis in bovines with the 
same affection in equines, we meet with many points of contrast. Though 
it is a dangerous and often fatal affection in both species, the equine 
patient seldom lives more than two days, and often dies within a few 
hours, while cattle so affected may live for several days. Enteritis due 
to mechanical causes is common in horses, but rare in cattle. Similar 
remarks apply to the peracute, apoplectic, and quickly fatal form of 
enteritis often met with in horses in the absence of any observable 
mechanical cause. Again, the signs of pain in bovine enteritis are much 
less violent, and this is doubtless due to some extent to the slower develop- 
ment of the circulatory changes in the affected bowel. It has sometimes 
been contended that the violence of some cases of so-called stomach , 
staggers is but an exhibition of pain arising from the congested state of 
the gastro-intestinal mucosa so often revealed on post-mortem examina- 
tion of animals that have fought themselves out, and hence that some 
forms of enteritis in cattle are as fatal as the peracute equine type. 


DISEASES OF THE INTESTINES: CATTLE 413 


Such reasoning is oblique, for these bovine patients exhibit. cerebro- 
spinal symptoms from the beginning, and though violent in behaviour, 
they have little consciousness from the first; their movements are almost 
without control, and they are quite unable to rise, while the lesions of the 
gastro-intestinal canal are not typical of true enteritis. 

We have already shown that enteritis in cattle is a common accom- 
paniment of gastritis, dependent either on a cause acting simultaneously 
on the abomasum and the intestines, or due to subsequent extension of 
the morbid phenomena from the stomach to the contiguous bowel, or 
vice Versa. 

Enteritis as it occurs in cattle assumes a variety of forms and degrees 
of intensity alike in the systemic disturbance to which it gives rise and 
the lesions observed on autopsy. It behoves us, therefore, to deal with 
it under several heads—viz.: 


1. Acute Enteritis. 

. Pseudo-Membranous Enteritis, Moor-Ill, or Wood-EKvit. 

. Hemorrhagic or Ulcerative Enteritis, commonly known as 
* Dysentery,” or “ Bloody Flux.” | 

. Chronic Enteritis, or Chronic Diarrhea. 

. Coccidian Enteritis, Coccidiosis, or Red Dysentery. 

. Dysentery of Calves. 

7. Drarrheic Enteritis of Calves. 


WwW bo 


oo Ol 


In addition to the above, cattle are subject to two forms of specific 
enteritis—viz., (1) Johne’s disease, an infectious malady rapidly increasing 
in Scotland, and which should be indictable (see Vol. I.); (2) tubercular 
enteritis (see Vol. I.). 

Chronic types of enteritis also associated with diarrhoea are met with 
which are due to distomatosis and helminthiasis. 


Acute Enteritis. 


Synonym.—Acute catarrhal enteritis. 

DeFInition.—A more or less acute inflammation of the mucous mem- 
brane of the intestines, which may be limited to a certain section of the 
tract, or be found to involve the greater portion of the intestinal mucosa. 
The small intestine is more liable to suffer than the large. As already 
shown, gastritis is very often coexistent with the more acute forms of 
enteritis; so much so, that some authors deal with both affections under 
the comprehensive title of “ gastro-enteritis.” 

Errotoey.—The exciting causes are many and varied, and while the 
majority of them would be incapable per se of setting up acute inflam- 


414 SYSTEM OF VETERINARY MEDICINE 


matory action, the effect: of the irritation or paralysis to which they give 
rise is to so profoundly prejudice the normal resistance of the mucosa, 
that the bacterial flora of the intestines—innocent pathologically while 
the circulation in and functions of the canal are normal—acquire unnatural 
pathogenic properties, and produce inflammatory changes in the unre- 
sisting mucosa. Any influence which debilitates the bowels constitutes 
a predisposition to enteritis—e.g., exhausting diseases, and diseases of 
other important organs that induce an atonic state of the intestinal 
circulation and functions, as well as chills, overdriving, overwork, semi- 
starvation, overfeeding with highly albuminous food-stuffs, sudden 
changes of food, undue exposure to extreme heat or cold, or draughts of 
cold water when in a state of perspiration. 

Other causes that directly impinge the mucosa and favour the bac- 
terial onslaught are drastic purgatives, irritant plants, cuttings from 
shrubs, irritant poisons, worms, decomposing roots, badly-got and in- 
digestible fodder, the rough, dry, and innutritious growth of a former 
season in inferior pasture-lands, the drinking of putrid water, etc. 

Morpip Anatomy.—lIt is in the small intestines that the most ad- 
vanced lesions are found. They are often quite empty of ingesta, and 
distended with gas. The whole mucosa of the affected section is con- 
gested, and thickened with infiltration, and there are numerous patches 
in which this condition is further advanced. These foci vary in size 
from mere points to the size of a five-shilling piece or larger. They show 
necrotic changes, and, if handled, the superficial layer easily separates, 
leaving a raw surface. In more advanced lesions the superficial slough 
has already been cast off, leaving an ulcer which may have been the 
seat of hemorrhage, and actual perforation of the bowel has been ob- 
served. ‘There is discoloration of the serous coat over the site of the 
intestinal lesions, and the peritoneal cavity often contains sero-san- 
guineous fluid. The solitary glands are enlarged and congested, and there 
may be slight evidence of false membrane formation. Besides gas, the 
intestines may contain sanguineous material varying in colour. 

Symproms.—In the early stages, besides loss of appetite, cessation 
of rumination, injected mucous membranes, dry muzzle and lachryma- 
tion, colicky pains are often manifest. The thermometer registers 2° or 
3° of fever, the pulse is small and weak, and the animal is thirsty. The 
bowels during the first day or two are often constipated, and the faces , 
passed are formed into discs, firm, and mucus-coated. Soon, however, 
diarrhcea sets in, and the discharge is blackish and liquid, or of tarry 
consistence and appearance, while straining is noticed after defecation. 
The urine is scanty and high-coloured. There is tenderness of the 


DISEASES OF THE INTESTINES: CATTLE 415 


abdomen when palpation is performed on the right side, eructations are 
often fostid, and there may or may not be tympany of the rumen; but 
if this is at all marked, moaning is a prominent symptom. In other 
cases the animal becomes tucked-up in appearance. The secretion of 
milk is greatly reduced. Grave symptoms are—excessive and per- 
sistent fever, weakening pulse, a haggard countenance, with sunken eyes, 
straining, constant pain and moaning, the passage of no feces, but 
mucus only, complete loss of appetite, stoppage of milk secretion, clammy 
cold mouth, foetid breath, and increasing physical weakness. Death 
results from exhaustion and auto-infection. If, however, after a few 
days the strength of the pulse is maintained, the temperature tends to 
fall, pain decreases, the faeces become more normal, and the secretion of 
milk is increased, the appetite soon improves, and, if carefully nursed and 
clothed, the animal is on the road to recovery. 

DIFFERENTIAL D1aGnosis.—From pseudo-membranous enteritis and 
dysentery or hemorrhagic enteritis it is distinguished only by the absence 
of many false membranes and clotted blood respectively in the faces. 
Otherwise the diagnosis of enteritis is based on the presence of fever, 
pain, the sensitiveness of the right side of the abdomen, the character of 
the feeces, and the course of the affection. 

Prognosis.—r his is only grave if the animal has been neglected, and 
is already very weak, with a high temperature and profuse diarrhea. 

TREATMENT.—Some authors recommend a saline purge of 1 pound of 
sulphate of soda or sulphate of magnesia to act as an intestinal antiseptic, 
but we consider these agents are only admissible when there is urgent 
need to get rid of toxic, irritant, or indigestible material that has been 
eaten, or in the very early stage when we are in doubt whether a state 
of actual enteritis exists; otherwise, cathartics can only do harm to the 
inflamed bowel. Others prefer the giving of repeated small doses of 
linseed or castor oil. If pain and diarrhcea become acute, small doses 
of chlorodyne or tincture of opium are admissible, while for the relief 
of pain before diarrhoea sets in, 1 ounce of chloral hydrate dissolved in 
water should be given in 10 ounces of linseed oil, and this can be repeated 
in oil or water. 

Internal antiseptics and antiferments should be given—e.g., hypo- 
sulphite of soda 1 ounce, or bicarbonate of soda | ounce, salicylate of 
soda 3 drachms, or chloride of soda | ounce, three times a day, and com- 
bined with potassium nitrate, gentian, and small doses of nux vomica. 
Formalin or chinosol may be given in |-drachm doses largely diluted 
with water. Potassium nitrate may be added to the drinking-water. 
External treatment comprises the use of hot-water rugs for a time, and 


416 SYSTEM OF VETERINARY MEDICINE 


the subsequent application of mustard to the abdomen, as recommended 
for gastric engorgement (see p. 350). 

The animal should be well clothed and carefully nursed. Advantage 
should be taken of the patient’s thirst to give linseed and bran gruels 
and hay tea, while milk and gruels should be carefully administered at 
intervals if the animal refuses what is offered. The return to bulkier 
mashes, cooked food, green grass, roots, and hay, should be made very 
gradually. : 


Pseudo-Membranous Enteritis. 


Synonyms.—Croupous enteritis; Pantas; Wood-evil; Moor-ill. 

DEFINITION.—An inflammation of the intestinal mucosa, with which 
is associated the formation of false membranes. 

GENERAL Remarks.—This affection is rather common in cattle in 
certain districts, and it is not unusual to find several members of the 
same herd suffering at the same time. It is usually chronic or subacute 
in character, but occasionally peracute cases are met with. Compared 
with equines, inflammatory conditions in bovines are prone to be of a 
croupous nature. This is probably due to their peculiar lymphatic con- 
stitution—at any rate, the exudate of many inflammatory affections is . 
of a plastic nature, rich in fibrin, causing extensive thickening of the 
tissues into which it is poured, and, when exuded on the surface of the 
intestinal mucosa, one or more adherent layers are formed. 

EtioLogy.—It may follow the operation of most of the causes that 
give rise to acute catarrhal enteritis already enumerated under that head. 
When several animals are affected in the same herd, this is not due to 
infection, but to some cause acting simultaneously on all, and which is 
often easily determined. It may be the drinking of putrid water, the 
consumption of acrid material, coarse, woody herbage, irritant buds and 
tips of trees, clippings of shrubs, etc. 

Morsip AnAaTtomy.—Throughout the small intestines and colon the 
false membranes are plentifully present. In the former, tubular casts of 
croupous material arranged in layers and of considerable length are often 
found, and in the lumen of the cylinder a little ingesta may be present. 
The membranes are of a dirty yellow colour, and their removal reveals 
an intestinal mucosa more or less inflamed, and the villi swollen with 
exudation. 

Symptoms.—The systemic disturbance is less than that observed in’ 
acute catarrhal enteritis, and the affection often lasts from seven to 
fourteen days. The symptoms are those described under Acute Enteritis, 
only much less acute, and with this difference—that false membranes are 


DISEASES OF THE INTESTINES: CATTLE are 3G 


plentifully found on and among the feces in the early stage of constipa- 
tion and the later stage of diarrhcea. 

Recovery is the rule, but some cases become dysenteric, and the 
animal succumbs. 

DirFERENTIAL Diacnosis.—T his affection is differentiated from other 
types of enteritis by the presence of false membranes in ropy or tubular 
casts among the feces. Often mistaken for worms or portions of the 
intestine, the amorphous character of the material, devoid of the elements 
of organised tissue, is easily proved. 

Proenosis.—T his is not unfavourable. 

TREATMENT.—In most cases a moderate dose of sulphate of soda or 
sulphate of magnesia is well tolerated, and rids the intestine of the 
croupous material. If necessary, these agents may be subsequently 
repeated in smaller doses, or recourse may be had to such alkaline salts 
as hyposulphite, bicarbonate or salicylate of soda, bicarbonate or iodide 
of potash, which help to disintegrate and dissolve the false membranes 
and assist in their removal. Later on these may be combined with bitter 
stomachics and nerve tonics. Hnemata are useful, and nursing and 
dieting should be as for acute enteritis. 


Heemorrhagic Enteritis. 
Synonyms.—Ulecerative enteritis; Dysentery; Bloody flux. 
Derrnition.—An inflammatory condition of the intestinal mucosa, 
accompanied by ulceration, hemorrhage, and the presence of blood in 
the excreta. The disease is in some instances enzootic. 

GENERAL Remarxks.—Dysentery is much more common in cattle 
than in horses. It is very often but an advanced stage of catarrhal 
enteritis, or it may supervene on protracted diarrhcea. It is at all times 
a grave affection. Some cases are rapidly fatal, while others run a chronic 
course. 

- Ertotogy.—Enteritis readily becomes ulcerative when it has been 
caused by excessively irritant, decomposing, or musty food, or by the 
drinking of putrid water during hot weather when the pastures are dry 
and the usual water-supply is deficient or dried up. The introduction 
of innumerable putrefactive organisms into the digestive tract must be 
a large factor in setting up enteritis and ulceration when the mucosa is 
unresistant during dyspeptic conditions, and this must be all the more 
potent if the food or water is polluted by the excreta of an affected 
animal. The causal microbes have not been demonstrated precisely. 
The disease is usually due to a mixed infection, and the pathogenicity of 
the bacteria varies, though the type of lesions produced in all cases 

VOL. II, 27 


418 SYSTEM OF VETERINARY MEDICINE 


is very similar. Tubercular ulceration of the bowels is common in 
cattle. | 

Morsip Anatomy.—If an examination of the bowels is made soon 
after death, there is abundant evidence of enteritis, with multiple ulcera- 
tive lesions varying in size and depth. In many cases the ulcerative 
process has involved the bloodvessels of the intestinal walls, causing 
profuse hemorrhage, and sausaging of a portion of the bowel with 
coagulated blood. The contents of the bowels may be sanguineous 
throughout, and contain necrotic sloughs and muco-purulent material, 
and actual perforation of the intestinal wall may have occurred, with 
escape of fluid into the peritoneal cavity, giving rise to septic peritonitis. 
Speaking generally, the ulceration is mainly confined to the large bowel, 
but not uncommonly similar lesions are seen in the small intestine and in 
the abomasum. Smears made from the blood of the intestinal wall, when 
stained, show innumerable putrefactive organisms. The liver is con- 
gested and altered in colour, and its tissue is soft and degenerated. The 
spleen in acute cases is markedly engorged, simulating its condition in 
anthrax. The mesenteric glands are also enlarged, softened, and watery- 
looking, when incised. 

Symproms.—Besides the symptoms depicted as occurring in acute 
enteritis, the passage of feces, blood-stained or mixed with bright- 
coloured liquid blood or dark clotted blood, is diagnostic. The tarry 
excrement adheres to the tail and surrounding parts, and attracts flies, 
giving the animal a most repulsive appearance. Sympathetic sores are 
often to be seen in the buccal mucosa, and often a primary brick-red 
appearance of the visible mucous membranes gives place to a blanched 
condition, associated with languor, sunken eyes, and great weakness, 
indicating internal hemorrhage. When this occurs, the pulse becomes 
almost imperceptible, the temperature falls, and the animal soon suc- 
cumbs. | 

CoursE.—Very acute cases die early, others linger on for two or three 
weeks, while milder cases recover within seven days. If the disease 
becomes chronic, there ig great emaciation, pronounced anemia, the 
animal becomes hide-bound, and the skin affected with scales and lice. 

DIFFERENTIAL Diaanosis.— From anthrax, with which it may be 
confounded on account of the presence of blood in the feces and the 
post-mortem engorgement of the spleen with black blood, it can be 
differentiated by the suddenness of the death in anthrax, the absence of 
anthrax bacilli in the blood of the dysenteric carcass, and the presence 
of lesions in the large intestine. 

From rinderpest it can be distinguished by the absence of a rapidly 


DISEASES OF THE INTESTINES: CATTLE — 419 


spreading contagion and of the specific local lesions, with shedding of 
epithelium, etc., on the buccal mucosa, the nostrils, and vagina. Again, 
the fairly constant localisation of the lesions of dysentery to the mucosa 
of the large bowel is in marked contrast to the more extensive presence 
of lesions over the whole alimentary tract in rinderpest. A similar dis- 
tinction obtains between the lesions of dysentery and gastro-enteritis 
set up by irritant poisons, and here the history of the case also assists 
the diagnosis. 

Proenosis.—This is very grave, and the mortality often exceeds 
50 per cent. 

PROPHYLAXIS.—T his comprises a wholesome food-supply and an 
abundance of pure water at all times. Stagnant pools which are often 
polluted by the excreta of the herd should be drained, and all affected 
animals should be rigidly isolated, their excreta destroyed, and the soiled 
premises well disinfected. 

TREATMENT.—The presence of blood in the faeces, with a tendency to 
looseness of the bowels, is at once the signal for a change of food or 
pasture. The animal should be isolated, and receive cooked mucilaginous 
mashes of fresh bran and linseed, with hay tea, etc., and if any water is 
allowed, it should not be given cold. It is a good practice to commence 
medicinal treatment with a full dose of raw linseed oil conjoined with 
antiseptics, carbolic acid, salicylic acid, salicylate of soda, hyposulphite 
of soda, chinosol, creosote, cyllin, Jeyes’ fluid, or small doses of turpentine; 
and if pain is well marked, an initial dose of tincture of opium or powdered 
opium is admissible, but should not be repeated without good reason. 
In some hands calomel has proved valuable as an intestinal antiseptic 
and in regulating the bowels, in daily doses of 10 grains given with 1 ounce 
each of chalk and gentian. 

Additional treatment includes the use of antiseptic enemata, tepid 
water to which has been added boracic acid, carbolic acid, glycerine, 
salicylic acid, or Jeyes’ fluid. If the patient is very weak, the strength 
is to be maintained by administering milk and eggs, and rice or flour gruel. 

During treatment the animal is to be well clothed, and must on no 
account be allowed out of doors, as exercise, chills from exposure, or the 
drinking of a quantity of cold water, invariably increases the gravity of 
the symptoms. 

In some cases good results have followed the use of 2-ounce doses of 
sulphate of magnesium or sulphate of sodium combined with 4 ounce of 
gentian four times a day. When fever abates, sulphate of iron with 
bitter stomachics should be prescribed, and the return to ordinary food 


should be gradual. 


420 SYSTEM OF VETERINARY MEDICINE 


Chronic Enteritis. 


Synonym.—Chronic diarrhcea. 

Diarrhcea of a chronic type which is but little influenced or only tem- 
porarily benefited by medicinal treatment is a very common affection 
among Ayrshire cattle. 

EtroLogy.—Many cases are but the relict of an acute attack of 
enteritis. The intestinal mucosa assumes a chronic state of irritability, 
the capacity of the bowels is greatly reduced, the increased peristalsis 
shortens the sojourn of the ingesta in the digestive canal, and much of 
the aliment escapes digestion and assimilation, so that the patient soon 
becomes emaciated. In some instances several members of a herd 
become simultaneously affected, when it may be possible to trace the 
causal factors ; but these are often obscure, and can only be put down to 
microbic infection. Many cases of chronic diarrhoea gradually merge 
into dysentery, with the occurrence of ulcerative lesions in the intestinal 
mucosa. Chronic diarrhoea is a common accompaniment of chronic 
disease of other organs—e.g., extensive disease of the liver, disease of 
the heart and lungs, and septic conditions of the uterus, etc.; while it is 
the chief symptom of such specific infections of the bowels as Johne’s 
disease, coccidiosis, and tubercular disease of the intestines (see Vol. I.). 

Morsip Anatomy.—There is a great deficiency of fat in the folds of 
the mesenteries, and the capacity of the bowels is much reduced. The 
intestinal mucosa is congested and thickened, and in some places shows 
erosions. The mesenteric glands, if free from tubercular deposit, are 
often enlarged, and exude an abnormal amount of fluid when cut into. 
At places we find portions of the intestinal wall attenuated and friable. 
Usually the small intestines contain only foetid mucus and some gas, 
while the meagre contents of the large bowels vary in consistence and 
colour, but are often dark in appearance. 

As already stated, chronic diarrhoea is often associated with chronic 
disease of other organs, and lesions are not uncommonly found in the 
lungs, heart, liver, or uterus, etc. 

Symptoms.—The disease may develop very gradually or result from 
a previous attack of acute enteritis. In the former case the bowels at 
first may be alternately constipated and relaxed, but sooner or later 
they become very irritable, peristalsis is increased, and there is frequent 
evacuation of foetid, fluid feeces, containing, it may be, whole grain or 
other rough aliment, and often mixed with bubbles of gas easily discern- 
able for some time after defeecation. The loss of bulk in the abdominal 
organs gives the animal a tucked-up “greyhound” appearance. The 


DISEASES OF THE INTESTINES: CATTLE © 421 


temperature may be slightly erratic, but is seldom very high. Thirst is 
often well marked, and the appetite is towards liquid food. Emaciation 
is progressive, and the animal wastes away to a skeleton. There are 
marked signs of anemia, including cedema of the brisket, and the patient 
eventually succumbs from exhaustion. 

DIFFERENTIAL DiAqanosis.—In life it is sometimes impossible to 
differentiate ordinary chronic enteritis from tubercular enteritis, not- 
withstanding the diagnostic value of tuberculin, unless we can determine 
tubercle bacilli in the dejecta, for it happens occasionally that a reactor 
to tuberculin is found to have suffered from non-tubercular chronic 
enteritis, and to have at the same time some remote lesions of tuber- 
culosis. 

Again, though in some cases of Johne’s disease it is possible to make 
a satisfactory diagnosis by rectal exploration, securing from the mucosa 
of the bowel at arm’s length a pinch of material for a stained smear that 
proves positive, still, m many cases one cannot reach any portion of 
bowel affected, and very often an examination of the scraping taken from 
the bowel and of the feeces are both negative in animals that on post- 
mortem examination were shown to have the lesions of Johne’s disease 
higher up in the alimentary tract. Such cases simulate ordinary chronic 
enteritis very closely, and the employment of the diagnostic vaccine of 
Twort and Ingram for Johne’s disease is indicated. | 

Prognosis.—This is always grave. There is no tenable reason for 
keeping in life the subjects of chronic diarrhoea from whatever cause 
arising, for they seldom or never do any good, and by their excreta they . 
are very often a menace to the health of their neighbours. 

TREATMENT.—If the treatment of chronic enteritis is to be successful, 
it must be carried out as early as possible before the bowels have become 
excessively irritable and relaxed. If the condition is dependent on disease 
of other organs, that must receive attention. In cases deemed worth 
treating, hydrochloric acid may be given in 2-drachm doses, as well as 
bitter stomachics, three or four times a day. Strict attention to diet is 
necessary. 

When the disease is well established, treatment should not be at- 
tempted. The animal should be slaughtered and an autopsy made, and 
the stall, etc., should be well disinfected. 


Coccidian Enteritis. 
Synonyms.—Coccidiosis; Red dysentery (see Coccidiosis, Vol. I.). 
For remarks on “ Dysentery”’ and ‘“ Diarrhcea”’ occurring in Calves, 
see Dyspepsia in Calves (p. 400). 


422 SYSTEM OF VETERINARY MEDICINE 


NEOPLASMS OF THE INTESTINE. 


Lipomata or, fatty tumours are not uncommon in cattle, and are 
usually found attached to the mucosa. 

Sarcomata and carcinomata are occasionally met with, as well as 
adeno-carcinomata and fibromata. The symptoms and treatment, etc., 
are as in the horse (see p. 298). 


DIARRHGA. 


The Editor’s remarks on this subject in the equine section apply 
equally to cattle. Cattle are, however, more prone to simple diarrhoea 
than horses; indeed, it often happens that the effect of over-rich and suc- 
culent pasture is to produce in every member of the herd such a condi- 
tion of looseness of the bowels that, without being sick, the animals: 
owing to the laxative effect of the food, actually lose some bodily con- 
dition, though they may always appear well filled with food. When on 
other fields known as “ scouring-lands” the effect on the bowels 1s so 
pronounced that the animals can only do well when they are allowed a 
certain amount of some corrective food, such as cotton-cake. Again, it 
is a common practice in the season when the turnip crop is being harvested 
to give the herd large quantities of the fresh green tops. This feeding, 
relished by many cows, reduces the excreta to an extremely fluid state, 
and if the animals are housed, their hind-parts and udders become readily 
soiled, especially if the byres are structurally deficient. The milk-supply 
is often increased in quantity for a time, but there is some loss of con- 
dition, and when the tops are given just before milking, the milk acquires 
a “turnip taste” in the same way as when the turnips themselves are 
fed to the beasts before milking. In this case, also, cotton-cake has a 
beneficial effect on the state of the bowels. Further, if a too liberal 
allowance of common salt is given with the food, the contents of the 
dung-channel are always unduly watery. 

In cattle, however, a pronounced simple diarrhcea is usually attribut- 
able to a distinct dietetic error, improper and irritant food, impure water, 
or draughts of icy-cold water, etc. 

Symproms.—The chief symptom is the frequent passage of very fluid, 
heavy-smelling feeces, often in a forcible spouting fashion, the evacuations 
being sometimes preceded and followed by a slight degree of uneasiness. 
Otherwise, there is little constitutional disturbance. 

TREATMENT.—The prophylactic measures are obvious. If the cause 
of the diarrhea is known, the difficulty in curative treatment is half 


DISEASES OF THE INTESTINES: CATTLE — 423 


over. When due to an error in diet or irritant food, recovery is soonest 
achieved by giving a moderate purge to rid the alimentary tract of the 
objectionable material. This, even in more advanced cases, often gives 
remarkably good results. In very many cases the initial diarrhoea 
itself accomplishes the desired end, and there is spontaneous recovery. 
If the case is considered not to merit a saline purge, it is a good practice 
to give a pint of raw linseed oil with a similar quantity of lime-water, 
and 1 ounce each of tinctures of ginger and opium, while allowing the 
animal only good hay and bran mashes to eat. 

If diarrhoea is persistent, recourse may be had to a combination of 
opium, antacids, and mild astringents—e.g. - 


R Pulv. opi mt nis ha Stud OME: 
Pulv. catechu 2 Ag at ek ORAS 
Pulv. zingib. “ x r as ae falB 
Pulv. crete preep. .. e it; Prinz: 


M. div. in pulv. ii. Sig.: One powder to be given every twelve or 
eighteen hours in a bottle of milk and flour gruel till diarrhoea 
ceases. 


For the same purpose repeated doses of chlorodyne may be used, or 
opium conjoined with acetate of lead or sulphate of copper. Tannic 
acid is also useful. 

During this treatment the animal’s food should be restricted to well- 
boiled milk, flour and starch gruel, a little bran mash, and some good 
hay. If the gruel is not taken voluntarily, it may be necessary to 
administer it. 

When the diarrhcea ceases, mineral tonics and stomachics should be 
prescribed, and the return to ordinary food should be made gradually. 


PROLAPSE OF THE RECTUM. 


Neither prolapse of the anus nor of the rectum is common in cattle 
This is in great measure due to the fact that the contents of the rectum 
are naturally soft and pultaceous, and are but seldom in a cohesive and 
dry condition, unless during the temporary paralytic stage of milk fever 
and other diseases affecting the brain and spinal cord. 

When it does occur, prolapse of the rectum is usually due to violent 
straining during a difficult parturition, when the foetus becomes fixed in 
the pelvis, or it may result from the tenesmus that sometimes accom- 
panies metritis, vaginitis, or cystitis. 

The prolapse is usually a temporary matter. 


DISEASES OF THE DIGESTIVE SYSTEM IN 
SHEEP 


By G. MAYALL, M.R.C.V.S., Bouton. 


General Remarks.—Avoidance of digestive troubles in sheep will best 
be accomplished by producing strong, well-nourished lambs of good stock. 
Lambs fed too sparingly will have the cells of the digestive canal in- 
sufficiently developed, whilst the capacity of the stomachs and intestine 
will remain cramped. The formation of good bone will be hindered by 
lack of nourishment, and the animal remain on the small side, the cells 
of the skin will not grow sufficiently, and good wool will be at a premium. 

A rational feeding must be undertaken from due consideration of 
the anatomical build of sheep and their possibilities. Copious milk 
secretion of ewes and the right composition of the lacteal fluid are 
important points. The dam’s milk may be too watery in composition 
from the giving of too great quantities of such substances as turnips, 
brewers’ grains, sloppy food, etc. A sufficient amount of water must be 
taken up to allow of the formation of lacteal fluid, but too much moisture 
causes pressure on the uterus, hindering the development of the foetus 
and limiting the supply of a well-formed vital blood-stream to the young 
in the womb. 

The whole structure of the ovine is adapted chiefly for the digestion 
of raw food, because it possesses in a high degree the ability of dissolving 
cellulose or woody fibre in the long intestinal canal. 

As regards concentrated food, ewes should have from + to 4 of a 
pound per head per day some weeks before lambing. The higher or 
lower quantity may be given according to the quality and supply (whether 
plentiful or scarce) of hay. Supplementary food will be regulated 
according to price and facility for obtaining same. Crushed rape cake 
and wheat chaff are common articles of diet, and much relished by, 
sheep. 

For the rest salt licks should always be handy, as without their use 
digestion is not carried out to its full extent. A good water-supply is 
also a necessity. Lambs at six months’ old may receive 4 pound con- 

424 


DISEASES OF THE DIGESTIVE SYSTEM: SHEEP 425 


centrated food per head per day, and this may be advantageously kept 
up until they are twelve months old. At a year with lambs fed thus, 
only hay and straw, and in the winter months 1 to 3 pounds per head per 
day of turnips need be given. A flock going out in rainy, foggy, and 
dewy weather is subject to digestive ailments. In fattening lambs at 
nine months old, 14 pounds per head per day of concentrated food should 
not be exceeded. Four chief causes of digestive troubles in sheep are— 
(1) Lack of salt licks. (2) Irrational feeding : too voluminous food and 
too watery diet. (3) Attempts at too quick fattening of lambs. 
(4) Failure of hay in the ration. There is a popular idea that sheep 
require no water. When living on fresh green pasture or watery roots, 
a considerable quantity of moisture is taken up this way, and pools 
or streams are not much patronized. In dry, hot weather, and when 
on dry food, they should always have access to a good water-supply. 
The tissues of the animal organism consist to a considerable extent of 
water (70 per cent.). It serves as a vehicle for nutritive principles and 
the products of combustion which are eliminated by the kidneys, lungs, 
or skin. By its evaporation it acts as a temperature regulator. Ewes 
suckling their lambs, or ewes kept as milking animals, especially need 
diet in which liquid plays a prominent part. The amount of water 
needed by sheep is from 3 to 5 pints for every 2 pounds of dry matter 
in the food composition of the ration. Good water should be fresh, 
sapid, free from organic matter, and not containing any too great excess 
of salts in solution. 


DISEASES OF THE MOUTH, PHARYNX AND CESOPHAGUS. 


Stomatitis —Catarrh or Inflammation of the Mouth.— This disease 
as a non-bacillary ailment is seldom observed in sheep. It may arise, 
however, from eating acrid or poisonous vegetation, such as spurge, 
spotted hemlock, charlock, or certain members of the Ranunculacesz 
family. Where sheep have been too freely dressed with mercurial 
preparations it is sometimes seen. Lice, caterpillars, or acrid-secreting 
insects in the pasture or fodder may cause occasional cases of the com- 
plaint. A further consideration of the matter may doubtless be gleaned 
from the section on Poisons. 

Symproms.—Soreness of the mouth ; swelling of the lips or gums ; 
feeding badly, masticating with difficulty ; dribbling of saliva from 
the mouth, and in some cases dropping of the cud. 

TREATMENT.—Change of pasture, destruction of the offending plants, 
insects, or feeding-stuff ; cold water to drink. 


426 SYSTEM OF VETERINARY MEDICINE 


Spraying or syringing of the mouth with 2 per cent. boracic acid 
solution. Potassium iodide as an antidote for mercurial poisoning. 

A Disease similar to Aphthous Stomatitis—Stomatitis Erosiva—False 
Foot and Mouth Disease—“ Dirty Mouth.””—Hutyra and Marek describe 
a malady in cattle and sheep which has at times been mistaken for foot 
and mouth disease. 

CausEs.—The disease assumes three forms from an etiological point 
of view. One is due to infection, and a part of these cases may be 
ascribed to the bacillus of necrosis (see Necro-bacillosis, Vol. I.). The 
second group comprises diseases due to peculiarities in food, and out- 
breaks have been noticed in sheep after feeding on green clover. This 
complaint is not infectious, and cannot be transmitted from diseased to 
healthy animals. 

The third form is considered to be due to food that irritates the gums 
when given irregularly or at times of fatigue (after long railway journeys 
or road marches). 

SYMPTOMS are exhibited in two different ways: In the one the 
mucous membrane of the mouth, and the skin of the upper lip in contact 
with and near the gums only are attacked. On the mucous membrane 
of the hard palate and the gums, rarely on the edges and point of the 
tongue on the inner surface of the lips and buccal mucous membrane, 
greyish-white or greyish-brown leathery deposits form on a more or less 
inflamed surface. In other cases there are rounded, scarlet, epithelial 
defects, whose surface is partly covered with greyish-red or yellow, thin, 
soft epidermis. In some cases one also sees numerous punctiform 
hemorrhages in the papille of the mucous membrane. On the skin 
of the upper lip, in a few animals, lentil-like elevations and ulcerous 
epithelial defects arise. 

In the other way, the skin of the upper lip, the limbs, and the udder 
may be attacked. There is loss of appetite and fever, salivary flow and 
smacking of the lips, as in foot and mouth disease. The mucous membrane 
appears inflamed and with yellowish, and now and then wrinkled, diffuse 
deposits, especially on the hard palate, gums, and inner surface of the lips. 

On the furrow of the upper lip and nasal mucous membrane small 
yellowish or grey nodules appear, or scabs with a central red depression. 
Similar nodules may affect the mucous membrane of the mouth. The 
hind extremities show symptoms of dermatitis. Nodules, vesicles, or 
scabs may form on the udder. 

The disease runs a mild course, and ends favourably within a week, 
or in the latter described form in two to three weeks after slight falling 
away in condition. 


DISEASES OF THE DIGESTIVE SYSTEM: SHEEP 427 


DIFFERENTIAL Dracnosis.—In these complaints there are no vesicles 
on the coronets or on the folds of the tongue, and there is lack of the 
distinctive deposits on the oral mucosa. The infectious character of 
foot and mouth disease is not evidenced in these maladies. 

TREATMENT.—Many cases recover without any attention. Inflam- 
mation of the mouth may be treated by syringing with dilute boric 
solution or electuaries, and the udder and leg trouble according to 
antiseptic surgical principles. 

Aphthous Inflammation of the Mouth in Lambs — Sore Lips. — A 
contagious disease of the mouth of sucklings and weaners, seen especially 
in lambs, is described by Hutyra and Marek. It is characterised by the 
formation of false membranes of a white, grey, or greyish-yellow colour 
in the buccal mucosa. The disease has been attributed to Otdiwm albicans, 
(perhaps incorrectly), and some consider it as connected with the bacillus 
of necrosis. Weakly and anemic lambs suffering from gastric disturb- 
ance are said to be chiefly lable to it, whilst weak movements of the 
jaws and throat when sucking, leaving the mouth insufficiently cleansed, 
contribute to an attack. 

Symproms.—Inflamed mucosa of the mouth, formation of pseudo- 
membranes, which appear first as whitish points and then grow and 
enlarge. These spots may coalesce and extend as pseudo-membranes 
over the whole mucosa, when the case becomes serious. On the other 
hand, the membranes may fall off, leaving bleeding erosions, which subse- 
quently heal. Vesicles and incrustations may appear at the corners of 
the lips. Sick animals may die from inability to suck or take food, 
followed by emaciation, diarrhcea, and catarrhal pneumonia. 

Coursre.—The disease takes a rapid and fatal course in lambs under 
two weeks old, but in older animals is more favourable. The mortality 
may range from 8 to 20 per cent., and apart from actual losses, the disease 
is difficult to eradicate, and has a prejudicial effect on the growth and 
development of the animals. 

Dr1aGnosis.—The formation of white or yellow spots on the mucosa, 
the symptoms of stomatitis, and the vesicles on the margins of the lips, 
enable a diagnosis to be made. Severe cases usually occur side by side 
with mild cases: 

TREATMENT.—Separate healthy from sick animals. Clean and dis- 
infect the pens. Feed lambs on milk from the ewes, as the ailing subjects 
may not be able to suck. Wash out the mouth with boracic acid or chlorate 
of potash solutions, 4 per cent. Dress the lips with boracic ointment. 

Defective Teeth—Broken Mouths.—Ewes that cannot graze properly 
are generally cast by the shepherd or sheep owner. The fault mostly 


428 SYSTEM OF VETERINARY MEDICINE 


arises from teeth having been lost or broken. Condition, fattening, 
and the production of good lambs, wool, and milk cannot be kept up if 
the ovine is unable to graze and ruminate to the best advantage. The 
flock is periodically overhauled, and such offenders discarded. 

Causrs.—Breaking the teeth on hard objects, wear due to age — 
(breeding ewes naturally being kept longer than other members of the 
flock), loss of teeth when tugging at hard fibrous herbage, disasins of the 
sums (sporadic aphtha, necro-bacillosis, etc.). 

Symproms.—Gaps in the mouth and broken teeth seen on examina- 
tion ; quidding or dropping the food; loss of condition ; pot-bellied 
appearance if kept long enough, and symptoms of indigestion and 
unthriftiness. 

TREATMENT.—Discard from the flock early, and slaughter while in 
fair condition. 

Inflammation of the Tongue—Glossitis.—Arises from the same causes 
as stomatitis, and may be dealt with in the same way, or electuaries of 
honey and boracic acid or alum may be given. 

Dropping the Cud.—Due to acid or inferior food. Seen where poor 
turnips or mangold leaves have been fed to sheep. 

Symproms.—Ground covered with half-masticated food. The con- 
tents of the stomach are returned to the mouth, but are in too nauseating 
or watery a state to be re-masticated. 

TREATMENT.—Mild aperients and antacids, followed by vegetable 
tonics. 

Pharyngitis.—Rarely seen in sheep, and then probably due to lodg- 
ment of a foreign body at the entrance to the gullet or to eating frozen 
food. Treatment: removal of the obstruction, and electuaries. 

Choking—Obstruction of the Gsophagus—Foreign Body in the Gullet. 
—Sheep choke occasionally from a piece of root lodging in the gullet, or 
from the accumulation in the tube of coarse food taken in a dry state, 
and the cesophagus may be filled to a considerable length in this way. 

Symptoms.—Head stretched out, eyes staring, frequent gulps, cessa- 
tion of feeding and rumination, vomiting, or attempts at it. If the 
cesophagus is completely closed, the rumen soon fills up with the gases 
of fermentation, and tympany is easily perceived. Manipulation of the 
throat and gullet reveals the presence of foreign bodies, and gives some 
indication of their nature. 

TREATMENT.—Open the mouth wide, and note if anything can be 
seen or felt. Manual removal may be undertaken if this is the case. 
A little linseed oil, in which a drachm of turpentine has been incorporated, 
may be cautiously given, and attempts made to pass the obstruction 


DISEASES OF THE DIGESTIVE SYSTEM: SHEEP 429 


down towards the stomach. If this is unsuccessful, a suitable hollow 
probang may be inserted, and the offending object pushed down, leaving 
the probang in for a time to allow of the escape of accumulated gas. 
Occasionally the tympanites may be so marked and cause so much distress 
that puncturing the rumen with a small trocar and cannula must precede 
the passage of the probang. When the choking has been relieved, give 
mucilaginous fluids for a time, and discard roots or coarse food-stufts for 
many days, feeding instead on soft, sloppy diet, or tender, succulent 
herbage. 


DISEASES OF THE STOMACH. 


Indigestion — Stoppage of the Rumen—Atony of the Rumen, 
Reticulum, and Omasum—Obstruction of the Omasum.—In this com- 
plaint all three of the anterior compartments of the stomach are usually 
involved. It corresponds to the gastric catarrh of single stomached 
animals without the signs of catarrh and inflammation always being 
distinctly evident. Rumination is suppressed, fermentation of the 
contents of the two anterior divisions of the stomach occurs, and drying 
of the contents of the third compartment ; there is lack of activity of the 
intestine and drying of its contents, constipation, and catarrh of the 
large intestine. 

Causres.—Atony of the stomachs due to previous debilitating disease 
or to coarse, fibrous food, along with little hay or green fodder. Dry 
innutritious and indigestible or muddy pasture, grasses of late autumn, 
or early winter wet with fog. 

Sudden changes of food and over-fatigue after long travelling or 
railway journeys, difficult parturition, or overfilling of the rumen, cause 
lack of tone in its muscular coat. Fermenting or frozen food also produces 
the condition. There is failure of contraction of the anterior compart- 
ments of the stomach, and a faulty mixing and distribution of their 
contents. 

Symproms.—Loss of appetite, sluggish or totally suppressed rumina- 
tion, no movements of the stomachs, slight tympanites, evacuation at 
long intervals of dry, badly-digested, evil-smelling dung in small quan- 
tities. A slight attack with little rise of temperature may develop into 
an acute or chronic form of the complaint. In the former there will 
be complete cessation of rumination, bad-smelling eructations, obstinate 
constipation, continued recumbent position, changing temperature, and 
loss of milk-supply in ewes with lamb. This state may improve in a 
few days or a fortnight, and betterment is generally heralded by copious 
evacuation of dung and restoration of rumination. An acute attack 


430 SYSTEM OF VETERINARY MEDICINE 


passing on to the chronic form of the disease is shown by a considerable 
rise of temperature, total cessation of feeding, rumination and stomach 
movements, passage of mucous-coated dung. Skin dry and non-elastic, 
wool lustreless. Emaciation, eyes sunken, dejection, and subject lying 
most of the time, grinding of the teeth and complaining bleat. Death 
follows from exhaustion, emaciation, and auto-intoxication. 

Proenosis.—At the commencement or early stages favourable ; 
unfavourable if the condition has continued some time, and an action 
of the bowels cannot be produced. 

Post-Mortem.—Omasum enlarged and filled with impacted food, 
which is firm, dry, and hard. The internal coat sticks to the food, the 
leaves are hamorrhagically spotted, inflamed, and superficially necrotic 
(pressure necrosis). The two first stomachs are filled with masses of 
felted food and bad-smelling liquid, the mucous membrane peels off 
easily, and there is bluish-red discoloration of the visceral walls. The 
liver, abomasum, or bowel may also be diseased. 

TREATMENT.—Get the ailing subject up if out at pasture. Aim at 
restoring rumination and the movements of the stomachs. Do not 
be led astray by an action of the bowels, which may happen and yet 
the stomachs be unrelieved. Give water and linseed or camomile tea in 
moderate quantities. Internally, acid. hydrochlor. dil. (xv.-xx. minims) 
every three hours in water. Sodium sulphate (1 to 4 ounces) together 
with antimony tartrate (4 to 10 grains) dissolved in water. 

Knead the stomachs frequently, and give soap and water enemas. 
A little hay, if eaten, will help rumination to commence, and may be 
advantageously given with salted meal drinks, and ripe greenstuff aids 
the action of the bowels. Change the pasture if it is at fault, and the 
food if desirable. Give a good supply of liquid for many days. 

Overfilling of the Rumen seldom occurs in sheep which are chiefly 
grazing animals. The ailment is treated of under Diseases of the 
Digestive System in the Goat, and if it occurs in sheep, the same treat- 
ment may be adopted. 

Tympanites — Hoven — Dew Blown. SeiA sudden formation of large 
quantities of gas in the rumen. The gases arising are carbonic acid, 
carburetted hydrogen, marsh and sulphuretted hydrogen, together with 
small quantities of swallowed atmospheric air. The accumulated gas 
causes pressure on the diaphragm, difficulty in breathing, obstruction of 
blood circulation, and rupture of the diaphragm or rumen may occur — 
by the animal falling suddenly or rolling about. 

CausEs.—Hating greedily of young luscious plants, such as clover 
or lucerne, especially when wet with dew. Innutritious grasses wet with 


DISEASES OF THE DIGESTIVE SYSTEM: SHEEP 431 


fog readily produce the complaint. Cabbage and turnip leaves greedily 
eaten and not fresh, decomposing and frozen ‘roots, and the grasses, 
poa aquatica, and scirpus silvaticus, cause hoven. The prevalence of 
cold, strong winds and heavy falls of dew indicate favourable conditions 
for the production of the disease. The disease may also be due to a ball 
of wool blocking up an opening between the compartments of the stomach 
or the pylorus (see Wool-Hating). 

Symptoms.—Great swelling of the rumen, so that the left compart- 
ment of the stomach is blown up and resonant like a drum. Total 
cessation of eating and rumination, pressing and straining, restlessness, 
anxious look, quickened breathing, weak pulse, cold extremities, and 
swaying hind-quarters. Death may occur in a few hours or less if the 
symptoms are not relieved. Repeated eructations are a favourable sign. 

TREATMENT.—By inserting a straw rope smeared with tar in the 
mouths of single animals, the symptoms may be relieved. Half-ounce 
doses of aromatic spirits of ammonia in 4 pint of water, to which 15 grains 
of ext. hyoscyamus and 5 drops of ol. menth. pip. have been added, is 
a serviceable drench. Lime-water in 2-ounce doses, or 2 tablespoon- 
fuls of brandy in a little water, may be given at frequent intervals. 
Pass the probang or puncture the rumen in urgent cases. Knead the 
swollen flank. If the whole flock is affected, drive them through water 
or send them up-hill at a quick pace. Do not turn out until the dew 
is off the grass. Give some concentrated food before turning out to 
pasture. Sowing caraway in the meadows which occasion the com- 
plaint, is said to be a good precautionary measure. 

Chronic Hoven is denoted by a moderate but continuous forma- 
tion of gas in the rumen, and here carbonic acid and marsh gases are 
chiefly generated. 

Causres.—Frequent attacks of acute hoven, followed by weakness 
of the digestive organs ; liberal supplies of indigestible, fermenting food ; 
organic changes due to growth of the rumen to the peritoneum after 
frequent use of the trocar; tumours or foreign bodies in the rumen; 
peritonitis. 

Symptoms.—Gradual accumulation of gas in the rumen so that the 
compartment has a flattened protrusion, and is not rounded, as in acute 
cases. Betterment for a few days, and return to the original condition. 
Small appetite, irregular or absent rumination, superficial breathing, 
scanty faeces, or at times diarrhoea. Loss of condition or emaciation. 

TREATMENT.—Empty the stomachs with laxatives, and seek to 
establish rumination. Hydrochloric acid (xv. to xx. minims) is the best 
drug to use, followed by digestive tonics. Give enemas regularly. 


432 SYSTEM OF VETERINARY MEDICINE 


Foreign Material in the Stomachs.—Badly-cleaned roots soiled with 
earth or clay and sand may cause digestive trouble in sheep. There 
is atony of the stomachs, dribbling of saliva from the mouth, arched 
back, attempts at rumination, lying about, and listlessness, and the dung 
passed may contain sand or soil, or obstinate constipation may be present. 
A bad habit that lambs sometimes contract’ is known as wool-eating. 
Here a ball of wool may obstruct the openings between the fore-stomachs, 
or block up the pylorus, and give rise to acute tympanites. 

Causes oF Woot-Katinc.—There is a diversity of opinion as to 
the cause of this bad habit. By some authorities it is attributable to 
the tedium and boredom of lambs when confined after free roaming, 
by others to insufficiency or poorness of food, or unsuitable chemical 
composition of the food, and as a result the animal becomes anemic, 
and the blood faulty in composition. 

In a herd of sheep single lambs in early winter, or generally later, 
begin to nibble at the wool of their mothers, especially on the thighs, 
belly, or tail, and where the body is soiled by urine or dung. More lambs 
follow the example, and later on, not only gnaw their mother’s coats, but 
nibble the wool of other sheep. Ewes affected gnaw the lambs’ tails and 
feet. Among the yearlings or older sheep there are fewer offenders, but 
there is a tendency for the vice to spread amongst them. At first the 
nibblers generally stick to one animal, but later transfer their attentions 
to a fresh victim. In this way the evil spreads until the whole flock 
becomes affected, and wool-eating becomes general. 

Symproms.—In yearlings or older sheep pallid mucous membranes, 
general weakness, disinclination to take water, emaciation and listlessness. 
Sometimes no pronounced symptoms, the animals seeming quite healthy, 
and only single lambs, or occasionally a number, die, because wool-balls 
have formed in, and occluded the opening of, a compartment of the 
stomach, or lodged in the intestine. 

Dracnosis.—Wool-eating only occurs as a rule during the day and 
between feeding-times, and animals nibble the wool of their companions 
and never their own. Hence this complaint should not be mistaken 
for commencing scab. f 

TREATMENT.—Give plenty of good hay. Avoid watery diet, turnips, 
potatoes, and brewers’ grains. Provide salt licks, and give liquor calcis 
in the drinking-water. Wool-eating generally subsides in the spring 
when the pastures are good and accessible. In stall-feeding, darkening’ 
of the abode during the day-time is said to check the habit. In the case 
of sucking lambs the wool should be trimmed from the ewes’ udders 
and from inside the thighs, and the lambs given more freedom. If the 


DISEASES OF THE DIGESTIVE SYSTEM: SHEEP = 433 
ewes are giving little milk, the supply should be supplemented with cow’s 
milk ; separate ewes and lambs as early as possible, and at feeding-time. 
Isolate the wool-eaters as well as the nibbled animals. Obstinate cases 
have been cured by the injection subcutaneously of apomorphine hydro- 
chlorate. 

Parasitic Gastritis. — Almost solely affects lambs and is due to the 
presence of strongyli (Strongylus contortus, fillicollis, convolutus, or 
gracilis) in the stomach and small intestine. Strongylus contortus is 
the most frequent inhabitant, and is easily distinguishable by its reddish 
colour, due to blood sucked from the host. It is from about 4 inch to 
14 inches long. The oviducts of the female are convoluted and wound 
round the intestine. 

The eggs of the strongyles are passed in the feces of affected sheep, 
the embryos become free, and are nourished by the organic matter in 
the warm dung, developing to a length of 1 millimetre, and hardening 
in the process. The larvee are taken up in the drinking-water or from 
damp meadows, especially where sandy soil prevails. The worms develop 
to their full length after two or three weeks’ residence in the stomach of 
the sheep. The larvee are very resistant to heat and cold. They may 
live thirty-five days or longer in summer. The cold of winter hardly 
affects them at all, and they remain alive on meadows for seven or eight 
months. 

Inrection.—Takes place through affected pasture, food, or drinking- 
water. The greater the number of parasites, the worse their effect. 
They penetrate the mucous membrane of the stomach, suck out the 
blood, and excrete toxins, exerting an injurious effect on the composition 
of the blood when absorbed into it. 

Post-Mortem APPEARANCES.—Acute or chronic catarrh of the stomach 
and the presence of the worms in large numbers. 

The carcass is anemic and dropsical. Sometimes the strongyles 
can only be detected microscopically. To be seen with the naked eye, 
the contents of the stomach should be mixed with water. 

Symproms.—There is falling away in bodily condition, and anemia 
seen in autumn or winter. Diarrhea alternating with constipation and 
abdominal pain. Passage of dark-coloured dung, in which occasionally 
the eggs of the worms may be seen. Dropsy and cachexia often occur. 

TREATMENT.—Tabloids containing arsenic are chiefly used nowa- 
days. A tabloid composed of 35 grains of areca-nut and ? to 14 grains 
of arsenic may be given twice daily for a time ; 45 grains per head of 
kamala may be given in corn food, of which affected sheep should have 
at least } to } pound per head per day. 

VOL. II. 28 


434 SYSTEM OF VETERINARY MEDICINE 


PRoPHYLAXIS.—Avoid damp, marshy, and suspected pasture. 
Separate sick and adult animals from lambs. Plough up infected land. 
Do not let lambs follow adult sheep on affected ground. 

Diarrhoea of Lambs—White Scour.—Is an infectious gastro-enteritis 
of sucklings frequently attacking a whole flock of lambs, usually within 
three days or a short time after birth. 

Causres.—Infection of the lambs by one or several virulent bacilli 
(paracoli bacilli, streptoccoci, Bacillus pyocyaneus) which inhabit the 
intestine, and are rendered specially active and injurious by such pre- 
disposing factors as improper feeding of the mothers, dirty, infected 
lambing-pens, cold and wet, etc. Contaminated ground on which 
lambs are born, affects the vagina and udder of the ewes, and the 
lambs take up the organisms whilst sucking or by way of the unhealed 
navel. 

Symproms.—Slimy diarrhcea followed by liquid, whitish evacuations 
appearing in by far the greater number of cases within the first three 
days after birth. Painful straining, involuntary passage of feces, now 
and then tinged with blood. Falling away in sucking and then ceasing 
entirely, restlessness, then lying about listlessly with deep, sunken eyes. 
Cold and slimy oral mucous membranes. Many lambs die in from one 
to three days. 

TREATMENT.—Separate lambs from their mothers, put in a clean, 
airy pen, and feed with boiled milk. Each lamb may receive a dessert- 
spoontul of castor oil, followed up with a teaspoonful dose of the following 
powder: Pulv. rhei 6 parts, magnesii carb. 1 part, pulv. opii 4+ part, 
given in a wineglassful of camomile tea or dilute brandy. 

As domestic medicine, rice-water, mixed with raw eggs, is sometimes 
given. 

PREVENTIVE Mrasures.—The disease often appears endemic to 
certain lambing-pens and ground. Where the malady has previously 
occurred, ewes must be removed to a place clean and warm, with separate 
attendance. Four to six weeks before lambing this should be done, if 
not from the first. 

Diarrhoea—Symproms.—Discharge of yellow fluid excrement, and 
emaciation. Loss of appetite, and fever. 

CausEs.—Too rich, tainted, or indigestible food. 

TREATMENT.—Prepared chalk (3 drachms) in a wineglassful of linseed 
mucilage three or four times daily for an adult sheep, or a teaspoonful of 
dilute hydrochloric acid distributed in the day’s ration. 

Constipation or Stoppage.—Lack of defecation or passage of slimy- 
coated fxces, associated with dry mouth, listlessness, loss of appetite. 


DISEASES OF THE DIGESTIVE SYSTEM: SHEEP = 435 


CausEs.—Want of exercise in stalled rams. Indigestible, dirty (soil 
fouled) food, or food with sand clinging to it. 

TREATMENT.—Green succulent food, clysters, as well as 3 to 4 drachms 
of sodium sulphate and 1 drachm of gentian root given as a drench. 

Enteritis.—It is probable that enteritis as a disease confined to the 
bowels alone does not exist in sheep, but gastro-enteritis, on the other 
hand, does now and then occur. 

CausEs.—Hating rotten and fermenting roots, feeding on mouldy 
grain food, eating acrid and irritant vegetation. Gastro-enteritis may 
develop from a simple gastro-intestinal catarrh arising from feeding on 
sugar-beet leaves, frozen roots, or pasturing on frosted meadows. 

Symproms.—Feeding and rumination cease; there is high fever, 
intense thirst, abdominal pain; severe straining, constipation, followed 
by passage of bad-smelling feces, which may be streaked with blood; 
grinding of the teeth, exhaustion, stupefaction, dizziness, and con- 
vulsive movements. 

Diacenosis.—Ascertain the history of the cases, note any extraneous 
likely causes, and whether the disease is sporadic only. Hxamine the 
feed. Cessation of eating and rumination, accompanied by constipation 
and followed by diarrhoea, very characteristic. 

TREATMENT.—T hree or four ounces of linseed oil, to which § drachm 
of glycerine of belladonna has been added. ‘Tepid water or linseed 
mucilage in small quantities. Aromatic spirits of ammonia and bella- 
donna. Enemata of flour and water. Change the diet, and give easily- 
digested dry food. When turning out again, avoid fouled pasture, and 
put on a fresh grazing plot. 

Peritonitis.—Inflammation of the Peritoneum seen after castration, 
and as a result of direct injury. 

Symptoms.—Hard, thready pulse. Pain round the seat of injury, 
fluctuating temperature. Nose frequently put round to the flank, 
crouching, plaintive bleating, and grinding of the teeth. 

TREATMENT.—House in a warm, dry place. Attend to wound treat- 
ment with antiseptics. Warm fomentations to the abdomen. Ad- 
minister a tablespoonful of the following medicine three times daily 
in linseed tea: Ext. belladonna 2 drachms, ext. nux vomica 
1 drachm, solution aloes (1 in 4) 2 ounces, pulv. rhei radix 2 drachms, 
water to 8 ounces. 


DISEASES OF THE DIGESTIVE SYSTEM IN 
GOATS 


By G. MAYALL, M.R.C.V.S., Botron. 


General Remarks.—The goat is known to eat the widest range of plant 
food of any of the domesticated animals. In its natural habitat about 
the summits of hills and mountains it finds an ever-changing and ever- 
fresh bill of fare. When domesticated and being kept chiefly for milk 
production, it is fed much on the plan of that of a milch cow, but under 
these conditions it occasionally remembers its inherent faculty in the 
freedom of choice and wide range of diet, and metaphorically turns up 
its nose at stall-fed fare of good quality. Three meals a day are sufficient, 
and each goat, to avoid overeating and waste of food, must be fed separ- 
ately. When out in the domains of the wealthy, the mischievous and 
inquisitive faculty of the animal renders tethering necessary, but on 
many poor homesteads goats wander about and do little harm. The 
goat should have water offered twice a day when being stall-fed. One 
used as a milking animal, and being fed on corn and hay, will drink 
2 or 3 quarts of water in twenty-four hours. Naturally, in wet weather less 
water will be needed, especially if the animal is living on fresh vegetables 
or grass; but it is a mistake at any time to let the goat suffer from thirst. 
Copious draughts of water after green food are to be avoided. 

Digestive troubles in goats frequently arise from foreign bodies in 
the stomachs, usually taken voluntarily, or to poisonous drugs given in 
overdoses. Tobacco has caused trouble when given as a vermifuge. 
Nails, wire, bits of wood, leather, or part of a woman’s clothing who 
attends on the goat, may be amongst the articles swallowed. 

The eating of too great quantities of greenstuff, together with 
digestive weakness, causes overfilling of the rumen. In goats accus- 
tomed to stall-feeding, green food must be given only in small quantities ; 
hay should always be mixed with young green clover. Damp pasture, 
fermenting food, and drinking much water after green food cause hoven, 
or tympanites. Cold, damp grass and frozen food may bring about 
diarrheea. 

436 


DISEASES OF THE DIGESTIVE SYSTEM: GOATS 437 


1. Parotitis—Inflammation of the Parotid Gland.—Parotitis may arise 
in the goat ag a result of an injury (traumatic) to the gland, from specific 
infection, or following an inflammation of the pharynx. 

CausEs.—Bruising of the gland, penetration of grains or splinters of 
wood (branches of trees), infection from the mouth or pharynx. 

SYMPTOMS.—Swelling, increased warmth, pain varying in degree, 
stiffness of the neck, and difficulty in moving the head, inflammation of 
the sublingual glands, and at times salivation. Dispersion of the swelling 
generally follows, but pus formation or induration may result. 

TREATMENT.—Foment the swelling and afterwards rub with liniment. 
If pus formation threatens, poulticing helps suppuration. Induration 
is best treated by injecting tincture of iodine into the gland or inunction 
of iodine ointment, and 40 grains of pot. iodide given twice daily in water 
as a drench. , 

2. Hoven—Tympanites.—If fermenting green food is taken before the 
stall food, or if goats unaccustomed to grazing are suddenly turned out 
on to damp, luxuriant meadows or take much water when on green food, 
hoven frequently arises. 

Symproms.—The left flank is swollen up with gas and bulges out ; 
eating and rumination are suspended ; there is unrest, an anxious look, 
quickened breathing, weak pulse, and cold extremities. 

TREATMENT.—A quick emptying of the gas is desirable. Where there 
is much swelling, puncture the rumen with trocar and cannula. Passage 
of a suitable probang lets out the gas in commencing hoven. Massage 
the abdomen and stomachs, lead the goat about, and internally give a 
drachm of aromatic spirits of ammonia, or 2 drachms of lime-water in 
4 pint of water. One or two tablespoonfuls of olive oil may subsequently 
be administered. 

3a. Atony of the Rumen, Reticulum, and Omasum—Obstruction of 
the Omasum—Omasitis.—The giving of green food in large quantities to 
stall-fed goats without mixing hay with it frequently causes this com- 
plaint. Dry, fibrous indigestibie diet, or damp, frozen, or decomposing 
food may also bring it about. An animal exhausted after an acute 
illness or a long railway journey, if fed with unsuitable food, may especi- 
ally suffer thus. Atony of the stomachs may also arise from the presence 
of a foreign body, from inflammation of the rumen and reticulum, or from 
pressure on the stomachs from a pregnant uterus. 

Symproms.—Lack of appetite, and partially or quite suppressed 
rumination ; the rumen may swell after taking food, and then eradually 
decline to its normal size. Temperature about normal. Eructations 
seldom occur, and then the gas upraised smells badly. Constipation is 


438 SYSTEM OF VETERINARY MEDICINE 


obstinate.. Animal in the later stages lies about a good deal, and may 
show symptoms of intoxication. Emaciation takes place, the eyes sink 
in, the temperature rises, and finally the animal dies from stoppage of 
the digestive functions and auto-intoxication. 

TREATMENT.—Mucilaginous drinks such as linseed tea or barley- 
water, followed by aromatic drenches of sal volatile, camomile tea, or 
peppermint-water, and then aperients such as Glauber’s salts and agents 
to excite the action of the stomachs may be administered. Discard 
solid food for many days, giving meal drinks with a pinch of salt dis- 
solved in them, and a little good hay to aid rumination. 

3b. Overfilling of the Rumen—Acute Indigestion—Acute Dilatation 
of the Rumen with Food.—Liable to occur when goats are taken up from 
grass, and put on to stall-feeding. It is frequent in gross feeders, and 
may result from an insufficiency of water-supply. Feeding on volu- 
minous, dry, or unsuitably prepared food may occasionally produce it. 

Turnips, turnip tops, potatoes, or kitchen residue, indigestible food 
and overeating of sound food have caused this complaint, especially 
when any tendency to weakness of the rumen, as from previous scarcity 
of food, over-exertion after food, exists. 

SYMPToMs.—Small appetite at first, irregular, and sluggish rumina- 
tion ; later on suppression of both, little thirst, latterly no stomach 
movements, now and then bad-smelling eructations. 

Firm masses of food form in the rumen, and may be felt on pressing 
the lower portion of the left abdominal wall, which shows moderate or 
varying distension. The dung, normal at first, becomes scanty, dry, 
badly digested, and evil smelling. Lassitude, unconcern, arched back, 
often lying, varying temperature, falling off of milk-supply. There 
may be laboured breathing, colicky pains, and weakness of the hind- 
quarters. 

DiaGgnosis.—The occurrence of the illness shortly after a hearty and 
heavy meal, the increase of abdominal circumference, especially at the 
lower part of the left abdominal region; the firm consistency of the 
paunch, and dulness on percussion ought to enable a diagnosis to be 
made. 

TREATMENT.—Complete withdrawal of the unsuitable food. Thorough 
kneading of the paunch at regular intervals. Mucilaginous drinks, 
camomile tea, sodium sulphate, hypodermic injection of + to } of a. 
erain of veratrine sulphate. 

Dret.—At first no food should be given, until rumination again 
sets in. Then follow with only + or 4 rations along with a fair quantity 
of good hay. Pure lukewarm water, followed by meal drinks, aids 


DISEASES OF THE DIGESTIVE SYSTEM: GOATS 439 


recovery. Hydrochloric acid diluted (15 to 20 minims) mixed with. 
water and sprinkled over the food helps to restore the digestive func- 
tions. 

4. Foreign Bodies in the Rumen, Reticulum, and Omasum.—Goats 
examine all accessible objects inquisitively, lick, nibble, and may swallow 
them. Nails, wire, or bits of iron may be accidentally taken up in the 
food or from the crib. Insoluble substances, such as tobacco, may act 
as foreign bodies. Blunt objects may remain for a long time in the 
rumen ; pointed objects, on the other hand, penetrate the reticulum 
and cause purulent or fibrinous inflammation. 

SyMPToms.—Blunt objects cause symptoms of indigestion and atony 
of the stomachs, and if blocking up the openings out of the stomachs or 
the pylorus, tympanites may arise suddenly. Pointed bodies cause 
severe and sudden digestive disturbance, restlessness, an anxious look, 
colicky symptoms, expressions of pain. Strong pressure over the ensiform 
cartilage may be much resented and produce plaintive bleating. Rise 
of temperature is common; breathing is superficial; milk secretion 
stops. A slow perforation of the wall of the stomach may be followed 
by digestive disturbances disappearing and recurring, but a sudden per- 
foration gives rise to traumatic inflammation of the rumen, reticulum, 
and diaphragm. By wandering, the foreign body may occasion trau- 
matic pericarditis, pneumonia, or pleurisy. Acute or chronic peri- 
tonitis, septiceemia, or pyeemia, may likewise occur. ° 

TREATMENT.—Give the animal easily digested fluid nourishment. 
Castor oil, followed by a hypodermic injection of 4 to $ of a grain 
of veratrine sulphate. Generally a foreign body is only removed when 
rumenotomy is performed, but an expectant treatment is justifiable, as 
a spontaneous cure may occur. 

5. Constipation and Stoppage of Feeces in the Intestine—CausEs.— 
Feeding on dry, indigestible food (leaves or fibrous hay), damp, mouldy 
straw, faded, withered, and foul turnip tops or cabbage leaves. Faulty 
digestion and lack of exercise ; old animals inclined to stoppage. Change 
from pasture to dry stall feeding. Mechanical obstructions from foreign 
bodies in the intestine (hard to diagnose). 

SymMproms.—Passage of dry dung in small quantities often coated 
with slime, or absence of defecation. No intestinal murmurs, or only 
occasional and weak sounds. Lassitude, diminished appetite, bad- 
smelling mouth, swelling of the body, pain, and fever. Manipulation 
through the belly wall may reveal the bowel firmly distended with 
dung. 

TREATMENT.—Injections of soapy water per rectum. Three to five 


440 SYSTEM OF VETERINARY MEDICINE 


drachms of sodium sulphate daily in a pint and a half of water, given in 
three doses. Olive oil, 5 to 12 ounces. 

Continue the salts in small doses for a few days, and combine bitters 
(gentian or rhubarb) with them. 

6. Diarrhoea.—Due to chills and feeding on cold, damp grass and 
frozen food. In sucking kids, due to faulty nourishment of the dam, 
causing the mother’s milk to be wrongly constituted. Digestive dis- 
turbances, bad smells, and inflammation of the udder may all affect 
the dam’s supply harmfully. Working draft goats in hot weather and 
then letting kids suck is also an etiological factor. 

Symproms.—Passage of yellow fluid or semi-fluid feces, hind-parts 
soiled with excrement, tenesmus, fever. Variable or small appetite, 
thirst, falling in of the flanks, dejected appearance, emaciation, ex- 
haustion. 

TREATMENT.—Three drachms of prepared chalk in linseed mucilage. 
Twenty minims of acid. hydrochlor. dil. in each feed. Give water in 
small quantities in which a teaspoonful of flour has been mixed. Good 
long hay checks the diarrhcea, and helps to re-establish rumination. 
In kids, raw milk with egg-albumin, and a little powdered cinnamon 
checks the complaint. 

7. Takosis.—A disease of goats characterized by anzmia, emaciation, 
diarrhoea, dysentery, and inflammation of the lungs. It is due to an 
organism, which may be demonstrated in the blood and is called Micro- 
coccus caprinus. It is a very fatal ailment, and has been noticed many 
times by American observers in Angora goats, whilst Mr. Holmes Pegler 
has seen it in this country. 

Post-Mortem APPEARANCES.—A pronounced general anzemia, small 
heemorrhages in the serous membrane, catarrhal pneumonic foci in the 
lungs, accumulation of transudate in the pericardium, chronic catarrh, 
and here and there superficial necrosis of the intestinal mucous membrane 
(Hutyra and Marek). 

TREATMENT.—The best results have been obtained by giving calomel 
in 3-grain doses twice daily for two days, and following up with a powder 
morning and evening containing arsenious acid | grain, saccharated 
carbonate of iron 9 grains, and sulphate of quinine 3 grains. — Isolate 
the affected animals early. 


DISEASES OF THE DIGESTIVE SYSTEM — 
IN THE PIG 


By G. MAYALL, M.R.C.V.S., Botroy. 


General Remarks.— Mastication in swine is not carried out so completely 
as in sheep and cattle. It approaches more nearly that of carnivora as 
regards its duration and effect. Ptyalin is secreted during the act, and 
this ferment being kept from destruction in the left half or cesophageal 
portion of the stomach (because no acid juices are secreted there), accom- 
plishes the purpose required of it in this region—viz., the conversion of 
starch into sugar. When the pabulum arrives in the right half of the 
stomach, it is acted upon by the pepsin and acid juices of that portion of 
the organ, and the easily absorbable peptones are produced. The secre- 
tions of the stomach also deal effectively with food of animal origin, and 
convert it into easily assimilable material. The stomach of swine has a 
remarkable power of dealing with carbohydrates, and here the conversion 
of starch into sugar is capable of being carried out to a high degree. 
Potatoes and maize have been used for long years as staple food for pigs, 
and physiologists can explain the reason for their fattening effects to 
breeders and feeders. 

Food 1emains in the stomach of swine for about twelve hours — If 
rich in proteids it may remain longer, as swine digest such nourishment 
slowly when given alone or in abundance. A French observer, M. Colin, 
gave a pig 44 pounds of bread and meat sop, and found 22 pounds in 
the stomach fifteen hours afterwards. A small amount of absorption 
goes on in the stomach of the pig. In the small intestine digestion 
proceeds as in the stomach, and is aided by the secretion of bile from the 
liver and pancreatic juice from the pancreas. These gain access to the 
bowel by means of separate ducts having their openings in the duodenum. 
The pancreatic juice is of considerable importance in the process of 
digestion, as it acts energetically, dissolving all three of the chief con- 
stituents of food-stuffs—viz., carbohydrates, fats, and albuminoids. In the 
transverse folds of the intestine the food in solution is taken up by the 
villi as chyle, and the dissolved carbohydrates, water, and salts pass 


directly by absorption into the bloodvessels. 
441 


442 SYSTEM OF VETERINARY MEDICINE 


The rest of the food-pulp (chyme) travels by means of peristalsis into 
the large intestine, which is wide and well developed in swine. Here 
it undergoes fermentative and putrefactive changes, which are aided by 
its fluid state, the alkaline reaction of the chyme, and a proportionately 
high temperature. 

Cellulose, too, is digested in the large intestine by the process of putre- 
faction, marsh gas being a by-product of the change. 

As the contents of the bowel advance, its fluid part becomes more 
and more absorbed, putrefaction and fermentative changes decline 
through lack of moisture, and finally as feces the residue is expelled 
from the body. The amount of feces passed by adult swine daily is 
from 6 to 9 pounds. Food takes about thirty-six hours to pass through 
the body of a pig from mouth to anus, but this time varies in different 
breeds. Coarse and spoilt food may remain five or six days in the diges- 
tive tract. The stomach of the pig is capable of holding about 14 pints 
when full. 

As the function of a medical work ought primarily to be the prevention 
of disease, this short sketch of the digestive processes in the pig is given as 
a guide to indicate the kind of food swine are best able to deal with. We 
have seen that digestion in their case is a somewhat slow process (there 
is an exception to this rule in the case of potatoes, and when these are 
given a quicker following on of meal-times is indicated), and therefore 
time to digest one meal before another is put down is advisable. They 
are unable to digest coarse food-stufis properly. We have remarked 
that mastication in their case is incomplete, and the structure of the 
digestive tube does not enable them to deal effectively with rough, 
fibrous material. On the contrary, starchy nutriment is well taken by 
them and fully used out. It must be borne in mind, too, in considering 
the digestive disorders to which they are lable, that they are animals 
whose profitable breeding and rearing depend almost entirely upon their 
capacity for putting on flesh and fat. This they are eminently capable 
of doing if fed and treated rightly. To increase in weight 3 pounds 
cattle will need about 15 pounds of dry substance in the food ; swine will 
achieve the same increase in avoirdupois on less than half the quantity of 
this constituent (R. Gouin). 

With these facts before us, let us consider some of the general causes 
which bring about digestive disorders and diseases in swine. The staple 
foods for pigs in this country are what are variously known as sharps, 
middlings, thirds, fourths, dan, randan, or toppings. What is the 
composition of these materials? Are they always of good quality and 
unadulterated ? Middlings should contain less fibre than sharps, and 


DISEASES OF THE DIGESTIVE SYSTEM: PIGS 443 


be more easily digested. Really these offals should consist of parts of 
the outer husk of wheat, forming the residues in the grinding of the 
grain. Their nourishing and digestive properties will depend for their 
value on the proportion of gluten they contain. 

Their composition needs careful examination. We have known them 
to harbour a percentage of sand or to have a too large proportion of husk 
inthem. Middlings, which is the finest offal of wheat, may be adulterated 
with cheaper grain, such as barley-meal, ground oats, rice-meal, or may 
contain even finely ground sawdust or gypsum. Barley-meal also is 
not always up to standard, and is largely used in the feeding of swine. 
To spread sharps or meal in a thin layer on the palm of the hand enables 
a naked-eye examination of the food to be made. Sand in either may 
be detected by putting a small quantity of the material in water, when 
the foreign stuff will sink to the bottom. A rough test may also be 
made this way for the percentage of flour in meal by observing the layer 
floating on top of the water. Examination under the microscope or 
through a good magnifying lens may reveal adulterations or impurities. 
Too frequent or sudden changes of food and improper feeding lead to 
digestive troubles. Any change of food should be gradual. Roots 
should always be given in moderation, and we consider they ought to be 
used raw and never exceed above one-fourth by weight of the solid 
portion of the food. Several examples have come under our notice of 
swine dying suddenly after being fed on cooked swedes or mangolds. 

Scientific investigators state that when cooked the tastiness of the 
roots declines, the albuminous substance in them becomes harder of 
digestion, the ferments that exist naturallyin the roots are destroyed 
by boiling, and the sugar in them is extracted, and, unless the water in 
which they have been boiled is given with them, the sugar is lost to the 
ration. Potatoes, however, should always be cooked, and it is advisable 
that not more than a third part of the solid portion of the ration consists 
of the tubers. All fresh earth-grown stuff (whether raw or cooked) given 
to swine ought to be cleaned and freed from dirt before putting down 
as food. In many cases of poor condition too much swill is given and too 
little concentrated food. This applies especially to the poorer class of 
pig-ownets. 

Acorns in moderate quantity may be consumed pretty safely by pigs 
living in freedom and roaming about. They have a constipating ten- 
dency, especially when eaten with the cortex on ; to pigs in confinement 
they should be dried and shelled and given only in small quantities. 
Some digestive complaints not easily diagnosed arise from the con- 
sumption of decaying, mouldy, or fermenting food. Doubtless also 


t44 SYSTEM OF VETERINARY MEDICINE 


some swine go off their feed in consequence of sour-smelling, badly or 
never cleansed troughs. 

The custom of keeping a wooden tub to steam food in, or as a recep- 
tacle for swill, and using it year in and year out without cleaning, cannot 
but be harmful to the health of porcines. Salt and saltpetre accidentally 
finding their way into the wash may produce deaths in the sty. 

Pure water is very advisable where pigs are kept confined in sties. 
They naturally get much liquid in their ordinary diet, but they enjoy 
a bath in hot weather, and the hygiene of their skin is promoted thereby. 
Swine need 12 to 14 pints of water to each 2 pounds of dry matter in 
the food composition of the ration. 

The cleanliness of sties, too, is important, as contamination of a 
sound food-supply may occur by swine infecting their repast by putting 
their feet in the trough. This may be avoided to a certain extent by 
having receptacles that can be put out of action (hinged troughs) when 
pigs have done feeding. 


DISEASES OF THE MOUTH, PHARYNX, AND GESOPHAGUS. 


Stomatitis, Catarrh, or Inflammation of the Mouth may arise from 
injuries, burns, or chemical irritants. The special way by which swine 
must be controlled in order to doctor or operate on them renders the 
mouth liable to injury from a rope either too coarse and hard or too 
fine and sharp. The lesion here will generally be situated at the back 
of the tusks, and may be a clean-cut incision or an erosion. The mucous 
membrane may be wounded by foreign bodies in the swill or wash, such 
as bottle stoppers or sharp pieces of bone, or perhaps occasionally a piece 
of broken glass or china. 

Pigs wandering about a farmyard may pick up strong awned fodder 
such as barley, and thereby wound the mouth, or when at liberty in a 
field they may get a thorn from a hedge stuck fast in the lining of the 
mouth, or a piece of a branch fixed across the palate or injuring it. Too 
hot food may give rise to scalding, tenderness of the orifice, the snout 
suffering also in this case. Mouldy food may also produce the complaint. 
Chemical irritants may be accidentally partaken of, such as those mislaid 
where disinfecting operations have been in progress, carbolic acid, 
copper sulphate, or corrosive sublimate. Paint-pots carelessly left about, 
have caused the death of more than one pig. Too concentrated or 
irritant medicines given by laymen may also produce the same effect. 
Fuller information on these points may be gained from the section on 
Poisons. 


DISEASES OF THE DIGESTIVE SYSTEM: PIGS 445 


Here it may be stated that Bang and Lauritsen have observed in 
swine diphtheritic-like (pseudo-diphtheritic) membranes on the mucosa 
of the lips and mouth in conjunction with painful swellings of the skin 
in the region of the mouth, together with a diphtheritic necrosis of the 
mucous membrane of the bridge of the nose. Scraping of the necrotic 
spots and subsequent swabbing of the surfaces with beens solutions 
resulted in cure (Hutyra and Marek). 

Catarrh of the mouth may arise in connection with the eruption of 
the teeth, a broken tooth, and in conjunction with foot and mouth disease, 
swine fever, or diseases of the stomach or intestines. Naturally, any one 
of these ailments may bring about loss of condition in an affected subject, 
but unless of bacillary origin they do not usually react harmfully on the 
other organs of the digestive tract in the pig. 

Symptoms.—Refusal of food, thirst, swelling, tumefaction, and sensi- 
tiveness of the oral mucous membrane. Dribbling of saliva from the 
mouth, or ropy slime within the oral orifice or hanging from the corners 
of the mouth, also fur on the tongue. At times the lips and cheeks may 
be swollen, and a discharge from the nose appear, especially where food 
attacked by fungi has been partaken of. The colour of the membrane 
will be greyish-yellow or brown, and if erosions are present, a bright red 
surface will be exhibited. 

Dracnosts.—An examination of the mouth by means of a gag will 
enable the condition to be ascertained. In the case of foot and mouth 
disease, which seldom attacks the nose and oral cavity of swine, vesicles 
will probably be seen at the snout, and the characteristic smacking of 
the lips and dribbling will be present if the mouth is affected. An examina- 
tion revealing that all other organs of the body, apart from the one 
affected, appear to be healthy, will exclude the disease from being mis- 
taken for one secondary to any other ailment. 

TREATMENT.—Cold water to drink, or lukewarm mucilaginous fluid, 
such as thin linseed tea, barley-water, milk-and-egg, or soft sloppy 
food. An electuary made up of boracic acid 1 ounce, and honey or 
treacle 5 ounces, may be given three or four times daily in tea- 
spoonful doses. Powdered alum may be used in the same way and 
dose. 
| A broken tooth can be removed with difficulty, or its sharp edges 

may be filed down, and soreness from eruption of the teeth will disappear 
in time with suitable feeding. 

In the case of hot or mouldy food, a change of procedure or diet will 
correct the continuance of the mischief. Inflammation of the mouth 
from injuries and chemical irritants may also be treated in the above- 


446 SYSTEM OF VETERINARY MEDICINE 


mentioned way, though if the poison be known, the administration of its 
antidote is indicated. 

Diphtheritic Inflammation of the Mouth in Young Swine—* Pharyn- 
geal Diphtheria.”—A part from this complaint, arising as a complication 
in swine fever, it may be seen now and again as an independent affection 
attacking individual young animals, such as suckers and stores. 

Symproms.—Inflamed, swollen, hard, painful elevations on the lips, 
tongue, and mucous membrane of the cheeks. Fever and small appetite. 
Necrotic spots arise after a few days in the centre of the inflamed parts. 
Dirty greyish-yellow dry patches form. The necrotic piece of tissue is 
cast off, and the defect cicatrises, or the necrosis spreads farther and 
deeper. The animals eat badly, and have difficulty in swallowing. 
There is swelling of the pharynx, coughing, diarrhoea, and often symptoms 
of pneumonia. 

HTIoLogy.—Several investigators (K. Glasser, Glage, Jess, etc.) have 
found the Bacillus necrophorus in the necrotic masses removed from the 
lesions. In quite similar cases characterised by an acute course and 
contagious spread Guillebeau found diphtheria bacilli. 

TREATMENT.—Separate sick animals from healthy ones. Paint the 
necrotic spots with tincture of iodine, and internally give 15 to 40 grains 
of potassium iodide internally. Remove any necrotic shreds from the 
lips, and effectually destroy (burn) the pieces removed. 

Inflammation of the Tongue, or Glossitis, may arise from the same 
causes as stomatitis. The superficial layer of the organ may suffer, or 
the inflammation may be deep-seated and attack the substance of the 
tongue itself (foreign bodies, wounds, or contusions). 

Where the outside layer only is affected, there will be redness and 
swelling of the mucous membrane, increased warmth and sensitiveness, 
and cracks, fissures, or erosions. 

The symptoms of severe injuries or disease of the tongue are as 
follows:—The organ is painful, hard, swollen, stiff, and red or purple in 
colour. The circumvallate papille on the sides of the tongue are enlarged 
and prominent. The mouth may be held open, and any attempt at 
swallowing will be painful. : 

There may be discharge of saliva mixed with epithelial shreds from 
the mouth, or at times a purulent discharge. The tip of the tongue 
may mortify. The root of the tongue may be inflamed by extension of 
inflammation from the pharynx (pharyngitis). 3 

TREATMENT of glossitis may be carried out as for stomatitis. In 
addition, the injection of cooling and antiseptic (iced water, boracic or 
chinosol solution), fluids into the mouth is indicated. 


DISEASES OF THE DIGESTIVE SYSTEM: PIGS 447 


Professor I. Poenaru described a case of thrush in the pig due to 
Saccharomyces albicans, in Arhiva Veterinara for 1911 (see Veterinary 
Journal, 1911, pp. 254-255). The animal was being nourished on the 
artificial teat, and presented rounded plaques of a dirty cream-white colour 
on the tongue. The plaques assumed the form of pseudo-membranes, 
and were easily detachable from the mucosa. The pig was thin, held its 
mouth open, and suction and deglutition were painful. Poenaru demon- 
strated the parasite under the microscope, and transferred the disease 
to experimental animals by inoculation. 

Inflammation of the Pharynx— Pharyngitis— Angina, occurs rather 
frequently in swine. It may be due to mechanical injuries, burns, 
chemical irritants, or chills followed by bacterial invasion, the bacteria 
in this case being coli and proteus bacilli and streptococci (K. Glasser). 
Inflammation of the pharynx may be acute or chronic, the latter lasting 
for some time with frequent relapses. The complaint may occur as an 
accompaniment of some of the infections diseases of pigs (anthrax, swine 
fever, diphtheria of young pigs). 

Symproms.—Refusal of food, pain and difficulty in swallowing, a 
painful squeal when the attempt is made. Dribbling of saliva from the 
corners of the mouth, head poked out straight, and neck stiff. The throat 
is generally swollen and glands painful, and the skin of the region may 
assume a bluish-red colour externally. There is discharge from the nose, 
coughing, and a rise of temperature. Difficulty in breathing may arise 
through swelling of the larynx and tonsils. The larynx, pharynx, and 
tonsils are generally all implicated in the disease. Vomiting may occur 
reflexly through irritation of the throat by the disease or from coughing. 
Hutyra and Marek state that one of the reasons for swine being so sus- 
ceptible to pharyngitis is that their tonsils (and those of the horse also) 
possess several foramina ceca (and not one foramen cecum as with 
other animals), and consequently more ports of entry exist for exciters of 
inflammation. 

Dracnosis.—Is not as a rule difficult, especially where a view of the 
pharynx can be obtained. The fever, swelling of the region, and perhaps 
the discharge coughed up enable a satisfactory judgment to be formed. 
In the early stages the possibility of the development of anthrax or 
hemorrhagic septicemia must not be overlooked (Hutyra and Marek). 
In tuberculosis the lymphatic glands at the entrance to the larynx are 
swollen. 

Procnosis.—Simple inflammation of the pharynx generally ends 
favourably. Injuries due to foreign bodies followed by pus formation 
or a diphtheritic affection of the throat frequently end fatally. 


448 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—Milk or milk and barley-water to drink, in which 
20 to 40 grains of potassium chlorate have been dissolved. Boracic 
electuary may be smeared in the mouth and on the lips. An attack of 
pharyngitis may be cut short if a sharp saline purge such as Rochelle 
salts can be given. Vomiting may relieve the condition and may be 
excited by giving 15 grains of tartar emetic and 45 grains of powdered 
ipecacuanha. ‘The tartar emetic may be dissolved in milk, and the pig 
allowed to drink it, and the ipecacuanha divided into two portions, one 
half being given first, followed by the other half after a quarter of an 
hour’s interval. Apomorphine 4 to 4 grain injected hypodermically 
seems worthy of trial as an emetic, and would do away with the trouble 
of administering medicine by the mouth. Steam the head with disin- 
fectants if possible, such as creolin or lysol solution. Apply liquid mus- 
tard or liniment to the throat. Frequently clean out the sty, give 
warm dry litter, and protect the subject from cold draughts. 


French authors (P. Cagny and R. Gouin) describe a malady of pigs 
under the name of Soie, which is common enough in France and always 
serious. It is caused by invagination of the skin of the throat imme- 
diately beneath the parotids ; deviated bristles penetrate into the pharynx 
or larynx, perforate them, and give rise to symptoms of angina and 
asphyxia. The animal may be affected on one or both sides. The 
origin of this affection is a fault in conformation. 

TREATMENT consists in excision of the tissues penetrated by the 
offending bristles. 

Inflammation of the Gesophagus—Csophagitis.—This disease in the 
pigis generally due to irritation of a foreign body lodging in the gullet, 
or to a wound produced by the rough or sharp surface of some object 
in passing down the tube. Pieces of potato, carrots, swedes, bones, 
leaves, fruits, etc., may lodge in the cesophagus and cause choking. 
These substances are swallowed with little or no mastication, and may 
stick at the head of the gullet or in the tube itself. In the pig the former 
position, or just in front of the entrance of the gullet into the chest, is 
the commonest. 

Symptoms.—Ceasing to eat food ; attempts at vomiting with head 
depressed and mouth open; flow of glairy or thready saliva. Water, 
if taken, returns down the nose. Painful squealing, lying down and getting 
up frequently, swallowing of saliva in a “gulpy”’ manner. If the 
offending object remains long in position, tympanites may occur. 

TREATMENT.—If there is reason to believe that the foreign body has 
been cooked and is moderately soft, it may disappear spontaneously 


DISEASES OF THE DIGESTIVE SYSTEM: PIGS 449 


after a time if mucilaginous drinks are placed before the animal. Manipu- 
lation on the sides of the throat and neck may help to remove it. Hypo- 
dermic injections of veratrine (+ grain) or apomorphine (} to } grain) 
may be given. 

The writer has a lively recollection of passing the cattle probang in 
a large black boar of the Berkshire breed, and relief was given by the 
operation. This instrument may therefore be used in fairly large 
animals. 


DISEASES OF THE STOMACH. 


Overloading, Surfeit, or Surcharge of the Stomach—<Acute Indiges- 
tion—Acute Dilatation of the Stomach.—We have observed that swine 
swallow their food without much mastication. Food which swells in the 
stomach after being eaten, indigestible or fermenting food, sour grain, 
especially of the leguminous variety, if taken in large quantities, cause 
overloading of the stomach and acute dilatation. If the pigs are very 
hungry, and large meals are fed at long or irregular intervals, they are 
likely to gorge themselves more with harmful food than otherwise, and 
the effect produced will be so much the worse. 

Too large quantities of bread in the swill, especially if mouldy, may 
aid in producing the condition. A chronic dilatation of the stomach 
may arise from too copious feeding on greenstuff during the growing or 
store period. Frequent attacks of gastritis may be followed by chronic 
dilatation of the stomach. 

Symproms.—Soon after partaking of food the animal becomes de- 
jected, groans, and the breathing is laboured and accelerated. It may 
assume the dog-sitting posture or move restlessly about (K. Glasser). 
It may le prone on its bed with a complaining grunt, refuse to move, 
even when urged to do so ; ears and extremities cold. 

TREATMENT.—The use of emetics is indicated ; 15 to 30 grains of 
tartar emetic may be given in three doses, or powdered ipecacuanha 15 to 
30 grains. Hot fomentations may be applied to the abdomen by means 
of cloths wrung out of hot water. After vomition has been produced, 
a gastric sedative such as 15 grains of chloretone or 10 to 15 grains of 
8-naphthol may be administered, together with teaspoonful doses of 
powdered wood charcoal. 

Gastritis—Acute Gastric Catarrh—Inflammation of the Stomach.— 
This disease may arise from too cold or hot food, from very indigestible 
aliment, or may be an accompaniment of the previous ailment (over- 
loading of the stomach). Adulteration of the various millers’ offals or 
the meals given to pigs may produce it. Thirds or fourths may contain 

VOL. II, 29 


450 SYSTEM OF VETERINARY MEDICINE 


harmful ingredients such as sawdust, husks of rice, peas or maize, and 
even finely ground chalk. Foreign bodies such as stones, sand, pieces of 
wood, balls of hair, or the small hairs in oats, etc., may cause it. Salt 
and saltpetre in the wash, and poisons (arsenic, sheep dip, or wheat 
dressing), and bacteria and their toxins may bring it about. The pig, 
when free, is a great scavenger, and when hungry may eat much that is 
harmful, and when stied the uncleanly state in which it is often kept, 
together with its habit of feeding (feet in the trough), render it hable 
to contaminate its food with bacteria, and suffer accordingly. In a sub- 
acute or chronic form, the affection may arise from spoilt food (swine are 
frequently given food that is damaged). Asa secondary acute disease it 
is Seen in swine fever, swine erysipelas, and other infectious diseases. 

Symproms.—Little appetite for food ; not coming up to the trough 
but isolating itself; arched back and tucked-up abdomen ; crouching 
in the litter ; thirst ; hot and red skin ; dejected appearance and subdued 
erunt ; rise of temperature, cold ears and extremities ; vomiting and 
colicky pains ; restlessness. Gastric tympanites may be noticed, and the 
feeces may be hard, dry, and dark coloured, or there may be diarrhcea 
where the bowels are also involved. Vomiting of blood may arise where 
foreign bodies have been swallowed. 

In acute indigestion and gastritis a rash may arise on the skin of 
swine, especially if they have been kept poorly and. in damp, dirty sties. 
An inquiry into the composition of the rations is always advisable in 
order that a rash due to digestive ailments be not mistaken for the skin 
eruption of swine fever. 

Post-Mortem APPEARANCES. HGP rt shmy coating on the 
mucous membrane of the stomach, seen chiefly in the chronic form of the 
complaint. Intense reddening and solution of the mucous membrane, 
and serous infiltration. Hemorrhagic or diphtheritic patches on the 
membrane, mostly near the pylorus. 

TREATMENT.—Emetics, hypodermic injections of veratrine (4 grain). 
Rest to the stomach. Mucilaginous fluids, barley-water, linseed-tea, 
later on milk, milk-and-egg; potassium iodide and soda RICHRDAR AT, 
aa ors. xx. to xl., dissolved in milk twice daily. 

Vomiting occurs easily in swine, and does not always indicate a serious 
disease. Slight irritation of the stomach, as that arising from catarrh, 

may be the cause, or the act may be induced by reflex irritation due to 
coughing or chills. 

. Generally it is a healthy sign by which indigestible, poisonous, or 
a too great quantity of food is thrown up again off the stomach. Vomit 
may contain dung, blood, slimy mucus, or gall. 


DISEASES OF THE DIGESTIVE SYSTEM: PIGS 45] 


A serious condition is generally indicated when feces appear in the 
material voided (see below). 

The Cause of vomiting may be anything that excites the vomit- 
ing centre directly, or acts reflexly on it, such as irritability or 
disease of the digestive organs. One of the most frequent causes is over- 
loading of the stomach or catarrhal or inflammatory conditions of its 
mucous membrane. It may occur in intestinal disease, where the lumen 
of the bowel is obliterated or obstructed (antiperistaltic action). In 
choking it arises, and in pharyngitis and laryngitis, and is also seen in 
dilatation, stricture, and paralysis of the cesophagus. A. severe blow 
on the head, or brain disease, may cause it by acting indirectly on the 
vomiting centre. 


DISEASES OF THE INTESTINE. 


Fnteritis—Inflammation of the Intestine is occasioned by the same 
causes as gastritis. Cold, mouldy, or spoilt food and toxic plants produce 
it. It may arise from rupture, twist, or invagination of the bowel. 

Symproms.—Acute and painful in grave affections of the intestine, 
such as those last mentioned. Colicky pains, restlessness, plaintive 
erunting or squealing, and illness of short duration, ending fatally. If 
the lumen of the bowel is unobstructed, diarrhoea sets in, whereas, if an 
obstruction exists, vomiting of dung may occur, together with tympanites 
and colicky pains. Owing to the facility with which swine vomit, the 
nature of their ordinary food, and the fact that they are seldom exhausted 
before enteritis sets in, this disease is perhaps not so enen or fatal 
with them as in the horse. 

TREATMENT.—Varied according to the cause. If no serious intestinal 
involvement or alteration (rupture, strangulation, twist, etc.), laxative 
medicines, such as sulphate of soda | to 2 ounces, cream of tartar 1 to 14 
ounces, castor oil 2 to 3 ounces, together with 15 grains of calomel, may 
be given. Fresh milk, mucilaginous wash, semi-liquid food are the diets 
indicated when the acute symptoms are past. Solid food must not be 
given for many days, and the patient must be kept warm and dry. 

Tympanites, Flatulent Colic, Gaseous Intestinal Indigestion, occurs 
after partaking of fermenting food such as brewers’ grains, from digestive 
weakness, and is also symptomatic of poisoning and inflammation of 
the stomach and intestine. ‘As a secondary affection it is seen in stoppage 
of peristalsis, ruptures, twist, and invagination of the bowel. 

Symproms.—Painful grunting or squealing, frequent change of posi- 
tion, belching, choking, and vomiting. Swelling of the abdominal region. 

TREATMENT,—Kneading and massage of the abdomen, stirring the 


452 SYSTEM OF VETERINARY MEDICINE 


subject up, and encouraging movement; hypodermic injections of 
apomorphine or veratrine; calcined magnesia given in milk or thin 
electuaries. It may be necessary to puncture the distended bowel, 
and this may be done with a suitable trocar and cannula (not too big 
or long), at a spot about the middle of the left or right side of the belly. 

Mesenterial Emphysema.— Under this name K. Glasser, Professor 
at the Royal Veterinary College in Hanover, describes a disease of the 
small intestine of pigs which is not infrequently seen as a post-mortem 
condition. Little vesicles or bladders occur in the lymph spaces of the 
intestine (especially those of the subserous tissue) between the leaves of 
the mesentery and in the intestinal lymphatic glands. These vesicles 
in the mesentery and subserosa may be the size of a pea or hazel-nut, 
and in the lymphatic glands are generally about the dimensions of a 
millet-seed. The little bladders under the serosa are often pedunculated, 
and on pressure on the pedicle, blood is extruded into the wall of the 
vesicle or its cavity. Near the vesicles may be seen firmly adherent 
shaggy appendages. Symptoms of chronic intestinal catarrh were often 
present. Thickening of the tissue by small cell infiltration in which 
eosinophile leucocytes predominated was seen in one case. This pig had 
eaten badly for several weeks before slaughter. The causes of this con- 
dition are not well known. One observer (Heydemann) attributes it to 
atmospheric air swallowed during attacks of catarrh, which passes into 
the lymph spaces. Other investigators (Jaeger, etc.) consider that it 1s 
due to the presence of gas-forming bacteria that penetrate into the 
intestinal wall. Glasser believes that there is no bacterial invasion 
because in his investigations he found no bacteria nor any inflammatory 
reaction in the neighbourhood of the vesicles. 

Constipation — Obstipation — Stoppage of the Bowels — Indigestion 
through Intestinal Surcharge.—Thickened masses of ingesta accumulating 
in the intestine cause stoppage of peristaltic movement and secondary 
dilatation of the bowel involved. 

An animal much be-stied like the pig often gets insufficient exercise, 
and is yet forced on to fatness by much feeding ; hence this complaint 
arises somewhat frequently. Dry grain food and insufficient fluid 
nourishment bring it about, as does also the eating of sand, hair, or 
hard and indigestible food, such as a too great quantity of acorns (es- 
pecially if unshelled) or beech-nuts. 

As a secondary affection it may occur in swine fever, tuberculosis, 
or chronic thickening of the mucous membrane of the bowel (stenosis). 
A hard, dry, blackish state of the bowels is not uncommon in sows before 
and after parturition, and it may end fatally. 


DISEASES OF THE DIGESTIVE SYSTEM: PIGS 453 


Symproms.—Lack of appetite, frequent grunting, and straining. 
Passage of small, hard, blackish feces, followed by complete stoppage. 
Palpation of the abdominal region may reveal a large intestine dis- 
tended with hard feces. Oppenheim records a case where impaction 
of the colon brought about retention of urine by pressure of the impacted 
bowel on the neck of the bladder (Hutyra and Marek). Severe cases of 
constipation may lead to inflammation of the bowels. 

TREATMENT.—Injections of warm soapy water per rectum. Sodium 
sulphate, 1 to 2 ounces, in the drinking-water or on the tongue ;_ castor 
oll, 2 to 3 ounces; calomel, 15 grains to 1 drachm; tartar emetic, 
4 to 15 grains. Hypodermic injection of eserine, =45 to #5 grain. As 
diet, good vegetable wash, green food, sour milk, or whey, may be given. 

Stenosis—Incarceration and Strangulation of the Intestine—Volvulus 
and Torsion of the Intestine.—These serious conditions may all occur in 
swine, 

(a) Stenosis is a more or less chronic disease of the intestine, develop- 
ing gradually, and causing a reduction in size of the lumen of the bowel. 
It may result from cicatricial tissue developing in the wall of the bowel 
after an injury from a foreign body. It may follow chronic peritonitis, 
or be occasioned by the presence of tumours. In swine, stenosis may 
occur after an operation for prolapse of the rectum, as a result of pressure 
from a pregnant uterus or enlarged spleen, or from an abscess pressing 
on the intestinal wall. 

SymMPtToMs.—Gradually developing constipation. 

DiaGNosis may be made-by palpation, and the presence of hard 
bodies in the intestine or mesentery detected. Rectal exploration will 
enable narrowing of this section of bowel to be ascertained. 

(b) Incarceration and Strangulation of the Intestine arises from rupture 
of the mesentery and passage of a loop of intestine through the rent, 
from connective-tissue bands forming after chronic peritonitis, from 
pedunculated tumours, and from Cysticercus tenurcollis, where the 
duodenum was found to be incarcerated and strangulated (Hutyra 
and Marek). . he condition also occurs in hernias (ventral and scrotal). 

SyMPToMS.—Dejected look, painful grunting, uneasiness, lying on 
the belly, eructation, persistent vomiting (dung may be present in the 
vomit), complete cessation of the passage of feeces. 

Abdominal palpation may reveal the incarcerated portion of gut, 
which will be much distended. The great unrest first observed may 
disappear after a few hours, but this is only due to lack of sensitiveness 
in the part affected from necrosis, or dulling of sensation in the nerve 
endings. 


454 SYSTEM OF VETERINARY MEDICINE 


High temperature, increased pulse-rate, and obstinate vomiting 
indicate that the serious condition is still present. 

(c) Voluulus and Torsion of the Intestine is a condition arising where 
the lumen of the bowel is suddenly closed by the gut being twisted round 
its own axis or being snared and compressed by an adjacent loop of bowel. 

Symproms.—Similar to those of incarceration and strangulation of 
the intestine. , 

Dracnosis.—Abdominal palpation or rectal examination may reveal 
the condition. Laparotomy is a certain means of diagnosis, but is seldom 
undertaken in swine. 

Peritonitis.—Inflammation of the peritoneum may be due to ulcer 
and perforation of the bowel, to an external wound, to a foreign body, 
to rectal injury or disease, and rupture of the uterus or vagina. It may 
be seen also in a chronic or acute form when bacterial invasion of the 
intestine occurs (swine fever, anthrax, etc.). 

Symptoms.—Rise of temperature, sensitiveness of the abdomen, 
quick weak pulse. 

Diaenosis.—Palpation of the abdomen or an exploratory puncture 
may reveal the nature of the disease. 

TREATMENT.—Antiseptic surgical measures to any external wound. 
Potassium iodide, 20 to 40 grains. Nourishing, easily digested food. 
Treatment seldom undertaken in swine. 

Diarrhoea—Acute Intestinal Catarrh.—Repeated evacuation of thin 
fluid, or semifluid excrement is brought about by an inflammatory 
irritation or catarrh of the mucous membrane of the intestine. There is 
an increased flow of blood to the part, and a stimulation of peristaltic 
movement. 

It is frequently seen in suckers and young swine when being 
weaned, or separated at too early an age from the dam. As an 
infectious complaint it is due to bacteria which set up intestinal] catarrh. 

CausEes.—Improper food, irregular feeding, dirty, cold, and damp 
sties. The sow’s milk may be affected through poor food, decaying food, 
a too great quantity of vegetable matter, feeding on swedes or mangel- 
wurzels which have been richly manured. Bad smells such as those 
arising from decaying animal (dead rats) or vegetable matter, bad 
drainage, may upset the sow’s milk and cause diarrhoea amongst the 
youngsters. A faulty secretion of the digestive juices in subjects’ 
attacked may occasion the complaint. 

Foul or bad smelling milk given to weaners soon causes diarrhea, 
and even cow’s milk when fresh, given to swine of too tender an age 
which have been separated from the dam through untoward circum- 


DISEASES OF THE DIGESTIVE SYSTEM: PIGS 455 


stances, may disagree with them and produce the disease. A sudden 
change from prepared food to green food may cause diarrhea in the 
dam, while fouling of the sow’s teats by putrefying matter may occasion 
it in the litter. 

Symproms.—In the first few days of life, or shortly after separation 
from the mother, fluid or semi-fluid feeces of a yellowish or greyish-white 
colour are passed. There is little general indisposition at first, but continued 
diarrhoea soon exhausts the strength of the subjects ; they get weak and 
listless, and do not suck or come up to the trough. The bristles, if 
present, stand up and appear lustreless, the rosy tint of the skin turns 
to grey, greyish-yellow, or yellow (icteric). Eczema, nervous spasms, 
prostration, kicking at the body, and loss of consciousness may precede 
death. Diarrhoea may continue several days, and then gradually dis- 
appear, or 1t may cease for a time and be followed by constipation and 
tympanites, only to reappear again later on. This condition may even- 
tually cease, but it may become continuous and intermittent, and lead 
to exhaustion and death. 

Post-MortEM APPEARANCES show that in simple diarrhcea the 
mucous membrane of the small intestine is more diseased than that of 
the large bowel, Peyer’s patches and the solitary follicles being much 
swollen. The carcass is anemic, the neighbourhood of the rectum soiled 
with slimy or caked dung, the perineum excoriated and hyperemic, 
diffuse reddened surfaces on the mucous membrane of the stomach and 
intestines. . 

PREVENTION AND MepictnaL TREATMENT.—Clean, warm, dry sties, 
clean troughs and utensils. Suitable and sound food. Avoidance of 
weaning swine before the lapse of six weeks. Access to fresh earth or 
pond slime. This may be put on the floor of the sty, and besides pre- 
venting disease, absorbs bad gases. Small coal or ashes in the sty, 
wood charcoal in the food, are among the prophylactic measures adopted 
by breeders. Change the diet of the dam where ‘suckers are affected. 
In the early stages 3 ounces of castor oil may be given. Later on, such 
agents as subnitrate of bismuth 30 to 45 grains, tannic acid 3 to 15 
grains, pulv. rhei 15 to 30 grains, may be given three times daily. 
Starch enemas allay irritability of the lower bowel. Young swine 
suffering when fed on fresh cow’s milk may be saved by giving sour 
milk in its place. Then rice or wheat-flour gruel may be given as diet. 

Sows when attacked must be separated from their litters if possible, 
and fed on dry food or sweet skim milk. The youngsters may be induced 
to take thin arrowroot, made to the consistency of skim milk, from the 
artificial teat. 


DISEASES OF THE DIGESTIVE SYSTEM 
IN THE DOG 


By E. WALLIS HOARE, F.R.C.V.S. 


DISEASES OF THE MOUTH AND TONGUE. 
GENERAL REMARKS. 


In canine practice diseases of the mouth occupy a very important 
position. Not only are there primary affections of this region requiring 
attention, but also lesions of a secondary character are not uncommonly 
met with. The condition of the oral cavity is an index of the general 
health of the animal. If it is foul and offensive, it points either to an 
abnormal state of the teeth, gums, or buccal mucosa, or to derangement 
of the alimentary canal. Again, in certain diseases, such as some cases 
of canine distemper and in canine typhus, oral lesions occur, and often 
prove very serious (see Vo]. I.). The tongue in health is of a bright 
pinkish colour; it is mobile, and the papille are noticeable. Many 
authors describe a “furred ” tongue as present in certain gastric dis- 
orders, but a whitish or soapy condition of the organ is more commonly 
met with, or it may be of a copper-coloured tint. 

A careful examination of the mouth is essential in the diagnosis of 
canine ailments, and, as compared with horses and cattle, the procedure 
can be carried out with far greater facility. Neglect of this simple 
measure is responsible for many errors in diagnosis. The presence of 
foreign bodies located between the teeth, also sharp objects, such as 
needles, pins, etc., fixed in the tongue or buccal mucosa, produce symp- 
toms which may be mistaken for those due to other affections, unless a — 
proper examination be made. Small particles of bone lodged between 
the teeth or attached to the tuberculate crowns of the molars cause 
serious discomfort to the dog. It is of importance also to detect the | 
presence of diseased teeth, of abnormal conditions of the gums, the 
various forms of stomatitis, and any other morbid states of the buccal 
mucosa and of the pharynx. 


The best mouth-gag for the dog and cat is the pattern invented by 
456 


DISEASES OF THE MOUTH AND TONGUE: DOG 457 


Gray, as with it a very complete examination of the mouth, teeth, and 
pharynx, can be made. A small electric torch also proves of great 
assistance in this direction. ‘The tongue should be gently drawn forward 
between the thumb and forefinger, a soft towel being employed to pre- 
vent the organ from slipping. 


STOMATITIS. 


Catarrhal Stomatitis—This signifies a catarrhal inflammation of the 
buccal mucosa, and is a condition of frequent occurrence in the dog. 
It varies in intensity according to the nature of the etiological factor, 
and to the vitality and state of health of the animal. When occurring 
in aged and debilitated animals, especially those suffering from aflections 
of the teeth, it may terminate in an ulcerative or septic form of stoma- 
titis. As a secondary affection, it occurs in connection with gastric and 
intestinal disorders, and certain infectious diseases, such as distemper. 

Kt10oLogy.—Modern authorities regard the condition as depending on 
microbial infection, and hold that the causes formerly accepted simply 
act as predisposing factors by either lowering the vitality of the buccal 
mucosa or by causing abrasions, through which the micro-organisms that 
are always present in the mouth gain entrance and set up stomatitis. 
The presence of tartar on the teeth or of dental diseases also favours 
infection. 

Foreign bodies in the mouth, irritating medicaments, too hot food 
taken by hungry dogs, accumulations of particles of food about the 
teeth, are the predisposing causes generally recognised. Stomatitis may 
also be associated with the presence of retention cysts or tumours in the 
mouth. As a secondary affection associated with certain infectious 
diseases and with disorders of the digestive organs, 1t probably depends 
on interference with the nutrition of the buccal epithelium, so that 
infection is facilitated. 

Symproms.—Probably the first symptoms observed are a difficulty 
in mastication, offensive breath, salivation, and a disinclination to take 
hard food or large morsels. This leads to an examination of the mouth— 
a procedure which the animal resists. The mucous membrane of the 
cheeks, gums, and borders of the tongue, is congested, reddened, dry, 
and hot, and desquamation of the epithelium may be observed. The 
dorsum of the tongue may be covered by a greyish or yellowish coating. 
According to Hutyra and Marek, the surface of the tongue is covered 
by a light or dark greyish, cracked layer, formed by the loosened epi- 
thelium mixed with particles of food. In severe cases the mouth has a 
foetid odour, salivation is present, and saliva mixed with mucus hangs 


458 SYSTEM OF VETERINARY MEDICINE 


from the commissures of the lips. Such instances may be followed by 
the ulcerative form of stomatitis, especially when associated with the 
presence of diseased teeth, or when the exciting causes are permitted to 
continue. 

Mild cases may recover either spontaneously or with simple treat- 
ment. . 

TREATMENT.—Attention to diet is necessary, and all food of a hard 
nature should be interdicted. If accumulations of tartar around the 
teeth are present, the operation of “ scaling ” the teeth should be carried 
out. Various agents in the form of mouth-washes are advised, such as 
those composed of dilute hydrochloric acid, tannin, and honey, or of 
permanganate of potash, boric acid, etc. Tincture of myrrh may also 
be applied to the gums. Solutions of peroxide of hydrogen are also 
useful. If dyspepsia be present, it will require suitable treatment 
(see p. 483). If decayed or loose teeth are present, they should be 
extracted. 

Ulcerative Stomatitis.—This is a far more serious affection than the 
catarrhal form, and, unless treated early, complications are apt to ensue. 

Etiotogy.—As exciting local causes, affections of the teeth are of 
importance. Accumulations of tartar around the teeth favour infection 
by acting as receptacles for micro-organisms. Such deposits also act 
mechanically by burrowing between the free border of the gum and the 
surface of the tooth, and thus forming culs-de-sac in which food accumu- 
lates and ferments. Various micro-organisms are concerned in the 
production of the ulcers. 

The affection may also occur in connection with distemper, rickets, 
dyspepsia, and all debilitating diseases. It is common in aged, pam- 
pered animals. | 

Symptoms.—Loss of appetite and the presence of salivation lead the 
practitioner to examine the mouth. The mucosa of the cheeks and lips 
is swollen and congested, and shows greyish-yellow spots, with disintegra- 
tion of the epithelium. The gums are spongy and friable, bleed readily 
if handled, and greyish-yellow spots are found, especially close to the 
teeth. The epithelium is shed in patches, and round or oval ulcers are 
formed, having irregular borders of a violet-red colour. The ulcers on 
the gums are often in the form of a ring around the incisor teeth, and 
in young dogs especially may extend to the commissures of the lips and 
to the skin in the vicinity. | 

In old dogs particularly the ulcers may form rapidly, and finally lead 
to loosening of the teeth and necrosis of the alveoli. Salivation is profuse, 
the saliva is foetid and viscid, and contains portions of food, as well as 


DISEASES OF THE MOUTH AND TONGUE: DOG 459 


débris of the mucosa. The dog resents violently any attempt to examine 
the mouth, and if the latter is forcibly opened, he shows evidences of 
pain by howling. Difficulty in mastication is present, and in some cases 
shght fever. The lymphatic glands of the throat or neck may be swollen, 
due to septic infection. In grave cases general septicemia may result, 
and death occurs in from six to ten days. Chronic cases may last from 
three to four weeks, and succumb to gastric or intestinal complications. 

TREATMENT.—The mouth should be frequently cleansed with anti- 
septic solutions. These include solutions of boric acid, peroxide of 
hydrogen, etc. Cadéac advises a 10 per cent. solution of oil of thyme. 
A mouth-wash containing small amounts of dilute hydrochloric acid with 
quinine is also useful. All loose teeth should be extracted, and incrusta- 
tions of tartar removed from the remaining teeth. As an application to 
the ulcers, the above author recommends | part of thymol, 3 parts of 
alcohol, and 50 parts of water. Attention to the general health of the 
animal is essential, and the gastric disorder which is usually present will 
require suitable treatment. 

Follicular Stomatitis.—This condition is described by some authors as 
occurring in the dog. The excretory ducts of the mucous glands become 
occluded, and small greyish nodules are observed, especially on the 
internal surfaces of the lips. In rare instances small shallow ulcers form, 
which tend to heal spontaneously. Nothing is known with reference to 
the etiology. The treatment is similar to that advised for the forms of 
stomatitis already described. 

Mercurial Stomatitis—This is one of the symptoms of mercurial 
poisoning. It may arise from the animal licking parts to which oint- 
ments containing mercury have been applied, or from absorption of the 
agent by the skin; also as the result of the continued internal administra- 
tion of the drug, or the use of lotions containing perchloride of mercury. 
According to some observers, the development of mercurial stomatitis is 
largely influenced by the presence of abnormal conditions of the gums, 
teeth, etc., and the lesions are most marked in the vicinity of diseased 
teeth. . 

Symproms.—The gums are inflamed, especially in the region of 
previously diseased teeth; accumulations of tartar are present, the mouth 
exhales a foetid odour, salivation is profuse, the teeth become loosened, 
ulcers may form on the labial mucosa, and the appetite is impaired. In 
erave cases septic infection occurs, ulcers are observed in the vicinity of 
each canine tooth, and on the buccal mucosa; also erosions and ulcera- 
tions of the gums are present; the saliva is viscid, foetid, and blood- 
streaked, and the submaxillary glands swollen and painful. 


460 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—AIl loose teeth should be extracted. Mouth-washes 
composed of chlorate of potash (2 per cent.) or of peroxide of hydrogen 
should be prescribed. In severe cases small doses of potassium iodide 
should be given internally. 


RETENTION CYST. 


A soft, bladder-like swelling is not infrequently found at the lateral 
or under surface of the tongue, usually in the vicinity of the frenum. 
The condition is generally termed a “ ranula,’ and is often described as 
depending on an obstruction in Wharton’s duct, or a dilatation of the 
mucous glands of the mouth or of the sublingual glands. Hobday 
attributes it to “cystic degeneration, or perhaps to blocking and con- 
sequent enlargement of one of the mucous glands of the mouth.” Accord- 
ing to Cadéac, the cyst should be regarded as congenital in origin, as it 
does not contain saliva, and has generally no connection with Wharton’s 
duct. It contains a thick glairy mucous fluid. According to Gray, the 
affection is more commonly met with in long-coated dogs. 

In some instances it burrows into the neck, and forms a prominent 
soft swelling in the submaxillary region and superior extremity of the 
neck. This form is termed by Cadéac “‘ subhyoideal ranula.” In some 
cases the cyst is covered by the facial muscles, and is situated on the 
anterior aspect of the pharyngo-laryngeal region; in others, a large multi- 
locular cavity is formed, with thin walls composed of connective tissue 
lined by epithelium. 

SymMproms.—The cyst may develop rapidly, and causes the animal 
discomfort. Salivation and difficulty in swallowing are present, and the 
tongue may be displaced to one side. When the cyst is of large size, it. 
may prevent closure of the mouth. In some instances two or three 
cysts are found adherent to the floor of the mouth, and situated on either 
side of the frenum. When extending down the neck, the cyst develops 
slowly. We have observed cases in which the sublingual and subhyoideal 
forms have been associated. 

TREATMENT.—When occurring in the mouth, Hobday advises that 
the cyst should be punctured with a scalpel, and the whole of its wall 
dissected away as closely as possible. If any portion is left, a recurrence 
will take place in a short time. C. French also recommends complete 
excision of the lining membrane. Gray advises to remove a wide tri- 
angular portion of the lining membrane. In cases where the lesion extends 
down the neck, excision is very difficult, as the cyst may extend behind 
the cesophagus and larynx. We have found such instances very obstinate 


DISEASES OF THE MOUTH AND TONGUE: DOG 461 


to treat, and recurrence was the rule. Frohner advises that the contents 
be removed, and the sac injected with a 2 per cent. alcoholic solution of 
iodine. This causes marked irritation and pain. In two or three days 
an aspirator is employed to ascertain if pus is present, and if the result 
proves negative, the injection of iodine is repeated. When suppuration 
is established, the part should be opened freely and the pus evacuated. 
A tampon of gauze is then inserted. Recovery occurs in from three to 
six weeks. 


GLOSSITIS. 


Inflammation of the tongue may occur in the dog from contact with 
irritating agents, from wounds, from injuries caused by the teeth during 
an attack of epilepsy, also from the presence of a sharp foreign body in 
the organ, or from the sting of a bee or wasp. It is sometimes associated 
with canine typhus. 

Symproms.—The tongue is swollen, and in severe cases may protrude 
from the mouth. Salivation is present, also difficulty in mastication 
and deglutition. 

TREATMENT.—If the organ be extensively swollen, scarification may 
be necessary. Antiseptic mouth-washes similar to those advised for 
stomatitis are indicated. 


PARALYSIS OF THE TONGUE. 


This affection is occasionally met with in the dog. It occurs in the 
form of a partial paralysis of the organ, and arises in connection with 
injury, extreme debility, or nervous affections. It may be associated 
with loss of teeth in the front and sides of the mouth. Woodroffe Hill 
has observed it in some cases of long-continued chorea. The tongue 
generally hangs from one side of the mouth, and from exposure to the 
air it becomes dry and “coated.” Sometimes the papille become 
enlarged and horny. Only in rare instances does the condition interfere 
with lapping. In some dogs, especially pugs, the tongue protrudes from 
the side of the mouth in a permanent manner, and the abnormality is 
regarded as a congenital deformity. 

TREATMENT.—When the affection is of long standing, treatment 
seldom gives good results. In recent cases the administration of nux 
vomica may prove beneficial. 


462 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE SALIVARY GLANDS. 


PAROTITIS. 


Two types of this affection are recognised in the dog—viz., (1) Specific 
or Infectious Parotitis, and (2) Ordinary Parotitis. 

Specific Parotitis—This is described by Hertwig, Schtssele, Muller, 
Cadéac, Hutyra and Marek, and other writers. It is believed to be 
analogous with the disease known as ““mumps”’ in man. Cases are 
recorded by Busquet and Boudeaud, also by Prietsch, in which dogs 
became infected during an epidemic of mumps in children. The former 
observers isolated a diplococcus in pure culture from Stenson’s duct, 
and in one instance found that the affection spread to another dog. 
According to C. French, it is a rare disease, and frequently confounded 
with inflammation of the submaxillary and retropharyngeal lymphatic 
glands, which is a common affection in the dog. Specific parotitis is 
described by Sewell.* Woodroffe Hill does not recognise an infectious 
form of parotitis. According to Cadéac, it is a very rare disease, and al] 
attempts to convey the human type of the affection to the dog by means 
of inoculations have failed. 

Symproms.—The characteristic feature of the disease, as compared 
with the ordinary parotitis, is that it is bilateral, and suppuration of the 
gland does not occur. After a period of incubation of three or four days 
the animal is dull, may show evidences of coryza, coughs and sneezes, 
and has difficulty in feeding. The parotid glands become rapidly tume- 
fied, the swelling being located close to the ears; the submaxillary glands 
may also be involved. The swelling is tender to palpation, the head is 
carried in a stiff manner, the saliva becomes viscid and accumulates at 
the commissures of the lips, and in some instances Stenson’s duct is 
swollen and prominent. The disease runs its course in about twelve 
days, and terminates favourably. 

Ordinary Parotitis.—This is said to arise from injuries, or from infec- 
tions originating in the mouth and reaching the gland by way of Stenson’s 
duct. It may also be associated with distemper. Purulent foci may. 
form between the lobules, and subsequently become confluent, forming 
a large abscess. In some cases the connective tissue and the lymph 
glands in the vicinity are involved, and suppurate. 

Chronic Parotitis may occur as a sequel to an acute attack. The 
swelling is firm, indurated, and not painful. In a case recorded by 


* “ The Dog’s Medical Dictionary.” 


DISEASES OF THE SALIVARY GLANDS: DOG 463 


Woodroffe Hill the muscles of the parietal region were extensively 
atrophied. 

We have observed one instance in which cystic transformation oceurred 
in the parotid gland. 

TREATMENT.—In specific parotitis, beyond attention to diet, little or 
no treatment is required. The food should be of a soft nature, so as to 
enable the animal to partake of it with little movement of the jaws. In 
cases where the swelling is extensive and very painful, a cataplasm of 
kaolin and glycerine applied hot will give relief. 

In the ordinary form of parotitis a similar application is indicated, 
and may be followed by the use of one of the non-irritating 1odine oint- 
ments, of which there are now several prepared by manufacturing 
chemists. If there are evidences of suppuration present, the abscess 
should be opened, care being taken to avoid injury to the gland and to 
the important bloodvessels in the vicinity. 

In chronic parotitis iodine liniment should be applied locally, and 
iodide of potassium given internally. 


MAXILLITIS. 


Inflammation of the submaxillary gland is a rare affection in the 
dog as a disease per se. It may be associated with parotitis, and occa- 
sionally with severe forms of stomatitis. Abscess formation may occur, 
and the pus may escape into the mouth, or find its way externally through 
the skin. The affection is recognised by the presence of the swollen 
eland on the inner side of the angle of the inferior maxillary region. 

The treatment is similar to that advised for parotitis. 


DISEASES OF THE TONSILS AND PHARYNX. 


TONSILLITIS. 


Inflammation of the tonsils is generally associated with pharyngitis and 
laryngitis. Repeated attacks lead to hypertrophy of the organs, and 
the latter condition predisposes them to microbialinfection. On examina- 
tion, the tonsils are found swollen, and the space between them is nar- 
rowed, ‘They are of a deep red or brownish-red colour, and their mucosa 


464 SYSTEM OF VETERINARY MEDICINE 


is often covered by a viscid greyish exudate. In severe cases they may 
be cedematous. The lymphatic follicles are prominent, and the crypts 
may be filled with a thick purulent material. 

The symptoms and treatment are similar to those mentioned for 
pharyngitis (see below). 


PHARYNGITIS. 


The following varieties of pharyngitis are recognised in the dog— 
viz., Catarrhal, Phlegmonous, Pseudo-membranous, and Chrome. 

Acute Catarrhal Pharyngitis.—This, as in the horse, is a superficial 
inflammation. It may be limited to the pharyngeal mucosa, or be of a 
diffuse character, affecting the mouth, fauces, and tonsils, as well as the 
pharynx. : 

Et1otocy.—As a primary affection, it may be due to chills, the inges- 
tion of irritating agents, and the presence of sharp foreign bodies. These 
factors are believed to act by permitting the entrance and development 
of micro-organisms in the mucosa. Blades of green couch-grass, swallowed 
by the dog, may, during the process of vomiting, enter the posterior 
nares and nostrils, extend into the pharynx, and cause pharyngeal 
and nasal irritation, manifested by coughing, snorting, etc. If not 
removed, pharyngitis results. 

As a secondary affection, acute pharyngitis is observed in connection 
with distemper and rabies. It may also be associated with broncho- 
pneumonia, in which instance it is ascribed by Cadéac to infection result- 
ing from the expectorate, the latter containing micro-organisms and 
toxins. 

Symptroms.—Dysphagia and salivation are present. The animal 
shows marked difficulty even in swallowing fluids; the saliva is viscid, 
and mixed with stringy mucus, and hangs from the commissures of the 
lips; the region of the pharynx is tender to palpation; the cough is dry 
and irritable, and the animal makes frequent efforts as if to dislodge 
some material from the throat. Spacm of the pharyngeal muscles may 
be present, and is manifested by “ gulping ”’ movements when attempts 
are made to swallow. In some cases retching is observed. On examining 
the pharynx by opening the mouth and depressing the tongue, in the 
diffuse form of the disease, the soft palate, tonsils, and pharyngeal 
mucosa are found red, swollen, and may be covered by a yellowish 
mucus. The alterations in the tonsils are described on p. 463. In 
uncomplicated cases recovery usually takes place within.a week, but a 
recurrence is not uncommon if the animal is exposed to chills or sudden 
changes of temperature. 


DISEASES OF THE TONSILS AND PHARYNX: DOG 465 


TREATMENT.—Attention to diet is necessary, and fluid foods should 
be provided. In severe cases a cataplasm composed of kaolin and 
glycerine should be applied to the region of the pharynx. Inhalations 
of steam medicated with terebene or oil of eucalyptus prove useful. 

A linctus containing glycerinum boracis may be applied to the pharynx 
by means of a brush. 

Phlegmonous Pharyngitis—In this disease the infection extends 
from the submucous tissue of the pharynx to the lymphatic glands in 
the vicinity, and abscess formation occurs in the latter, and also sub- 
cutaneously. The condition is not uncommon in young dogs, especially 
in foxhound puppies, and also in pugs and bulldogs. It is considered 
by some authorities as a form of distemper, and may occur as an enzootic 
affection in a kennel (see Canine Distemper, Vol. I.). 

Symptoms.—In many instances the leading symptom is a diffuse 
painful swelling in the region of the pharynx, which may extend to the 
intermaxillary space, and even to the cheeks and facial region. Respira- 
tion may be impeded, and there is also difficulty in swallowing. The 
animal keeps the nose “ poked out,” and is not inclined to lie down, 
nor to turn his head from side to side. The appetite is generally di- 
minished or totally in abeyance. In a variable. period suppuration occurs, 
and an abscess is formed containing a thin sanguineous purulent material. 

Secondary abscesses are not uncommon, and the course of the affec- 
tion. may be protracted. 

In some cases there is considerable swelling of the facial region, and 
an oedematous condition of the eyelids. An abscess may form midway 
between the pharynx and the sternal region after the primary abscess 
has healed. 

The affection may run a long course, and may terminate fatally from 
pyemia when a series of abscesses succeed each other. 

We observed one case which was complicated by suppurative arthritis 
of one hock-joint. The disease bears a strong resemblance to strangles 
in the horse. In some instances the affection is complicated with puru- 
lent parotitis and maxillitis. Abscess formation may also occur in the 
region of the forehead, in the occipital region, and in the axilla. 

TREATMENT.—In mild cases we have observed good results from 
the application of one of the non-irritating ointments of iodine to the 
swelling. This causes an early maturation of the abscess, and the latter 
can then be treated surgically by a free incision. In severe cases a 
cataplasm of kaolin and glycerine should be applied hot, and frequently 
repeated. 


When fluctuation occurs, but not until then, the abscess should be 
VOL, Il, 30 


466 SYSTEM OF VETERINARY MEDICINE 


opened, the contents evacuated, the cavity irrigated with a solution of 
peroxide of hydrogen, and then packed with gauze soaked in a similar 
solution. When there is a tendency to the occurrence of secondary 
abscesses, the administration of nuclein, either subcutaneously or per os, 
often gives good results. 

In some instances the resulting wound heals with difficulty, and not 
rarely the internal lining of the abscess cavity has no inclination to 
become effaced by cohesion to surrounding tissues, but persists as a 
sac with an external opening, unless surgical measures be adopted to 
bring about its removal. 

Pseudo-Membranous Pharyngitis.—This is also known as “‘ croupous ” 
or ‘‘ pseudo-diphtheritic pharyngitis.” As in the horse (see p. 44), 
various micro-organisms have been discovered in the lesions, but none 
are specific. According to Cadéac, dental caries and morbid conditions 
of the mouth are predisposing causes of the affection. It may be associ- 
ated with canine typhus. The lesions are similar to those described 
as occurring in the horse (see p. 44). 

Symptoms.—In addition to the ordinary symptoms of pharyngitis, 
there is marked dysphagia, and even the attempted swallowing of liquids 
causes a fit of coughing, and sometimes vomiting of a glairy material. 
Marked constitutional disturbance is present, the region of the pharynx 
is swollen, and the head is held in a fixed manner. On inspecting the 
mouth and pharynx, the characteristic false membranes are detected. 
Various complications may occur, such as broncho-pneumonia, enteritis, 
etc., and death results from general toxemia after a course of about 
a week, 

TREATMENT.—Various local applications to the mouth and pharynx 
are advised, such as solutions of salicylic acid, methylene blue, peroxide 
of hydrogen, iodine, etc. Some practitioners recommend that vomiting 
should be induced by the administration of ipecacuanha, with a view 
to causing expulsion of the false membranes. 

The administration of nuclein by hypodermic injection is indicated. 
The disease is often very fatal, in spite of every form of treatment. 

Nourishment should be supplied by means of nutrient suppositories. 
As a cardiac stimulant, normal saline solution should be administered by 
subcutaneous injections, and repeated at intervals. 

Chronic Pharyngitis ——This may be a sequel to an acute attack of 
pharyngitis, or may be secondary to other diseases, such as cardiac affec- 
tions and renal disorders, in which venous stasis and congestion of the 
pharyngeal mucosa are present. It is often associated with chronic 
laryngitis and chronic dyspepsia. A granular form of the disease occurs 


DISEASES OF THE TONSILS AND PHARYNX : DOG = 467 


in tubercular pharyngitis. Chronic pharyngitis may be observed in 
connection with chronic bronchial catarrh. According to Cadéac, the 
explanation is that in the latter affection the dog breathes through his 
mouth, and this brings about irritation of the pharyngea] mucosa. 

SymMproms.—Frequent attacks of coughing with attempts at expec- 
toration are observed, especially if the animal tries to swallow food of a 
tough solid nature. Dysphagia to a varying extent is also present. On 
palpation of the region of the pharynx coughing is readily induced. An in- 
spection of the pharynx shows the pharyngeal mucosa and the tonsils 
swollen and inflamed; the soft palate may also be involved. Remissions 
are not uncommon after apparent recoveries, and attacks are likely to 
recur during the winter months. 

TREATMENT.—The internal administration of potassium iodide is 
advised by some authors. The local application of a linctus composed 
of nitrate of silver (2 per cent.), or of tincture of iodine (3 parts in 25 parts 
of glycerine), gives good results in some cases. When the affection is 
secondary to other diseases, the primary condition must receive suitable 
treatment. 


TUMOURS OF THE PHARYNX. 


These are of rare occurrence in the dog. C. French describes cases 
in which a myxoma occurred in the form of a polypoid growth from the 
pharyngeal mucosa, and caused sudden fits of dyspnoea and vomiting, 
especially when the region of the pharynx was palpated. 

He also describes epitheliomata of the pharynx as a very rare affection 
in aged dogs. The symptoms are obscure at first, then dysphagia is 
observed, and a profuse flow of foetid saliva. The cervical glands become 
involved, and in some instances a raw ulcer is observed by inspection of 
the pharynx. Polypi can sometimes be removed by means of a wire 
écraseur. Malignant tumours are inoperable. 


DISEASES OF THE GSOPHAGUS. 
GESOPHAGITIS. 


Inflammation of the cesophagus may arise from injuries inflicted by 
sharp foreign bodies, also from chemical irritants, and from the careless 
employment of a probang in cases of “choking.” The lesions resemble 
those described as occurring in equines (see p. 55). A follicular form ot 


468 SYSTEM OF VETERINARY MEDICINE 


the affection is described by Cadéac, in which the glandular structures 
are hypertrophied, and a number of small whitish spots are observed 
on the mucosa. In some cases due to swallowing chemical irritants 
there is a well-marked desquamation of the epithelium, and infiltration 
of the submucous tissue. 

Symptoms.—In ordinary cases dysphagia is observed, but in severe 
instances swallowing may be impossible, and vomiting of a blood-stained 
material containing shreds of the epithelial layer of the cesophagus may 
occur, followed by evidences of general septic infection. Death in such 
cases may take place in two or three days, and may be preceded by 
abscess-formation or perforation of the organ. 

TREATMENT.—In mild cases soft food should be allowed, and simple 
demulcents should be administered. In severe cases accompanied by 
pain a hypodermic injection of morphine is indicated. When swallowing 
is impossible, the animal’s strength must be maintained by the adminis- 
tration of nutrient suppositories, and by subcutaneous injections of normal 
saline solution. 


CESOPHAGISMUS. 


Spasm of the csophagus is a very rare affection in the dog. We 
observed two cases in which severe paroxysms occurred when the animals 
attempted to swallow dry food, such as a piece of bread. The bolus of 
food passed along the cervical portion of the gullet without difficulty, 
but on entering the thoracic portion of the tube the animals showed 
marked convulsive movements of the head and neck, and made efforts 
as if to vomit. After a time the bolus of food was swallowed. In one 
of the cases even swallowing fluids was sufficient to produce the 
symptoms. ; 

According to Friedberger and Fréhner, cesophagismus is frequently 
observed in cats after the swallowing of a pin. It occurs as a secondary 
condition in cases of rabies and epilepsy. Gray has observed cesopha- 
gismus in cases of retention of urine, etc. 

TREATMENT.—Lhis is unsatisfactory. The administration of mor- 
phine, atropine, or chloral hydrate, is advised to overcome the spasm. 
Some practitioners advise the careful passing of a probang. Bromide of 
potassium may be given during the intervals between the attacks. In 
some instances the affection disappears spontaneously. 


DILATATION OF THE G&SOPHAGUS. 


As in the horse, this lesion may occur in the form of—(1) Hctasis, and 
(2) Diverticulum (see p. 61). 


DISEASES OF THE (HSOPHAGUS: DOG 469 


Symproms.—Difficulty in swallowing is a prominent symptom, and 
is due to an accumulation of ingesta in the dilated portion of the gullet 
or in the diverticulum. When the lesion occurs in the cervical portion 
of the tube, a soft tumour-like swelling is observed, which can be reduced 
by compression. Regurgitations or attempts at vomition may occur, 
and may be followed by the temporary disappearance of the swelling. 
The complications are similar to those described as liable to take place 
in equines (see p. 64). 

TREATMENT.—According to Cadéac, cylindrical dilatations are in- 
operable, but in the case of diverticula surgical measures for their ex- 
tirpation may be attempted. For the technique of the operation the 
reader is referred to “‘ Surgical Diseases of the Dog,” by C. French. 


STRICTURE OR STENOSIS OF THE GSOPHAGUS. 


This condition is seldom met with. It may result from various 
causes, such as injuries due to foreign bodies, or to the careless introduc- 
tion of a probang, neoplasms of the gullet, the presence of tuberculous 
mediastinal glands causing compression of the organ, tumours in the 
vicinity of the cesophagus, etc. In rare instances stenosis may be a 
congenital condition. The presence of Spiroptera sanguinolenta in the 
walls of the esophagus may induce stenosis. These parasites are met 
with in various parts of the Continent; also in Asia, Japan, and Brazil. 

Symproms.—Dysphagia varying in degree according to the extent of 
the stenosis is observed. Regurgitations of food, ascending contractions 
of the cesophagus, alternated with attempts at swallowing, are also in 
evidence. In some instances the food accumulates above the seat of 
stricture, and if this occurs in the cervical region an elongated soft 
swelling is observed. Paroxysms of coughing and attempts at vomition 
are present in some instances. The employment of the probang will, as 
in similar cases in the horse, show an obstruction to the passage of the 
instrument at the seat of stenosis. 

TREATMENT.—This is rarely successful. Morphine or chloroform may 
be given. Gradual dilatation carried out by means of probangs of various 
sizes may be tried, but with little hopes of any benefit resulting. 


FOREIGN BODIES IN THE CESOPHAGUS (CHOKING). 


This condition is not uncommon in the dog. The foreign bodies 
most frequently met with are portions of bones or of gristle, needles, 
and pieces of wood. Irregular portions of bones may be greedily taken, 


470 SYSTEM OF VETERINARY MEDICINE 


and lodge in the gullet. The vertebre of game (poultry, pheasants, 
rabbits, etc.) and of fish frequently become lodged in the pharynx or 
cesophagus. In puppies foreign bodies are often taken into the mouth 
during play, and accidentally enter the csophagus. Many cases are 
recorded in which a lady’s hat-pin gained entrance to the csophagus 
and stomach. The majority of such instances occurred in kittens. We 
met with a case in a greyhound puppy, in which a hair-pin was lodged in 
the cervical portion of the gullet. The most common seats of obstruction 
are immediately behind the pharynx, at the lower extremity of the cer- 
vical portion, and in the thoracic portion just before the cesophagus 
passes through the diaphragm. 

Symptoms.—The following phenomena are observed: Frequent at- 
tempts at deglutition, the return of fluids by the nostrils if the animal 
attempts to swallow them or if they are forced on him, salivation, marked 
distress, and in some instances attempts at vomition. It must be remem- 
bered that cases occur in which the foreign body does not completely 
occlude the lumen of the tube, and fluids carefully administered may be 
swallowed. When the foreign body is of sufficient size and situated in 
the cervical portion of the cesophagus, careful manipulation of the left 
side of the neck will enable us to detect its presence; but when it is 
lodged in the thoracic portion, the employment of the probang or of 
radiography is necessary in order to arrive at a correct diagnosis. Occa- 
sionally the repeated attempts at vomition succeed in bringing about 
the expulsion of the foreign body ver os. 

Various complications may occur as follows: A  pericesophagea 
abscess results when a sharp foreign body perforates the gullet, and 
causes abscess formation in the cervical region. This may rupture 
externally, and give exit to the obstacle. 

Perforation of the gullet may occur in its thoracic portion owing to 
necrosis induced by an irregular-shaped foreign body. The result is 
septic pleurisy. A similar condition may result from the careless use of 
the probang. Cases are recorded in which perforation of the trachea 
and of the aorta was induced by migration and pressure exerted by the 
foreign body. Gray met with an instance in which a sharp plate of 
bone worked its way through the gullet, perforated the carotid artery, 
and produced rapid death from hemorrhage. 

Occasionally a large foreign body may cause Rrcseure, on the heart, 
and induce circulatory disturbances. 

DIFFERENTIAL Dragnosis.—In all cases where retching, dysphagia. 
etc., are present, a careful examination of the pharynx should be carried 
out by visual and digital means, assisted by a mouth-gag and small . 


DISEASES OF THE GSOPHAGUS: DOG ~ 47] 


electric torch. If this proves negative, the cervical region of the gullet 
must be carefully examined, and then the probang must be employed. 
Krrors in diagnosis are not uncommon, especially when the foreign body 
is lodged in the thoracic division of the gullet. The condition has been 
mistaken for gastritis, gastric catarrh, etc. Gray has met with a case 
in which the attending practitioner did not suspect the presence of an 
cesophageal obstruction, but a portion of mutton-chop bone was found 
in the thoracic division of the gullet. In this case a pronounced spasm 
of the left fore-limb was a marked symptom. 

TREATMENT.—When the foreign body is situated at the upper part 
of the cesophagus close to the pharynx, an attempt should be made to 
remove it by means of forceps. Unfortunately, this is only possible on 
rare occasions. Some Continental authors advise the subcutaneous in- 
jection of apomorphine, with a view to bringing about expulsion of the 
obstruction by the attempts at vomiting which are induced. Cadéac, 
however, points out the danger of such a procedure when the foreign 
body contains asperities on its surface, as perforation of the cesophagus 
is likely to be produced. 

The available surgical methods, when removal by means of forceps 
is impossible, are as follows: 

The Use of the Probang.—By this means the foreign body is forced 
onwards, and enters the stomach; but occasionally, in the case of needles 
or fish-bones, if a probang composed of horsehair at its extremity, and 
provided with a portion of sponge, be employed, the above-mentioned 
bodies may be removed during the withdrawal of the instrument from 
the gullet. Various patterns of probangs are employed. The one men- 
tioned above is very safe, but we prefer an instrument made of flexible 
steel wire, on the extremity of which a smooth conical metal top is 
screwed. The metal tops are of various sizes to suit small, medium, and 
large dogs. In passing the probang, a speculum is inserted in the animal’s 
mouth, and the instrument, well lubricated, is passed carefully along the 
palate in the median line (the tongue being depressed by the fingers of 
the left hand) over the epiglottis and into the cesophagus. Care should 
be taken that the instrument does not enter the trachea. When the 
foreign body is reached, gentle pressure is to be applied; but any force 
is to be avoided, as rupture of the cesophagus may be produced. This 
accident is more likely to occur when the foreign body has been in situ 
for some time before treatment is attempted. It must be remembered 
that small foreign bodies, such as needles, pins, fish-bones, etc., may not 
be detected by the use of the probang, as the instrument may glide past 
them and enter the stomach. The presence of blood on the probang is 


472 SYSTEM OF VETERINARY MEDICINE 


suggestive in such instances. For such cases, as already mentioned, the 
probang equipped with a horsehair and sponge extremity is to be pre- 
ferred. 

If gentle pressure fails to dislodge the foreign body, and if the latter 
can be located, the operation of cesophagotomy must be carried out. 
For details of the technique and after-treatment the reader is referred 
to “Surgical Diseases of the Dog and Cat,” by Hobday. When the 
foreign body is situated in the thoracic portion of the gullet, it may be 
advisable to perform gastrotomy, and by the aid of a pair of thin forceps 
passed up the cesophacus through the cardiac orifice of the stomach the 
obstruction may be reached and removed. Full details of the operation 
and a description of illustrative cases will be found in the surgical work 
already alluded to. 


TUMOURS OF THE G&SOPHAGUS. 


Myxomata in the form of polypi have been met with on rare occasions. 
According to Hutyra and Marek, sarcomata, chondromata, and retention 
cysts are occasionally observed. Retention cysts may develop in con- 
nection with dilated mucous glands. Hobday* described a case of car- 
cinoma of the cesophagus. ‘‘ The probang could distinctly be felt to pass 
over a fixed and hardened body in the gullet, both when going down and 
when being withdrawn.” Fibroid enlargements due to the presence of 
Sprroptera sanguinolenta are observed in: various foreign countries where 
this parasite is prevalent (see section on Parasites). 


DISEASES OF THE STOMACH. 


GENERAL REMARKS. 


The facility with which vomition occurs in the dog no doubt prevents 
many cases of gastric disorder, but in spite of this, diseases of the stomach 
are of common occurrence in canine practice. As compared with the 
horse, ordinary gastric affections offer more facilities for diagnosis, and 
are generally more amenable to treatment. On the other hand, toxemic 
gastritis, while comparatively rare in the horse, is frequently met with 


* “ Surgical Diseases of the Dog and Cat.” 


DISEASES OF THE STOMACH: DOG 473 


in the dog, and often proves fatal in spite of treatment. Secondary 
types of gastritis are more common in the dog than in the horse, and the 
vicious circle induced by gastric disorders is better marked in the former 
animal than in the latter. 

Physiology teaches us that the stomach of the dog is a very important 
organ in connection with the digestion of proteids, and also that a flesh 
diet is best suited for this animal. According to F. Smith,* a flesh diet 
requires very little saliva and practically no mastication, and its digestion 
is slow. Colin showed that a meal of meat takes twelve hours to digest, 
and also that cooking interferes with its digestibility. 

The gastric juice of the dog is possessed of considerable activity. It 
contains a large amount of pepsin, and 0°46 to 0°56 of hydrochloric acid. 
The enzymes are pepsin and rennin. Pepsin is unable to act, except in 
an acid medium. The gastric juice withstands putrefaction for a long 
time, and its antiseptic properties are attributed to the hydrochloric 
acid which it contains. Starch and other carbohydrates are not digested 
in the stomach. 

These physiological facts are of importance in connection with gastric 
disorders. As we shall point out later on, a lack of acid in the gastric 
secretion or an alkaline reaction occurs in cases of toxeemic gastritis, and 
indicates a special line of treatment. 

But in spite of the frequency of gastric affections, it cannot be said 
that our knowledge of them is by any means complete, or that treatment 
is always satisfactory. A consideration of the views expressed by various 
writers on the subject will show that the classification of gastric affections 
is far from being uniform or perfect, and their differential diagnosis 1s 
attended by considerable difficulty. 

The term ‘‘ indigestion or dyspepsia” is very widely employed, and 
in ordinary practice is often used to describe various conditions. At the 
same time, we must admit that it is not possible to differentiate these 
affections with the same degree of accuracy that obtains in human prac- 
tice. Moreover, acute gastritis in man is not by any means so serious 
an affection as in the dog, and, except as the result of irritant poisons, 
the intense forms of inflammation so frequent in the canine species do 
not occur in the human being. On the other hand, gastric ulcer and 
cancer of the stomach are frequently met with in man, but are com- 
paratively rare in the dog as well as in other animals. 

The tendency of the dog to eat decomposing meat and filth of all 
kinds would seem at first sight to render him specially liable to toxemic 
forms of gastritis. But on considering the matter, we are forced to con- 


* “Veterinary Physiology.” 


474 SYSTEM OF VETERINARY MEDICINE 


clude that the tendency mentioned renders the animal immune to a 
certain extent to the effect of such materials. But when such are denied 
to him for long periods, and if he then gets the opportunity of satisfying 
his natural cravings, it is rational to conclude that, under these con- 
ditions, the decomposing material may act as a predisposing cause of | 
gastric toxemia. Moreover, we have to admit that such gastric troubles 
are often seen in dogs that are denied access to decomposing food, but 
ingest such material when opportunity offers. Again, we have to con- 
sider the irrational treatment to which pet dogs especially are subjected, 
such as want of exercise, excessive feeding on starchy diets unsuitable 
to the canine digestive system, also on foods containing large amounts of 
sugar, which tend to bring about dyspepsia. 

The comparative immunity from gastric disorders of dogs in country 
places leading an outdoor life and not overfed, also of foxhounds, etc., 
shows the evil effects of an indoor life and irrational feeding, on the canine 
species. 


ACUTE GASTRIC INDIGESTION. 


This signifies the abnormal retention of food in the stomach, accom- 
panied by irritation of the gastric mucosa, and in severe cases associated 
with suppression of the movements of the organ and with a varying 
degree of gastritis. The affection is termed by Hutyra and Marek 
“acute dilatation of the stomach.” We must point out, however, that, 
although it is accompanied by a varying degree of dilatation of the organ, 
the latter condition is only temporary, as, when relief is afforded by 
vomiting, the dilatation disappears. Some writers, indeed, assume that 
acute gastric catarrh is present to a varying extent in all cases of acute 
indigestion, as they describe both affections together. 

Owing to the facility with which vomition occurs in the dog, impac- 
tion of the stomach to the extent met with in the horse is seldom en- 
countered in canine practice. Lafosse states that rupture of the stomach 
can occur in the dog in connection with acute gastric indigestion. Livesey* 
has met with one case of overloaded stomach in the dog, which terminated 
fatally. 

Et1oLocy.—Bulky indigestible food taken in large amount can pro- 
duce the condition when from any cause vomiting does not occur. Some 
authors hold that unless vomiting occurs early, the gastric walls become 
paralysed, and alimentary stasis is brought about, so that the ingesta 
cannot be got rid of by vomiting, nor can they pass onwards by way of 


* Paper on “Diseases of the Stomach and Intestines of the Dog,” National 
Veterinary Association, 1913. 


DISEASES OF THE STOMACH: DOG 475 


the pylorus to the intestine. Fermentation and tympany occur, and 
toxic products are formed, which tend to produce gastritis and auto- 
intoxication. Substanzes such as portions of tendon, cartilage, bacon- 
rind, etc., are found to be especially liable to bring about acute indiges- 
tion. The condition may also be associated with gastritis, chronic gastric 
dilatation, and various intestinal affections, accompanied by obstruction 
of the bowels. 

Morsip Anatomy.—The stomach is dilated, tympanitic, and contains 
a large amount of ingesta. A varying degree of gastric catarrh is present. 
In cases which are secondary to other affections the lesions of the latter 
will be observed as well. : 

Symproms.—In mild cases relief occurs by vomiting, and beyond 
preliminary dulness and restlessness no symptoms are observed. Not 
infrequently the animal will again ingest the vomited material. When, 
however, this salutary vomiting fails to take place, the animal shows 
marked uneasiness, an anxious expression of countenance, salivation, 
accelerated respirations, tenderness of the abdomen to palpation, ab- 
dominal distension, first of the left, and later on of the nght side. In 
some instances colicky pains are present, and whining or actual cries are 
emitted. Retching may be observed, and dyspnoea may occur. An 
unsteady gait and vertigo are not uncommon symptoms. 

CoursEe.— Unless relief be afforded by treatment, the course is generally 
rapid, and death may occur from nervous exhaustion or dyspneea in from 
one to two hours. In mild cases recovery may be complicated with 
gastric catarrh. | 

TREATMENT.—An emetic is indicated, so as to cause expulsion of the 
gastric contents by vomiting. The most reliable is apomorphine adminis- 
tered hypodermically in a dose of 5 to 75 grain, according to the size 
of the patient. Ipecacuanha in the form of vinum ipecacuanhe may also 
be employed. Continental authors advise washing out the stomach by 
means of a funnel and a rubber tube. If evidences of gastric catarrh 
are present after the ingesta have been removed, suitable treatment for 
this condition must be adopted (see p. 481). 


ACUTE GASTRIC TYMPANY. 


In this condition the stomach becomes greatly distended with gas. 
The affection has been observed by Gray chiefly in the large breeds of 
dogs, such as the Great Dane, St. Bernard, and bloodhound, and unless 
speedy relief was given a fatal result rapidly ensued. According to some 
observers, the disease depends on the rapid development of the Bacillus 


476 SYSTEM OF VETERINARY MEDICINE 


coli communis, which produces an almost sudden evolution of gas, causing 
extreme distension of the stomach. The result is that the gas cannot 
escape by either eructation or via the pylorus, the dilated stomach 
causes pressure on the diaphragm, thus interfering with circulation and 
respiration, and death occurs from either syncope, asphyxia, or toxemia. — 

SyMproms.—Extreme tympanitic distension of the abdomen, marked 
respiratory distress, an anxious expression of countenance, restlessness, 
and a cyanotic condition of the visible mucous membranes are observed. 
These svmptoms usually follow the ingestion of unfit or improper food, 
especially in hot weather. The affection is more often met with in dogs 
that are carefully tended and hygienically fed when they obtain access 
to unwholesome food. 

DIFFERENTIAL Dr1aanosis.—The symptoms resemble those occurring 
in torsion of the stomach, and the differential diagnosis must be based 
on the results of treatment, as in the affection named only a surgical 
operation can give any chance of recovery, while acute gastric tympany 
may yield to the treatment advised below. 

TREATMENT.—This must be prompt in order to be of service. 
In many instances the practitioner arrives on the scene after his 
prospective patient has succumbed. A hypodermic injection of apo- 
morphine hydrochloride (,!, grain) should be given. If this does not give 
relief by inducing emesis in a few minutes, the trocar and cannula should 
be employed to give exit to the gas; or a stomach-tube in the form of a 
horse catheter should be passed into the stomach in a similar manner to 
a probang. When relief has been obtained by these means, gastric 
and intestinal antiseptics, such as 8-naphthol, charcoal, etc., should be 
administered. Some dogs are liable to a recurrence of the affection. 


DILATATION OF THE STOMACH. 


99 


This is sometimes termed ‘“‘ chronic dilatation,’ to distinguish it 
from the acute distension of the organ occurring in acute gastric indi- 
gestion and in acute gastric tympany. 

Errotogy.—Insufficient power of contraction in the gastric walls or 
any obstruction of the pylorus or of the intestine may induce dilatation 
of the stomach. The affection occurs especially in aged dogs, but Livesey 
has frequently observed it in an acute form in puppies, when the pylorus 
or duodenum was impacted with a collection of ascarides. Repeated 
attacks of acute indigestion may induce the condition, and it may also 
be associated with chronic gastric catarrh, the prolonged retention of 
food in the stomach bringing about atony of the gastric walls. 


DISEASES OF THE STOMACH: DOG . 477 


Ulcers and neoplasms in the pylorus or duodenum interfere with the 
passage of food from the stomach, and cause tympany, thus inducing 
dilatation of the organ. A temporary hypertrophy of the gastric walls 
first occurs, succeeded by atrophy and attenuation. Dilatation is also 
associated with torsion of the stomach (see p. 486). 

Morsip ANAToMyY.—The capacity of the stomach is greatly increased, 
the gastric walls are attenuated, and the mucosa is smooth, pale, and 
anemic. In some cases chronic gastric catarrh is present. Care should 
be taken not to mistake post-mortem distension of the stomach (disten- 
sion of putrefaction) for a pathological] condition. 

Symptroms.—In some instances the symptoms are similar to those 
occurring in chronic gastric catarrh (see p. 481). In others, distension 
of the organ appears in two or three hours after the ingestion of food, 
and on percussion of the space between the eighth rib and the umbilical 
region a tympanitic sound is elicited, provided the stomach is not dis- 
tended with food. In the latter instance the sound is not well marked, 
or may disappear. Deep palpation may reveal the presence of a large 
immovable doughy mass. Fcetid diarrhoea, the dejecta containing un- 
digested food, may be observed in some cases. Thirst and a morbid 
appetite, evidenced by a tendency to eat foreign bodies, such as grass 
and straw, etc., are amongst other symptoms present. In puppies 
Livesey observed the vomiting of large amounts of chyme, followed by 
the further vomiting of mucus (sometimes bile-stained), and containing 
a few parasites or a mass of them. Retching, succeeded by temporary 
collapse, may be associated with the above symptoms. Unless relief be 
obtained by treatment, a fatal gastritis may ensue. 

TREATMENT.—If the stomach is distended by ingesta, an emetic is 
indicated. Easily digested food should be allowed, such as milk, soups, 
egos, etc. Gray recommends an exclusive milk diet. Livesey advises 
the use of bulky food, such as porridge containing chopped meat, and 
states that such diet, by its bulk, will often dilate the contracted pylorus 
and carry any obstruction present into the intestine. Gastric antiseptics, 
such as benzo-naphthol, with charcoal, etc., sometimes prove useful. 
Cadéac advises a combination of salicylate of bismuth, bicarbonate of 
soda, benzo-naphthol, carbonate of magnesia, charcoal, and pepsin, 
administered in the form of cachets twice daily after feeding. 


GASTRITIS. 
Acute Gastritis—Synonyms.—Acute catarrhal gastritis; Acute gastric 
catarrh; Toxemic gastritis. 
Several forms or types of acute gastritis are met with in the dog, and 


478 SYSTEM OF VETERINARY MEDICINE 


they constitute by far the most important and the most serious affections 
of the stomach in this animal. Secondary forms of gastritis are common, 
and considerable difficulty is often experienced in deciding whether, in a 
given case, the gastric affection is to be regarded as a disease per se, or 
as a secondary malady associated with morbid conditions of other organs. 
On referring to the section on Canine Typhus in Vol. I., the reader will 
observe the importance of the gastric phenomena in that affection, 
and in some types of canine distemper gastric lesions are not uncommon. 
Again, diseases of the liver and of the kidneys are often accompanied by 
gastritis. Irritant poisons also produce gastritis, which varies in in- 
tensity according to the nature and amount of the toxic agent. A type 
of gastritis vaguely termed “‘ toxeemic”’ is met with, the etiology and 
nature of which is obscure, and its clinical differentiation from canine 
typhus is by no means well established. 

Some authors describe acute gastritis under the heading of “ gastro- 
enteritis,’ the reason assigned being that intestinal and gastric lesions 
are usually associated. While admitting that such is the case in many 
instances, we are quite aware, as the result of post-mortem evidence, that 
the lesions may be confined to the stomach; hence we deem it advisable 
to describe gastritis separately, and to consider the various forms that 
are met with in practice. At the same time, we must point out that 
clinically it is often very difficult to draw the border-line between gastritis 
and gastro-enteritis. Although attempts have been made to classify the 
various forms of gastritis, they have not proved successful from a clinical 
point of view; hence it seems desirable to discuss the subject under one 
general heading, and to draw attention to the various types that may be 
met with. 

ErtioLogy.—Various causes are said to produce the condition, such 
as irritating medicaments, putrefying food, impure water, etc. Chills 
are believed to act as a predisposing cause by lowering the vital resistance 
of the gastric mucosa, and thus rendering it hable to microbial infection. 
The affection may also occur as a sequel to acute indigestion or dilatation 
of the stomach. Mayall has observed cases in dogs fed on fish meal. 
As already remarked, a severe form of the disease is associated with 
canine typhus, and also occurs in some types of canine distemper. It 
is a common complication of puerperal septicemia, senile endometritis, 
etc. 

Morsip Anatomy.—The gastric mucosa is thrown into thick ruge. 
It is covered by a glairy mucus of a reddish or brownish tint. In the 
severe form ecchymoses are present, especially on the summits of the 
folds, and erosions may sometimes be observed in the same locality. In 


DISEASES OF THE STOMACH: DOG | 479 


toxeemic cases the inflammation is hemorrhagic in character, and hemor- 
rhages of a striped nature are present. The mucosa is of a chocolate 
colour. The lesions are generally most marked in the pyloric region, but 
may be diffused over the entire gastric mucosa. On removal of the 
hemorrhagic exudate the mucosa is found engorged with blood, the 
intertubular tissue is oedematous, and small hemorrhages occur in the 
submucous tissue. 

Gray has observed cases of hemorrhagic gastritis in which the entire 
thickness of the mucosa resembled a sheet of blood; also instances of 
submucous gastritis in which disseminated abscesses occurred under the 
mucosa resembling the tumours caused by Spiroptera sanguinolenta. The 
same writer met with a case where 'punctated ulcerations of the size of 
a split pea were disseminated over the mucosa, the lesions being associ- 
ated with purpura hemorrhagica and scorbutus. 

Symptoms.—Mild forms of gastritis are recognised in which loss of 
appetite, dulness, and occasional vomiting, are observed, and recovery 
may take place in a few days. Such conditions are probably often 
associated with acute gastric indigestion. 

In severe cases, persistent vomiting and marked thirst are prominent 
symptoms. The material vomited is a frothy mucus, which may be 
streaked with blood and bile-stained. After each attack of vomiting and 
retching the animal shows marked distress and fatigue, and accelerated 
respirations sometimes accompanied by panting. There is a great desire 
for cold water, which the animal drinks with avidity, but quickly vomits 
again. Warm fluids or milk are generally refused. The tongue is dry 
and shows a coppery tint, the mouth feetid, the expression of countenance 
anxious, and the eyes more or less blood-shot. The abdominal muscles 
are retracted, and palpation of the epigastrium shows tenderness, or 
usually actual pain is evinced. In cases where tympany of the stomach 
occurs the abdomen shows a varying degree of distension. The patient 
endeavours to find a cold place to lie on, and may assume a variety of 
postures, such as lying stretched out on the belly or flat on the side, or 
he may stand at intervals with the hind-quarters raised and the fore- 
limbs stretched out, and the head resting thereon. Fever is generally 
present, and the temperature may rise to 103° to 105° F., but as the 
disease advances a subnormal temperature is often observed. A partial 
loss of power in the loins and hind-limbs, due to nervous prostration, 
is a common symptom in the later stages, and is often followed by in- 
ability to stand. Constipation may persist from the start, or it may 
be succeeded by a foetid diarrhoea, the feces being dark coloured or 
may be blood-stained. Towards the end of the case marked exhaustion 


480 SYSTEM OF VETERINARY MEDICINE 


is present, the pulse becomes imperceptible, the cardiac action very 
feeble, the extremities cold, swallowing becomes impossible, the tem- 
perature sinks to subnormal, the animal becomes semi-comatose, and 
death occurs after a slight convulsive struggle, generally during an effort 
of vomiting. 

In some cases icterus may, occur as a complication. 

The symptoms in toxic gastritis are similar to the above, but their 
advent is generally more rapid, and their severity depends on the nature 
of the toxic agent and the amount ingested. 

In toxemic gastritis the clinical picture resembles that of canine 
typhus (see Vol. I.), and intestinal symptoms are also present. The 
vomiting and retching are very frequent and persistent, and the vomit 
is of a chocolate or prune-juice colour, very foetid, and alkaline in reaction. 
The feeces are fluid, deeply blood-stained, and foetid. The course may 
be rapid, and death may occur in nine hours after the first appearance 
of symptoms. 

DIFFERENTIAL DiacNnosis.—Considerable difficulty is often experi- 
enced in differentiating toxic gastritis from the ordinary form of inflam- 
mation of the stomach. The history of the case will assist, but it must 
be remembered that the owner of the animal very frequently jumps to 
the conclusion that the ingestion of poison is the cause of the symptoms. 

Gastritis as the result of putrid meat or fish simulates canine typhus, 
and it may be impossible to differentiate the latter from toxemic gas- 
tritis (see p. 493). Hutyra and Marek remark that they have repeatedly 
seen in dogs of all ages sporadic cases of hemorrhagic gastro-enteritis 
which both clinically and anatomically were similar to canine typhus, 
and when the disease had lasted several days it even led to a superficial 
loss of substance in the mucosa of the cheeks. 

It is important to remember that in cases of chronic endometritis 
symptoms such as loss of appetite, thirst, repeated vomiting, prostration, 
etc., may be present, and an erroneous diagnosis of gastritis is easily 
given, unless a uterine examination is made. In many instances, how- 
ever, gastritis is associated with the uterine disorder. 

Prognosis.—In all forms of acute gastritis the prognosis is grave, 
but more especially in the toxemic type. 

Gray has observed that as a rule, if recovery is going to take place, 
the dog can tolerate soda-water and milk, or Brand’s essence of beef, , 
although other forms of food are rejected. But if the former cannot be 
retained, within twenty-four to thirty-six hours the case will usually 
prove to be of a serious type. 

TREATMENT.—The indications for treatment are, to give the stomach 


DISEASES OF THE STOMACH: DOG © 48] 


as much rest as possible, and to administer gastric sedatives in order to 
check the vomiting. The first indication is fulfilled by the use of nutrient 
suppositories, and avoiding the administration of nourishment per os. 
With regard to the second, in ordinary forms of gastritis a combination 
of bismuth, hydrocyanic acid, and bicarbonate of soda, given at short 
intervals, often proves successful. If this fails, morphine is advised by 
some practitioners. We prefer chloretone, administered in the form of 
powder, placed on the back of the tongue, the dose varying from 3 to 
10 grains according to the size of the dog. When the vomiting is con- 
trolled, milk and lime-water, milk and soda-water, white of egg dissolved 
in water, Brand’s essence of beef, etc., may be allowed in small quantities 
at frequent intervals; but these agents should not be forced on the 
animal, otherwise they will be rejected by vomiting. When marked weak- 
ness and evidences of threatened collapse are present, adrenalin should 
be given by hypodermic injection, and normal saline solution should 
be administered subcutaneously, and repeated at intervals. Warmth 
should be supplied to the body and extremities by means of hot-water 
bottles and proper clothing. Toxemic gastritis should be treated on 
the lines advised for Canine Typhus (see Vol. I.), and we may here repeat 
the injunction pointed out by Gray that in this form of gastritis bismuth 
preparations and antacids fail to produce any beneficial effects. Reliance 
must be placed on the administration of hydrochlorate of quinine hypo- 
dermically, and dilute hydrochloric acid given per os. We have had 
excellent results in some cases from the employment of acetozone 
administered in solution. When the vomiting is obstinate, we have found 
chloretone very useful. Chloralose and veronal are advised for a similar 
purpose. 

During convalescence great care is essential in order to prevent a 
recurrence as the result of too rapid a return to solid food. 

In gastritis due to toxic agents suitable antidotes must be adminis- 
tered, and for information on this point the reader is referred to the 
section on Poisons, and to Lander’s ‘‘ Veterinary Toxicology.” 

Chronic Gastritis—Synonyms.—Chronic gastric catarrh; Chronic 
indigestion ; Chronic dyspepsia. 

As the majority of cases of chronic indigestion are associated with 
chronic gastric catarrh, it is not desirable to attempt a separate descrip- 
tion of the two affections. The condition depends on chronic alterations 
in the gastric mucosa, and the lesions vary in severity. 

It is a doubtful matter whether the affection known as “ nervous 
dyspepsia ” in man occurs in the dog; this is regarded as a neurosis of the 


stomach, and although well-marked functional disturbances of the organ 
VOL. Il. 3l 


482 SYSTEM OF VETERINARY MEDICINE 


are in evidence, no lesions may be present. Livesey* describes a chronic 
indigestion of the dog associated with increased and continued secretion 
of acid, and said to be due to chronic irritation arising from improper 
feeding, etc., but unaccompanied by chronic gastritis. He remarks, how- 
ever, that the affection frequently ends in chronic gastric catarrh. The 
important features in connection with chronic gastritis are an increase 
in the formation of mucus, alterations in the gastric juice, and a weakening 
of the muscular coats of the stomach, causing the abnormal retention of 
food in the organ; the ultimate result is the occurrence of morbid 
alterations in the gastric mucosa. 

Et1otocy.—The affection may occur as a sequel to a previous attack 
of acute gastritis. It may also arise from improper diet, such as constant 
feeding on starchy foods, an insufficient amount of meat being allowed. 
Too long fasts or excessive feeding may tend to induce the condition. 
Septic conditions of the mouth and teeth are also recognised as etiological 
factors. 

As a secondary affection chronic gastritis occurs in connection with 
dilatation of the stomach and gastric ulcer. It is also associated with 
cirrhosis of the liver and chronic cardiac disease, such conditions causing 
chronic engorgement of the gastric mucosa by inducing stasis of the 
portal circulation. 

Chronic nephritis is often associated with chronic gastric catarrh, 
and the latter affection is not uncommon in connection with chronic 
endometritis in the bitch, the toxins being absorbed and eliminated by 
the gastric mucosa. 

Morsip ANatomMy.—Lhe stomach is generally dilated. The mucosa, 
especially at the pyloric region, 1s of a pale grey colour, velvety appear- 
ance, and covered by a tenacious, closely adherent mucus. It is more or 
less thickened, and in some cases may show a corrugated wrinkled 
surface; occasionally it may be thinner than normal, and at times the 
surface may become nodular. On histological examination parenchy- 
matous and interstitial inflammatory changes are observed. The gland 
cells show granular swelling or atrophy, and the connective tissue between 
the glands and in the submucosa is much increased. In advanced cases 
atrophy of the mucosa, with disappearance of a large amount of the 
secreting tissue, occurs. Hypertrophy of the gastric walls, with sclerosis 
of the mucosa, is described by Cadéac as a rare condition in the dog, 
and generally due to the presence of neoplasms. 

Symproms.—In the early stages the symptoms are those which are 
usually attributed to “ indigestion ”—viz., dulness, occasional vomiting 


* Journal of Comparative Pathology and Therapeutics, 1905. 


DISEASES OF THE STOMACH: DOG | 483 


after feeding, a hacking cough, and attempts to expectorate a tenacious 
white mucus; constipation is present, alternated at times with short 
attacks of diarrhoea; the coat is unhealthy, and the mouth has an un- 
pleasant odour. In aged dogs slight icterus may occasionally be ob- 
served. These symptoms may continue for an indefinite period, and 
gradually become intensified ; the appetite becomes capricious, vomiting 
may occur more frequently, the vomit containing large amounts of mucus; 
the mouth becomes foetid, the intestines frequently become involved, 
and an intermittent diarrhcea is observed, the excreta containing un- 
digested material and mucus. As degenerative lesions become more 
marked there is a deficiency of acid in the gastric contents, and the dog 
loses condition. In some instances a depraved or ravenous appetite is 
present, and yet emaciation occurs. According to Cadéac, when the 
stomach is dilated and inert it can be felt by palpation of the epigastric 
region, and when the gastric walls become sclerotic the organ feels like a 
hard tumour. Hutyra and Marek state that marked symptoms may be 
absent, the only phenomena observed being a capricious appetite and 
nutritive disturbances, with occasional vomiting after ingestion of food. 

Gray has found the affection common in aged dogs, and generally 
associated with chronic diseases of the kidneys, liver, etc.; it is character- 
ised by recurrent or occasional vomiting, but with suitable dieting the 
animal may live for a long time. 

TREATMENT.—Attention to food is of great importance. As a rule a 
meat diet suits better than starchy foods. In some cases peptonised 
foods prove of service. Gray has found that it is advisable to try an 
exclusive milk diet at first, and then to put the dog on a diet composed 
of shredded raw meat supplied little and often. 

It is advisable to commence treatment by the administration of a 
dose of grey powder, to clear out the gastro-intestinal canal, and also act 
as a cholagogue. The reaction of the gastric contents 1s an indication 
for the therapeutical measures to be employed. If the reaction be alka- 
line, small doses of dilute hydrochloric acid, with pepsin, tincture of 
nux vomica and tincture of gentian or calumba, should be prescribed. 
If vomiting be a marked symptom, it must be controlled by a mixture 
containing bismuth and pepsin. 

Excessive acidity, such as may occur in the early stages, accompanied 
by irritability of the gastric mucosa, is best treated by the administration 
of alkalies, a combination of bicarbonate of soda, carbonate of ammonia, 
and small doses of oil of peppermint (soda-mint), in the form of tablets 
often proving useful. Diarrhoea, if excessive, will require attention ; the 
addition of small doses of tincture of opium to the bismuth and pepsin 


484 SYSTEM OF VETERINARY MEDICINE 


mixture generally gives good results. Gray prefers powders to liquids 
in the treatment of this affection, as the latter are troublesome to ad- 
minister, whereas the former:can be dropped on the tongue, or if the 
appetite be good and the medicament tasteless, it can be mixed with 
the food. Excessive fermentation, evidenced by gaseous distension of 
the stomach, is, according to Cadéac, best treated by a combination of 
salicylate of bismuth, carbonate of magnesia, benzo-naphthol, bicarbonate 
of soda, and wood charcoal, administered in the form of cachets. When 
the secreting structure of the stomach becomes permanently degenerated, 
it is obvious that treatment of any kind cannot prove successful, and 
can only be palliative. 


ULCERATION OF THE STOMACH. 


SynonymMs.—Gastric ulcer; Ulcerative gastritis. 

As regards the frequency of this condition in the dog a difference of 
opinion exists amongst authors and practitioners. According to Cadéac, 
it occurs frequently, while Hutyra and Marek and also Gray state that 
it is rarely met with. Peptic ulcer, according to C. French, is not rare 
in the dog. 

The varieties of ulcers are similar to those described as occurring in 
the horse (see p. 132). 

The etiological factors include distemper, in which erosions and catar- 
rhal ulcerations on the summits of the folds of the gastric mucosa are not 
uncommon lesions; prolonged attacks of catarrhal gastritis ; the ingestion 
of corrosive toxic substances ; the presence of rough foreign bodies in the 
stomach; extensive burns of theskin. Gastric ulcer has also been observed 
in connection with certain lesions of the spinal cord, in cases of rupture of 
aneurismal tumours of the stomach, and may occur from the effects of 
Spiroptera sanguinolenta. In some cases no cause can be determined. 

The ulcers are generally found in the right sac of the stomach, especially 
in the vicinity of the pylorus and at the origin of the duodenum. The 
lesion often occurs in the form of two symmetrical ulcers, resembling the 
round or perforating ulcer of man. According to Gray, the peptic ulcer 
is found more often at the pyloric opening; it may be the size of a shilling 
to that of a florin. It is usually shallow, but is deeper at the circumfer- 
ence than at the centre. 

Symproms.—The symptoms are by no means characteristic. ieee 
has frequently found gastric ulcer post mortem in cases that showed no 
diagnostic symptom during life, and his experience has been that the 
condition is generally iin BMNS by ulcers or new growths in some part 


DISEASES OF THE STOMACH: DOG 485 


of the intestine. According to Hutyra and Marek, the symptoms, when 
present, are identical with those of chronic gastric catarrh, and the 
affection may be surmised if heematemesis and hemmorhagic, black, tar- 
like faeces are observed. ‘The patient may show improvement for a few 
days, and then sudden relapses occur. Cadeéac has observed hematemesis 
to follow the ingestion of a full amount of food, also intestinal complica- 
tions, evidenced by a foetid diarrhcea, marked emaciation, and feebleness, 
weakness in the hind-limbs, and a change in the demeanour of the animal. 
In some cases symptoms of intense gastritis are present. The course of 
the disease is variable. Adhesions may be formed to organs in the vicinity, 
and thus perforation is prevented. If perforation occurs, symptoms of 
peritonitis rapidly develop. 

TREATMENT.—Attention to diet is necessary, and all foods of a bulky 
or coarse nature should be avoided. When hematemesis is present, the 
internal administration of adrenalin is indicated, and solid food should 
be interdicted. Vomiting is to be controlled by gastric sedatives, such 
as bismuth or chloretone. Some authors advise small doses of nitrate of 
silver. Hutyra and Marek recommend artificial Carlsbad salt, so as to 
neutralise excess of acidity and assist in removing the gastric contents ; 
while if obstinate vomiting is present these authors advise the administra- 
tion of opiates. In order to facilitate the healing of round ulcers, gastric 
antiseptics, such as salol, naphthol or benzo-naphthol, are recommended 
by Cadéac, also a combination of iodoform and extract of cinchona in the 
form of cachets. 


HZMORRHAGE OF THE STOMACH. 


This is observed in the dog as the result of the ingestion of irritant 
or caustic substances, which cause an intense gastritis or ulceration of 
the stomach. It may also occur in canine distemper, gastric ulcer, or 
from the presence of sharp foreign bodies in the stomach, etc. A modified 
form of hemorrhage occurs during the course of diseases which are 
associated with stasis in the portal vein, resulting in congestion of the 
gastric mucosa, such as cirrhosis of the liver and chronic valvular affections 
of the heart. 

Symproms.—lIf the hemorrhage be severe, hematemesis (vomiting of 
blood) occurs. The vomited material consists either of ingesta streaked 
with blood, or of blood arterial in hue, or in coagula of a dark brown 
colour. If the blood be retained in the stomach for any time, the 
hemoglobin is changed into hematin by the action of the hydrocliloric 
acid present in the gastric juice, so that the material vomited resembles 
ground coffee. Very often, however, the blood enters the intestine, and 


486 SYSTEM OF VETERINARY MEDICINE 


renders the feces discoloured or tar-like. It must be remembered that 
blood may enter the stomach from the mouth or from the respiratory 
organs; in the latter case it is first coughed up, and then swallowed. 
Sharp foreign bodies in the cesophagus or new growths therein may cause 
hemorrhage, and the blood enters the stomach. In such cases the source of 
the hemorrhage may be overlooked unless a careful examination be made. 

TREATMENT.—The principles of treatment are practically similar to 
those advised for gastric ulcer (see p. 485). 


FOREIGN BODIES IN THE STOMACH. 


This subject properly belongs to the domain of surgery, as the treat- 
ment consists mainly in operative measures. An extraordinary variety 
of foreign bodies may be swallowed by dogs, especially by young animals. 
Portions of cork or sponge, collections of horsehair, rubber balls, stones, 
etc., prove very dangerous. The usual symptoms exhibited are frequent 
attempts at vomiting, loss of appetite, depression, loss of condition, 
irregular action of the bowels, and in some cases the feces contain blood. 
In the case where the foreign body is of a sharp nature, such as a hat- 
pin or a skewer, it often happens that the first symptom observed is 
swelling and abscess formation, generally in the region between the 
posterior ribs, in the vicinity of the cesophagus, or in the flank. The 
history of the case is important from a diagnostic point of view, but it 
must be remembered that the owner not infrequently imagines that the 
dog has swallowed a foreign body. Hobday advises that in the case where 
small bodies, such as nails, etc., have been swallowed, a diet which is likely 
to surround them and gradually cause them to pass along the intestine 
should be ordered, and for this purpose he recommends suet pudding. 
When the foreign body is not sharp, the same author administers an 
emetic, preferably apomorphine, in order to cause expulsion by vomiting. 
Cases are recorded in which foreign bodies have remained in the stomach 
for a long period without any marked symptoms. For further particulars 
in connection with this subject, and also on the operative measures which 
may be necessary, the reader is referred to Hobday’s “ Surgical Diseases 
of the Dog and Cat.” ) 


TORSION OF THE STOMACH. 


This interesting condition was first described by Kitt, and afterwards 
by Cadéac, Jensen, Johne, and other observers. The organ, with the 
pylorus, turns around the cardia in a direction from right to left; the result 


DISEASES OF THE STOMACH: DOG 487 


of the altered position is that the larger curvature is directed to the 
right, and the pylorus to the region of the inferior aspect of the ribs on 
the left side, and both openings. of the stomach become occluded. The 
circulation in the gastric walls is interfered with, marked tympany 
develops, acute pain occurs, and owing to the enormous distension of 
the stomach, pressure is exerted on the diaphragm, so that respiration 
is impeded. | 

Et1oLogy.—According to Hutyra and Marek, torsion occurs owing 
to the mobility of the pylorus in the dog, and that in certain movements, 
such as jumping, rolling, rapidly running upstairs, the stomach easily 
changes its position. But owing to the full stomach being sufficiently 
fixed by the abdominal wall and by its attachments to other organs, this 
change of position can only occur when it is empty, or when it contains 
pieces of bone, meat, etc., which may produce a swinging motion of the 
organ during the movements mentioned above. 

Morsip ANATomy.—The stomach is enormously distended with gas, 
it displaces other abdominal organs, and by pressing on the diaphragm 
reduces the size of the thoracic cavity. The pyloric region and the first 
portion of the duodenum are displaced, so that they occupy a position 
between the posterior surface of the stomach and the posterior aspect of 
the liver. On opening the stomach the mucosa is found to be of a dark red 
colour, and the entire gastric walls are infiltrated and edematous. The 
spleen follows the change of position of the stomach, and its circulation 1s 
interfered with; it is enlarged, and assumes a curved shape, and is of a 
blackish-red colour. In some cases there are evidences of peritonitis 
present. 

Symptoms.—The leading symptoms are sudden abdominal pain, dis- 
tension of the abdomen, dyspnoea; the animal stands immovable, no food 
is taken, but in cases observed by Bonvicini thirst was present, and when 
water was taken it was quickly returned by the mouth and nostrils. 
Vomiting is absent and intestinal peristalsis is in abeyance. Percussion 
elicits a tympanitic sound most marked at the umbilical region ; abdominal 
palpation causes marked pain. The dyspnoea becomes intense, the pulse 
weak and imperceptible, and death occurs in from twenty-four to forty- 
eight hours after the first appearance of symptoms. 

TREATMENT.—It is advised to give exit to the gas by means of a 
trocar and cannula. Laparotomy must then be performed, and an 
attempt made to restore the stomach to its normal position. Hobday 
states that torsion of the stomach is a condition which can only be 
diagnosed by an exploratory laparotomy. 


488 SYSTEM OF VETERINARY MEDICINE 


INVERSION OF THE STOMACH. 


This is a very rare condition. A case was reported by Ainslie (vide 
Proceedings of the Veterinary Medical Association, 1838-39), in which 
the stomach was inverted into the csophagus. The dog was three or 
four years old, and for several months had been subject to occasional 
vomiting, which latterly became more frequent, and occurred an hour 
or two after feeding. The animal had been under treatment for a 
severe attack of distemper, and large doses of calomel had been ad- 
ministered; from that time the symptoms mentioned had persisted. A 
continual discharge of viscid saliva was observed from the corners of the 
mouth, and more or less blood accompanied every act of vomition. 
Death occurred after a continuous attack of vomiting. The autopsy 
showed an absence of the stomach from its usual location and a con- 
siderable enlargement of the cesophagus. On cutting into the latter, 
the inverted stomach was discovered therein, and the gastric mucosa 
was intensely inflamed. The dilatation of the csophagus commenced 
even from the pharynx, and had probably existed for a considerable 
time. 


TUMOURS OF THE STOMACH. 


These are very rarely met with. 

Eberlein has recorded a case of carcinoma of the stomach, and instances 
of sarcomata have been observed by Ball and Besnoit. 

Cases of lipomata, fibromata, myomata, and fibromyomata have also 
been recorded. | 

There are no diagnostic symptoms, and evidences of chronic gastritis 
may be the only phenomena present. According to Hutyra and Marek, 
also Cadéac, it may be possible by palpation to locate the tumour. 
Nothing can be done in the way of treatment. Gastrectomy was per- 
formed by Parascandolo in the radical treatment of tumour of the 
stomach, and with good success (Hutyra and Marek). 


PARASITES OF THE STOMACH. 


The most important and common parasite of this organ is the Spirop- 
tera sanguinolenta, for a description of which and of the effects it produces ° 
the reader is referred to the section on Parasites. 


DISEASES OF THE INTESTINES: DOG | 489 


DISEASES OF THE INTESTINES. 


GENERAL REMARKS. 


In the dog inflammatory diseases of the stomach are very frequently 
associated with similar affections in the intestines. Yet it is not un- 
common to find gastritis accompanied by inflammation of the duodenum, 
and the remaining intestines unaffected. Per contra the enteritis may 
be found in the latter region, while the former may present no lesions, 
It must be admitted that from a clinical point of view our knowledge of 
the subject and the means of diagnosis at our command are much in 
need of advancement, while from a pathological standpoint the necessity 
for further research is very apparent. 

A hemorrhagic form of enteritis occurs in connection with canine 
typhus (see Vol. I.), and also in certain types of canine distemper (see 
Vol. L.). 

The simple anatomical formation of the large intestine in the dog 
explains the absence of twists and displacements, which are of such common 
occurrence in the horse. Invagination, however, is often met with. Again, 
owing to the nature of the dog’s food, and to the comparatively small 
calibre of the colon, intestinal tympany only occurs to a moderate extent. 

Colic, such as is so frequently met with in the horse, is seldom observed 
in the dog. No doubt colicky pains, evidenced by restlessness, whining, 
or actual yelping, crouching down, first on one side and then on the other, 
occur as a symptom in various intestinal disorders. but there is an 
absence of the violent phenomena characteristic of the so-called spasmodic 
colic of horses. In puppies, however, it is not uncommon to find acute 
pain in intestinal affections, manifested by constant piercing cries. 
This is often observed in impaction of the bowels by collections of 
ascarides, but in many cases no cause can be discovered to account 
for the pain. Again, serious and often fatal enteritis may be present 
in the dog without any marked symptoms of abdominal pain; indeed, 
in some cases the usual evidences of pain may be absent. Colicky 
pains have been observed after the administration of full doses of areca- 
nut. | 
Fecal obstruction and obturation due to the presence of foreign bodies 
are of frequent occurrence in the dog, while intestinal lesions associated 
with specific diseases, such as canine typhus, canine distemper, and 
tuberculosis, are often met with. 


490 SYSTEM OF VETERINARY MEDICINE 


ENTERITIS. 


Inflammation of the intestines in the dog may occur in an acute and 
in a chronic form. 

Several varieties of the acute form are recognised, but for practical 
purposes it will suffice to describe acute catarrhal enteritis, and the 
affection known as ‘“‘ mycotic,” “dysenteric,” or “ croupous”’ gastro- 
enteritis. 

Acute Catarrhal Enteritis—Synonym.—Acute intestinal catarrh. 

This affection is frequently associated with gastritis, and is believed 
to depend on similar causes. Some authors regard it as always depending 
on microbial infection, but according to Hutyra and Marek this view 
requires further proof before it can be definitely accepted. Chills, fatigue, 
etc., are believed to act as predisposing causes by lowering vitality, and 
permitting infection from the micro-organisms which are normally present 
in the intestinal canal. These include staphylococci, streptococci and bacilli 
of the colitvpe. Enteritis also occurs as the result of irritant poisons. 

Morsip Anatomy.—The intestinal mucosa is swollen, infiltrated, of 
an intense red colour, and covered with a layer of mucus; the submucosa 
is oedematous. The villi and the solitary and agminated follicles are 
swollen, and in some cases small hemorrhages are present. The lesions 
may occur throughout the entire extent of the intestine, or may be 
limited to certain regions. According to some authors, the small bowel is 
more frequently involved than the large intestine. In some instances the 
solitary and agminated follicles exude a purulent material when subjected 
to pressure. Occasionally ulcers are observed. Hobday* has met with 
typhlitis (inflammation of the cecum), and Livesey~ has observed 
suppurative perityphlitis, with adhesions to structures in the vicinity 
of the caecum, and the presence of enlarged mesenteric glands. 

SyMPToMS.—Constipation may be observed at the outset, but is soon 
succeeded by diarrhoea. The intensity of the latter depends on the 
severity of the lesions present. According to Hutyra and Marek, if the 
small intestine alone is involved, diarrhcea may be absent. Vomiting is 
a variable symptom, but is generally observed if gastritis be present. 

Mucus and sometimes blood occur in the feces, and tenesmus 1s 
observed, especially if the large intestine be the seat of the lesions. 
Evidences of pain may be present, and palpation of the abdomen causes 
the animal to resist and whine. Amongst other symptoms observed are 

* “Surgical Diseases of the Dog and Cat.” | 


+ ‘Diseases of the Stomach and Intestines of the Dog,’’ National Veterinary 
Association, 1913. 


DISEASES OF THE INTESTINES: DOG | 491 


fever, loss of appetite, marked thirst, a ‘‘drawn-up”’ condition of the 


abdominal muscles, an anxious expression of countenance, restlessness, 
a tendency to he on cold surfaces, prostration, ete. When the duodenum 
is Involved, icterus from absorption may occur, owing to the ESM Ata 
extending to the bile duct. 

In typhlitis, Cadéac remarks that the symptoms are not characteristic. 
Hobday observed acute abdominal pain, especially after food was taken, 
and manifested in some cases by yelping, moaning, or screaming. 
Pressure on the posterior region of the abdomen caused evidences of pain, 
and in some cases the swollen caecum could be detected by manipu- 
lation. | 

Course.—In mild cases subjected to rational treatment recovery is 
the rule, but when the lesions are severe rapid prostration often occurs. 

TREATMENT.—In the early stages a moderate dose of castor oil is 
indicated to remove undigested food from the intestine. A small amount 
of chlorodyne may be given with the oil to relieve irritation of the 
intestinal mucosa. Some practitioners advise a dose of grey powder. 
Attention to diet is of importance; milk with lime-water, raw white of 
egg, etc., should be allowed, but no solid food. To check the diarrhea 
various medicinal agents are employed, such as salts of bismuth, Dover’s 
powder, etc. Intestinal disinfectants often prove useful to check fermen- 
tation and prevent auto-intoxication. For this purpose salicylate of 
bismuth, salol, naphthalin, acetozone, etc., are advised. Cadéac pre- 
scribes very small doses of sulphate of soda or sulphate of magnesia, with a 
view to suspend exosmotic action of the bowels. To prevent collapse, 
hypodermic injections of normal saline solution are indicated. Livesey 
advises for this purpose intramuscular injections of pituitary extract. 
When symptoms of dysentery occur, the treatment advised for that con- 
dition (see p. 494) should be adopted. When the case is complicated by 
icterus, very small, repeated doses of calomel may be prescribed, but 
such instances in our experience prove very fatal. 

Chronic Catarrhal Enteritis—This is one of the causes of chronic 
diarrhcea in the dog. It may result from recurring attacks of the acute 
form of the disease, but may also be associated with chronic affections of 
the heart, liver, or kidneys, which interfere with the circulation in the 
intestinal walls, and produce a condition of chronic passive congestion 
leading to intestinal catarrh. The affection may also depend on tuber- 
culosis or coccidiosis. 

Morsip Anatomy.—The intestinal mucosa may be of a brownish-red 
colour, or in some instances of a greyish tint. It may be thickened or 
show polypoid projections due to increased growth of the interglandular 


492 SYSTEM OF VETERINARY MEDICINE 


connective tissue. In some cases it is atrophied and of a pale tint. The 
intestinal glands may be enlarged and occasionally changed into cysts, or 
ulcers may be present in the colon and rectum. The lesions generally 
occur in the colon, and, according to Livesey, most frequently in the 
region of the sigmoid flexure. 

Symptoms.—An obstinate chronic diarrhoea, with gradual emaciation 
and anemia, are the leading symptoms present. In some instances 
cessation of peristalsis and diarrhoea may occur alternately. The feces 
generally contain a large amount of mucus, and Livesey has observed 
the passage of complete mucous casts of the bowel. When ulcers are 
present, the motions contain blood. 

TREATMENT.—The principles of treatment are similar to those advised 
for acute enteritis. Attention to diet is necessary, and solid food should 
be prohibited until the diarrhoea is checked. A mixture containing 
bismuth and pepsin proves useful in some cases. Gray advises large 
doses of subnitrate of bismuth in powder form. The diarrhcea is often 
very obstinate, and the usual treatment may fail. In such cases a com- 
bination of dilute sulphuric acid, decoction of hematoxylin, and infusion 
of cloves, often proves of benefit. Intestinal antiseptics prove useful 
in some instances. 

When the affection occurs in connection with chronic diseases of the 
liver, kidneys, etc., treatment suitable to these conditions must be 
employed. 


INTESTINAL CATARRH IN YOUNG DOGS. 


This is also known as “ diarrhoeic enteritis,’ and is described by some 
authors as a special disease occurring in young dogs, appearing within 
a short time after birth to the time of weaning. The etiological factors 
recognised are bad hygienic surroundings, artificial feeding, fermenting 
food, etc. Enzodtics of the disease have been recorded, and according 
to some observers the micro-organisms on which the affection depends 
are varieties of the Bacillus coli. The condition is generally accompanied 
by gastritis. In many instances this affection is probably a form of 
distemper. 

Symproms.—Vomiting and diarrhoea are prominent symptoms. The 
material vomited may be of a yellowish-green colour, being stained by 
bile; in some cases it may show streaks of blood. The feces are fluid, 
viscid, very foetid, passed at frequent intervals, and tenesmus may be so 
severe that it is often followed by eversion of the rectum. In the later 
stages blood may be passed with the feecés. The disease is accompanied 
by marked prostration, and is very fatal. 


DISEASES OF THE INTESTINES: DOG 493 


A differential diagnosis from the gastro-intestinal form of distemper 
is very difficult. 
The treatment is similar to that advised for other forms of enteritis. 


MYCOTIC GASTRO-ENTERITIS. 


Synonyms.—Dysenteric or Croupous enteritis. 

This is an intense hemorrhagic gastro-enteritis, associated in some 
instances with the formation of croupous membranes. In the majority . 
of instances it occurs from the ingestion of infected or decomposing meat, 
and is sometimes known as “ meat-poisoning.” According to Cadéac, 
the flesh of animals which have died as the result of excessive fatigue is 
capable of exerting toxic actions when ingested by the dog. Similar 
effects may occur from the use of the meat derived from animals that 
have succumbed to infectious diseases, such as anthrax, septicemia, etc., 
also from those which have died of septic metritis, septic peritonitis, etc. 
According to Hutyra and Marek, cases of gastro-enteritis have been 
observed in Hungary in dogs fed on the meat of swine which were affected 
with swine fever. Berger observed similar results in dogs fed on the 
flesh of chickens affected with fowl cholera. Putrefying horse-flesh, 
sausages, fish, etc., may also produce hemorrhagic gastro-enteritis. 
We have seen cases occurring in dogs that had access to the refuse of an 
hotel, which was permitted to accumulate for the purpose of feeding 
pigs. As already remarked, it is very difficult to differentiate such cases 
of gastro-enteritis from canine typhus. 

The putrefaction of albumin leads to the formation of ptomaines in 
meat, which may in some instances produce meat-poisoning. These toxic 
substances include neurin, muscarin, methyl-guanidin, cadaverin, putre- 
scin, and cholin. 

Various micro-organisms have been credited with being the essential 
cause of meat-poisoning. 

The Bacillus of Gartner, or Bacillus enteritidis, is the most important, 
and is said to render the flesh of animals affected with septic or febrile 
diseases pathogenic. Several varieties of this bacillus are recognised. 

The Bacterium coli and Proteus vulgaris occur in normal flesh which 
becomes putrid owing to exposure to air, also in tainted fish and sausages. 

The Bacillus botulinus occurs in tainted sausages and preserved fish, 
but pathogenic effects from this source are seldom observed in the dog. 

It is difficult to ascertain the extent to which gastro-enteritis due to 
meat-poisoning occurs in canine practice, as very similar lesions may be 
met with in canine typhus and in the gastro-intestinal form of distemper. 


494 SYSTEM OF VETERINARY MEDICINE 


Judging by the frequency with which dogs ingest decomposed meat with 
apparent impunity, we can only assume that when serious effects ensue 
some predisposing factors must be in existence. Probably in many cases 
the offending material is vomited before it has had time to exert dele- 
terious effects. Gray believes that dogs usually fed on fresh foods are | 
more liable to meat-poisoning when they gain access to tainted or decom- 
posed meat than dogs whose natural instincts are allowed free play. 

Morsip Anatomy.—The gastro-intestinal mucosa is swollen, and of a 
dark red or brownish-red colour, and the submucosa 1s cedematous. The 
gastro-intestinal contents are very foetid, and often hemorrhagic in 
character. The solitary and agminated follicles are swollen, and greyish 
pseudo-membranes are formed on the mucosa. In some cases ulcers may 
be observed. The mesenteric glands are swollen, and parenchymatous 
changes occur in various internal organs, pointing to a general infection 
of the system. 

Symproms.—The chief effects of the disease are exerted on the 
digestive and on the nervous system. In from six to twelve hours after 
the ingestion of the offending material persistent vomiting is observed; 
the vomited material is hemorrhagic in character and very foetid; colicky 
pains may be present; prostration is marked; the temperature may be 
elevated at the start, but soon becomes subnormal;-the pulse is small 
and weak; diarrhcea is a prominent symptom; the feces are very 
foetid, may contain shreds of tissue, and are hemorrhagic—in some 
instances pure blood may be passed; tenesmus may also be present. In 
the later stages nervous phenomena occur, such as profound prostration, 
muscular contractions, staggering, and finally coma and death. Hutyra 
and Marek observed loss of substance in the mucosa of the cheeks and 
gums. Livesey observed a profuse erythema of the skin in cases due 
to the ingestion of bad fish. 

The course of the disease is generally rapid in severe cases, and death 
may occur within two days, or even in twenty-four hours. 

DIFFERENTIAL Diacnosis.—This must be based on the history of the 
case. Hven in spite of every investigation errors will occur, and the 
disease may be mistaken for canine typhus or the gastro-intestinal form 
of distemper, while owing to lack of a correct history of the case the differ- 
entiation between the disease and irritant poisoning generally presents 
extreme difficulty. 

TREATMENT.—If the case is seen in the early stages, an emetic is’ 
indicated in order to get rid of the noxious material; for this purpose a 
hypodermic injection of apomorphine may be given. Hutyra and Marek 
advise lavage of the stomach. To check excessive vomiting, chloretone 


DISEASES OF THE INTESTINES: DOG | 495 


may be given; this will also act as a gastric disinfectant. Acetozone 
(gr. v. to 0.1.) is also useful as an internal antiseptic. If pain be a pro- 
minent symptom, morphine should be given hypodermically. Chloralose 
and veronal are also useful for a similar purpose. To combat the extreme 
prostration normal saline solution should be administered subcutaneously 
at frequent intervals. Some authors advise the addition to this of 
adrenalin. If the rectum is not involved, nourishment should be given 
by means of nutrient suppositories. It is useless administering either 
food or stimulants per os, as they are quickly rejected by vomiting. 


ULCERATION OF THE INTESTINE. 


This lesion is observed under a variety of conditions. Thus it may 
occur in connection with certain diseases—e.g., distemper, typhus, 
gastro-enteritis, tuberculosis, etc.—also as the result of chemical irritants, 
gastro-enteritis, the presence of rough foreign bodies in the intestine, 
and more often as the result of neoplasms. Cadeac has observed in- 
testinal ulceration associated with chronic eczema and extensive burns 
of the skin. Ulceration of the intestine as a disease er se is very rare. 

Morspip AnatoMy.—The common seats of the lesions, according to 
some authors, is the duodenum and other divisions of the small intestine. 
Other authors describe cases in which small ulcers occurred in the colon 
and more often in the rectum. Livesey has met with a few instances in 
which well-marked ulcers were present in the cecum. He also recorded 
a case of extensive perityphlitis,* in which ulcers were present in the 
duodenum and ileum, and in the latter region perforation of the bowel 
occurred, resulting in peritonitis. Cadéac remarks that the duodenum is 
often the seat of a double ulcer, which may be round, ovular, or irregular 
inform. Guy Sutton} recorded a case of perforating duodenal ulcer about 
the size of a pea in a fox-terrier; the lesion was associated with remarkable 
thickening of the intestinal wall. 

Symptoms.—All authors agree with reference to the absence of 
characteristic symptoms in cases of intestinal ulcers. In some instances 
the symptoms resemble those met with in enteritis of a dysenteric char- 
acter, the casts of mucus and the feces being blood-stained; chronic 
diarrhoea is present, and also loss of condition. Livesey states that he 
has never been able to diagnose with certainty the presence of ulcers in 
the intestine. In Guy Sutton’s case of perforating duodenal ulcer, already 
referred to, the symptoms observed were persistent diarrhcea for two 


* Journal of Comparative Pathology and Therapeutics, vol. xviii., p. 75. 
+ Veterinary Journal, July, 1913, p. 333. 


496 SYSTEM OF VETERINARY MEDICINE 


months, poor condition, a fair appetite, but the animal showed discomfort 
in about two hours after taking food; the temperature was 102°5° F.., 
and there was no regular history of vomiting. Later on the diarrhcea 
continued, and the feces consisted frequently of bloody mucus; there was 
occasional vomiting, the appetite failed, emaciation was extreme, blood 
was passed in increased amount, and the animal was destroyed. 

TREATMENT.—Some authors advise the administration of benzo- 
naphthol, salol, salicylate of bismuth, etc., with a view to promote 
cicatrisation of the ulcers; these agents may be combined with opiates, 
so as to check the diarrhcea. Livesey recommends the various com- 
binations of tannic acid and formalin administered per os, and also per 
rectum in the form of injection. He has also found sulphate of copper 
combined with opium to prove successful in some cases. 


FAACAL IMPACTION OF THE INTESTINE. 


This is a very common condition in the dog. It varies in degree and 
extent, some cases ylelding readily to simple medical treatment, others 
being very obstinate, and even requiring surgical interference. 

Kit1oLogy.—Any factors which tend to interfere with the normal 
peristaltic action of the intestines are likely to produce fecal impaction. 
As causes we may mention want of sufficient exercise; the use of dry or 
concentrated foods, or foods large in bulk and of an indigestible nature; 
gluttonous feeders which swallow large masses of meat, bones, etc.; old 
fat dogs in which the innervation of the intestine is deficient; habitual 
constipation when neglected; chronic disorders of the stomach, intestines, 
or liver; tumours in the abdominal cavity which press on the intestines. 
The anus may be obstructed by swelling and inflammation of the anal 
glands, or by an accumulation of fecal matters matted with the hair. 
This is not uncommon in the smaller breeds; in such instances the feces 
accumulate in the rectum and colon. 

It is important to distinguish fecal impaction from fecal stasis due 
to loss of nervous power. Certain affections of the nervous system, 
especially paraplegia, are accompanied by fecal stasis. This condition 
is well marked in cases of recurrent pachymeningitis, and also in rheu- 
matic affections of the abdominal muscles, so frequently met with in 
canine practice. Formerly the intestinal obstruction was regarded as 
the cause of the nervous symptom in cases of the above description, but’ 
we now are aware that it is in reality the effect of interference with peri- 
stalsis, and also with the action of the abdominal muscles, defecation 
being rendered so painful that the act is suppressed. 


DISEASES OF THE INTESTINES: DOG = 497 


Morspip Anatomy.—In fecal impaction the obstruction may occur 
in the cecum, the colon, or the rectum. Hobday recorded a case in a 
retriever in which the colon was obstructed by a mass as hard as a stone, 
fully a foot of the bowel being involved; the small intestine in front was 
enormously dilated and full of semi-fluid feeculent material, and no feces 
had been passed for at least three weeks. The same author draws atten- 
tion to an obstinate form of impaction met with especially in sporting 
breeds of dogs, caused by over-indulgence in game, rabbit-bones, etc. 
These become matted together with hair or fur, and form a hard, bony 
mass. | 

Livesey has met with several cases of impaction of the cecum, and 
in two instances found the bowel firmly impacted with ascarides, causing 
complete obstruction. It is common to find an obstruction in the form 
of a hard accumulation of feces situated close to the anus. In some 
instances the impacted mass contains spicules of bone. Such cases 
often occur in old dogs having a narrow pelvis, and fed on hard food con- 
taining bones, etc., and not allowed their liberty. In such animals the 
anus is generally sacculated just within the anal ring. 

In cases that are unrelieved, necrosis, enteritis, and occasionally 
perforation of the bowel, may be observed. 

Symproms.—The leading symptoms are obstinate constipation, con- 
stant straining, and crying when attempts at defecation are made, 
occasional vomiting, loss of appetite, distension of the abdomen, and 
tenderness evinced on palpation of this region. When the obstruction 
occurs in the rectum, it can be detected by a digital examination, and in 
other parts by extra-abdominal palpation. 

In impaction of the cecum Livesey has observed that the dog, when 
straining in attempts to defecate, holds the tail in a backward curve, and 
the abdominal muscles are brought into violent use, also the skin of the 
back is wrinkled in a similar manner to that observed in the bitch during 
parturition. 

In many instances, and generally when excoriation of the bowel has 
occurred, pain is well marked during the attempts at defecation, especi- 
ally if the obstruction contains sharp spicules of bone. Stercoraceous 
vomiting is sometimes observed, the vomit being composed of material 
from the intestine. This may be well marked in obstinate cases when 
aperients have been given or after the administration of enemas. It 
is usually attributed to an anti-peristaltic action of the intestine, but, 
according to Cadéac, this view is not correct. He attributes the phe- 
nomenon to an accumulation of liquid in the loop of bowel anterior to 


the obstruction; this is subject to marked oscillations which agitate the 
VOL. Il. 32 


498 SYSTEM OF VETERINARY MEDICINE 


liquid. These oscillations depend on the contractions of the intestine 
induced to overcome the obstruction, and from the pressure exerted on 
the diaphragm and abdominal walls by the distended loop of bowel 
in front of the obstructed portion. The course of the disease varies, — 
according to the degree of obstruction present, and the success or other- 
wise of the treatment adopted. Unless relief be afforded, complications 
set in, such as auto-intoxication, enteritis, septicemia, etc. Death may 
occur in from eight to fourteen days; occasionally it may be delayed to 
three weeks. 

In the diagnosis of impaction of the intestine palpation often gives 
valuable indications; thus a hard, swollen mass of variable length may 
sometimes be detected. Cases are met with in which, after the adminis- 
tration of a purgative, fluid material may be forced past the obstruction, 
and this phenomenon may be mistaken for a favourable element as regards 
prognosis. The condition must be differentiated from tumours of the 
intestine, or neoplasms of the abdominal cavity, foreign bodies in the 
intestine, etc. 

TREATMENT.—In mild cases (feecal stasis) success is generally obtained 
by the administration of a full dose of castor oil and by enemas of warm 
water. When the obstruction 1s more extensive, and if the case has been 
neglected, it proves more obstinate to treatment. Chief reliance must be 
placed on enemas administered by means of the long gum-elastic rectum- 
tube, care being taken not to injure the bowel during the procedure. 
Warm olive oil often proves more efficacious than water. When the 
obstruction is sjtuated in the rectum and within reach, it can be care- 
fully broken up and removed piecemeal by means of a blunt curette. 
Gray advises that the dog should be held head downwards and the bowel 
filled with warm water. The fecal masses should then be broken up 
by means of a small pair of obstetric forceps. This procedure may require 
to be repeated at intervals. When the stomach is in an irritable con- 
dition it is useless to administer medicines per os, as they are vomited 
immediately. Drastic purgatives are contra-indicated, especially in 
feecal impaction. 3 

If the above measures fail, the question of surgical interference must 
be considered. An exploratory laparotomy can, under the present con- 
ditions of surgical methods, be so safely carried out that we should not 
delay it, otherwise the patient’s system becomes so weakened that the 
efforts of the surgeon may be unavailing. Moreover, the difficulties of 
diagnosis must be kept in view, as the case may be one of obstruction 
by a foreign body, which can only be recognised by an exploratory 
operation. 


DISEASES OF THE INTESTINES : DOG 499 


For the details of the various operative measures which may be 
necessary, the reader is referred to Hobday’s “ Surgical Diseases of the 
Dog and Cat.” 


FOREIGN BODIES IN THE INTESTINE. 


These are a common cause of intestinal obstruction in the dog. A 
large variety of objects may be swallowed by dogs, especially by young 
animals during play. Such objects may be retained in the stomach, 
and may or may not give rise to gastric symptoms; but more frequently 
they pass on to the intestine, and the effects produced will vary according 
to the shape and location of the foreign bodies. The usual location is 
in the small intestine, in the region of the pylorus, and.also in the ileum 
just anterior to the ileo-cecal opening. 

Symproms.—lIf the foreign body causes complete obstruction of the 
bowel, the prominent symptoms are persistent vomiting and obstinate 
constipation. Prostration soon occurs, and on careful palpation of the 
abdomen the foreign body may in some cases be felt through the ab- 
dominal wall. But in other instances we only observe a capricious 
appetite, occasional colicky pains, frequent attempts at defecation, and 
the passage of a small amount of fluid feces, or blood-stained mucus. 
When complete obstruction does not result, the symptoms are very de- 
ceptive, and we have seen cases in which an irregular-shaped stone in the 
ileum was only accompanied by occasional vomiting, a capricious appe- 
tite, gradual emaciation, slight diarrhoea alter the administration of an 
aperient, and thirst, etc. In such instances the course may be prolonged 
to even two or three months, and the real nature of the case is not sus- 
pected. In some cases the foreign body may pass along the bowel and 
be expelled per anum. Sharp bodies, such as needles, may not cause 
any symptoms at first, but later on restlessness, intermittent pain, and 
marked tenderness on palpation of the abdomen, are observed. The 
course of these cases varies, and enteritis or perforation of the bowel may 
result in such instances. 

Amongst the most dangerous of foreign bodies are corks, as they 
swell, owing to becoming soaked in the intestinal contents. These tend 
to become lodged in the bowel close to the stomach, give mse to very 
urgent symptoms, and the course is generally more or less rapid. 

DIFFERENTIAL D1aGnosis.—The history of the case is of great im- 
portance, but attention must be directed to the fact that the history 
given by the owner cannot always be relied on. Thus it is not un- 
common for the practitioner to be informed that the dog has swallowed 


500 SYSTEM OF VETERINARY MEDICINE 


a foreign body, but after-events have proved that this was imagination 
on the part of the owner. 

Careful palpation of the abdomen will in many instances, especially if 
the patient be in thin condition, enable us to locate the foreign body; 
but in the case of fat dogs, and if abdominal distension be present, this 
measure will fail. Hutyra and Marek advise the employment of radio- 
graphy in such cases. 

TREATMENT.—If a reliable history can be obtained, and if the foreign 
body is of such a size and shape that it is not capable of passing along 
the bowel, then early surgical interference is indicated. Under opposite 
conditions laxatives, and enemas of warm water administered by means 
of the long rectum-tube, should be employed. 

In the case of sharp-pointed foreign bodies purgatives are contra- 
indicated. Livesey advises that the patient should be fed on a mixture 
of meat, suet pudding, and olive oil, and all handling should be avoided. 
If the foreign body be a needle and thread, the latter may be found 
hanging from the anus, and the above observer draws attention to an 
important matter—viz., that the thread must not be pulled, as by doing 
so the needle may be made to transfix the bowel, and thus cause obstruc- 
tion or perforative peritonitis. 

For details of the various surgical procedures which may be neces- 
sary in dealing with foreign bodies in the intestines, the reader is referred 
to the work on canine surgery already alluded to. 


STRICTURE OF THE INTESTINE. 


This is regarded as a rare condition in the dog. According to Cadéac, 
cases of stricture of the pylorus are more frequently met with. Gray 
has found that annular stricture is more commonly met with in the 
rectum, but may also be observed in the ileum. Cadéac and Ball met 
with an instance in which the wall of the duodenum was transformed 
into a fibrous structure, causing progressive occlusion of the bowel; also 
cases in which the small intestine showed a series of strictures caused by 
tumours which developed in its walls. These strictures were separated 
by more or less marked dilatations of the bowel. According to Hobday, 
stricture occurs most frequently in the rectum. 

Eriotocy.—The condition may result from alterations of the intes- 
tinal walls, or from the presence of tumours therein; from pressure’ 
exerted by neoplasms in the abdominal cavity; and from cicatrices 
following ulceration of the bowel. 

Symproms.—These are in no way characteristic, and the case may 
resemble one of chronic gastric catarrh. An irregular action of the 


DISEASES OF THE INTESTINES: DOG ~ 501 


bowels and vomiting may be observed. Miiller states that the amount 
of feeces passed is smaller than normal, and there is more or less difficulty 
in defecation. Palpation of the abdomen may succeed in detecting the 
presence of a firm, hard enlargement, indicating the seat of obstruction, 
but the nature of this enlargement is difficult to determine. 
TREATMENT.—Medicinal treatment cannot prove of any value. An 
exploratory laparotomy is indicated, and will enable the practitioner to 
decide whether surgical interference is likely to prove of any benefit. 


DILATATION OF THE INTESTINE. 


This may be associated with stricture of the bowel, and occurs anterior 
to the latter lesion. Diverticula of the rectum have been observed by 
various authors, especially in old dogs. Zundel recorded a case of 
dilatation of the duodenum resulting from the animal having swallowed a 
number of coins. Guy Sutton* described a case of dilatation of the colon 
in a bloodhound. At the post-mortem the dilatation, when opened, 
was found to be an abscess cavity with a capacity of about 5 ounces, and 
contained 1 ounce of pus. The intestine appeared to be continuous 
with the wall of the abscess. The latter had probably formed between 
the coats of the intestinal wall, and the division between the lumen of 
the bowel and the abscess cavity had ruptured shortly prior to death. 
The symptoms observed were loss of condition, iaboured breathing on 
slight exertion, a capricious appetite, occasional diarrhoea, a rise of 
1° in temperature. Treatment was continued for six weeks, the animal 
steadily getting worse, with intervals of temporary improvement. 
Occasional vomiting occurred immediately after a meal. The animal 
died suddenly after an attack of vomiting. We observed a similar case 
in which no symptoms were present. The dog was found dead, and the 
owner suspected poisoning. The post-mortem showed a large dilatation 
of the colon, which was filled with foetid pus. 


STRANGULATION OF THE INTESTINE. 


This lesion may occur under similar conditions to those mentioned in 
the equine section. According to Hobday, it may be caused by volvulus, 
hernia, or through the presence of peritoneal bands or of a Meckel’s 
diverticulum. This author has met with two instances of strangulation 
due to the presence of a Meckel’s diverticulum. 

The symptoms and treatment are similar to those described for 
volvulus of the intestine (see p. 502). 


* Veterinary Journal, July, 1913. 


502 SYSTEM OF VETERINARY MEDICINE 


VOLVULUS, 


or torsion of the intestine, is a very rare condition in the dog. The 
lesion may occur in the form of a single or a double torsion, or as a com- 
plicated knot. The small intestine only is involved, the immunity of the 
large bowel being due, according to Cadéac, to the shortness of the 
mesentery. 

Symproms.—According to Hobday, the symptoms come on suddenly, 
consisting of violent abdominal pain, occasional vomiting, marked dis- 
tress, and abdominal distension. These are followed by absence of pain, 
when gangrene of the affected bowel sets in. Cadéac observed in some 
cases an anxious expression of countenance, the animal lay constantly 
stretched out on the belly, and marked prostration was present; in other 
instances acute pain was manifested by the patient looking towards his 
flanks and uttering sharp cries, the limbs were moved in a stiff manner, 
the head extended, the jaws clenched, and nystagmus was present. The 
abdominal muscles were hard, contracted, and painful to palpation. 
Frequent retching was present, and the vomit was glairy and bile- 
stained. 

We met with a case in a foxhound in which no symptoms of pain 
were present ; the animal walked with a very stiff gait, the head was 
extended, nystagmus was marked, and the owner imagined that the 
symptoms were due to strychnine-poisoning. The autopsy revealed a 
complicated volvulus of the small intestines, the mesentery resembling 
a tight ligature around the bowels, which were of an almost black colour, 
and the contents were composed of dark-coloured blood. 

The differential diagnosis is extremely difficult, and an exploratory 
laparotomy is indicated. 

TREATMENT.—Obviously, medicinal treatment is of no value, and 
the only chance of success lies in early operative measures. For the 
details of the necessary operation the reader is referred to works on 
canine surgery. 


INVAGINATION OF THE INTESTINE. 


‘¢ 


This is also known as “intussusception,” and is of comparatively 
frequent occurrence in the dog. It is often met with as a surprise at. 
autopsies, and especially in young dogs that have succumbed to various 
affections. According to Cadéac, when it occurs in cases of broncho- 
pneumonia, it takes place a short time previous to death (“ during the 
death-agony ”’), is easily reducible post mortem, and inflammatory 


DISEASES OF THE INTESTINES: DOG. 503 


.lesions are absent in the bowel. He ascribes it to the presence of car- 

bonic acid developed during slow asphyxia, this agent being a very 
‘active excitant of the peristaltic movements of the intestines. In- 
vagination is also met with as a complication in some cases of canine 
distemper, and as the result of violent purgatives. Foreign bodies, 
such as balls of thread or twine, are said by Cadéac to be capable of 
bringing about invagination, owing to the continued traction exerted 
when the free end of the material is drawn towards the posterior bowel 
during peristaltic movements. 

Probably the so-called “infectious icterus ”’ of young dogs is more 
often associated with invagination of the intestine than is any other 
affection. In every autopsy of this disease which we have conducted 
intussusception was present. It is generally believed to occur during the 
prolonged “death agony” which characterises this form of icterus. 
Instances are recorded in which a number of cases of invagination 
in puppies have occurred in the same kennel without any appreciable 
cause. 

With reference to the seat of the lesion, it may occur in the small 
intestine, or the ileum may be invaginated into the colon. In some 
cases the invagination of the ileum may extend so far backwards that it 
protrudes through the anus, and may be mistaken for prolapse of the 
rectum—a serious error when operative measures are directed only to 
the relief of the latter condition. The ileum may be invaginated into 
the czecum, or the cecum into the colon. In the latter instance the 
intestinal contents may pass directly from the ileum into the colon, and 
the lesion assumes a chronic form. Cadéac records a case in which the 
duodenum was invaginated into the stomach. ‘The lesion may be simple, 
or may be formed of two or more cylinders. 

Symproms.—Colicky pains associated with continual straining and 
the passage of a small amount of blood-stained mucus are observed in 
some cases. In the early stages food may be taken, but in a few hours 
vomiting is observed. On careful palpation of the abdomen a sausage- 
shaped tumour may be detected in patients not in fat condition. Tender- 
ness is not observed in the early stages, but appears later on. In many 
instances there are no characteristic symptoms, and, as already remarked, 
the lesion is only discovered as a surprise at the post-mortem. This is 
especially the case when the condition is associated with infectious 
icterus. In rare instances a spontaneous recovery may occur by slough- 
ing of the invaginated portion of bowel and firm adhesion of the serous 
edges. During this process, however, septic peritonitis may occur, or 
stricture and ulceration may result. 


504 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—Some authors advise to narcotise the patient with . 
morphine, and then to slowly inflate the bowel by means of enemas of 
warm water administered with a long gum-elastic rectum-tube. But’ 
once a definite diagnosis is arrived at, we are of opinion that the above 
measure is only wasting valuable time, and that early surgical treatment 
offers the only chance of success. Hobday recorded a case in a bull 
puppy three months old in which an intussusception of the ileum 8 inches 
long was successfully reduced by operation, and the patient made an 
excellent recovery. 

For the technique of the operation the reader is referred to “ Surgical 
Diseases of the Dog and Cat,” by the above author. 

Tumours of the Intestine.—Epitheliomata and adeno-carcinomata 
occur in the intestinal wall, producing a stenosis of the affected bowel, 
or they may be found in the form of a vegetating tumour associated with 
ulceration of the intestine. Their seats are the duodenum, the other 
divisions of the small bowel, and occasionally in the ceecum and towards 
the rectum. 

Sarcomata generally occur in connection with a dilatation of the 
intestine, being situated in the submucosa, and involving the other coats 
of the bowel. Sarcoma of the omentum is met with, and may, when of 
large size, cause compression of the intestines. 

Amongst other neoplasms recorded are: chondro-sarcomata, lympho- 
sarcomata, lymphadenomata, leiomyomata, lipomata, and adenomata. 
Cases of adenomata in the rectum, associated with chronic disease of the 
anal glands or prostate, are met with. Livesey recorded an instance of 
carcinoma involving the duodenum in which the neoplasm appeared to 
have arisen from the pancreas. 

Tumours of the intestine are of more interest to the pathologist than 
to the clinician, as they are seldom diagnosed ; and even if their presence 
could be detected, they are inoperable. 


DISEASES OF THE RECTUM AND ANAL REGION. 


These include prolapsus ani, prolapsus recti, imperforate anus, cloaca, 
heemorrhoids, fistula of the anus, diseases of the anal glands, rectal and 
analtumours. As the majority of these are essentially diseases requiring 
operative interference, the reader is referred to the work on canine 
surgery already alluded to for a full description of the conditions and the 
necessary surgical technique. We shall here only consider the diseases 
of the anal glands, as they are of very common occurrence, and their 
successful treatment is of great importance. 


DISEASES OF THE INTESTINES: DOG - 505 


DISEASES OF THE ANAL GLANDS.* 


Catarrh of the Anal Glands—Cloacitis.—This is a very common disease 
in the dog, especially in those confined to the house and treated as pets. 
It is rare in those animals used for sporting purposes, tending sheep, or 
living almost at liberty in the open. It is chiefly set up by denying 
animals bony material, which after undergoing partial digestion in the 
stomach and intestine is passed in the form of a somewhat dry, hard, chalky 
material; this on passing through the anal ring presses against the glands 
and empties them of their normal secretion. This secretion is of a brownish 
colour, is of the consistence of butter, has an acid reaction, and is composed 
chiefly of a fatty material, giving off a characteristic offensive odour. 

Symptoms.—When the glands are the seat of catarrh, the anus 
becomes hot, swollen, reddish, and painful, causing irritation to the 
region, which is evidenced by the dog either drawing or rubbing his 
anus on the ground or frequently licking the part. It also generally 
causes some obstruction to the free passage of feces, which are passed 
with difficulty, and pain is caused during the act. Not rarely small 
quantities of blood are passed with the feces, which sometimes, in the 
case of long-haired dogs, become adherent to the hair in the anal region. 
The skin in the anal region may show abrasions, and the anal mucous 
membrane appears congested and is painful to touch. On pressure of 
the anal glands between the thumb and index-finger a yellowish, puru- 
lent, more or less liquid material, in variable quantity, squirts out of the 
openings of the anal glands, frequently on to the operator’s clothes, or 
even in his face, unless he adopts suitable precautions. 

Diagnosis.—This complaint is generally mistaken by the owner for 
worms or hemorrhoids. The latter are, however, rare, and the former 
exists in every dog during certain periods of the year or during the life 
of the animal. The detection of the malady is easy if one squeezes the 
anal region and obtains the characteristic purulent discharge. It cannot 
very well be mistaken for an anal abscess, which usually appears suddenly 
in the form, at first, of a circumscribed, hard, pinkish swelling, which 
after a short period becomes glistening, purplish, and fluctuating, when, 
if not opened, it shortly bursts and leaves an external opening with an 
internal cavity, which sometimes communicates with the anal gland and 
even the rectum. Usually, however, this abscess has no communication 
with the gland, although it seems to arise in the connective tissue in the 
vicinity of it. These anal abscesses generally occur on one side of the 
anus, rarely on both sides at once. At times the affection is unilateral, 

* For this note we are indebted to Mr. Henry Gray, M.R.C.V.S. 


506 SYSTEM OF VETERINARY MEDICINE 


it resolves, and a few weeks later appears on the other side. The Jesion 
is often recurrent after an interval of a more or less length of time. The 
condition is similar in nature to the interdigital abscesses so commonly 
seen in the feet of dogs kept as pets or companions. 

TREATMENT.—The simplest and safest treatment is to syringe out 
the glands or pouches with a 1 in 1,000 solution of perchloride of mercury, 
biniodide, or chinosol. This may be repeated every two or three days 
for a few times. Rarely any other treatment is necessary. The fluid 
should be injected with a three-ring quittor or ear-syringe of 4 or 1 ounce 
capacity, and fitted with a fine bulbous-pointed nozzle of the length 
of an inch or an inch and a half. The openings of the glands can readily 
be found on the lateral margins of the anus. Sometimes it is necessary 
to pass the finger in the anus to render the margin tense, and to prevent 
it incurving. A fine probe is sometimes a useful pilot. No force should 
be used in passing the nozzle of the syringe into the cavity of the gland. 
With a little practice one can quickly become expert with the technique. 

Some practitioners, without much experience of the requirements of 
the public or regard for the feeling of the animal, use caustics or powerful 
irritating injections, such as iodine, chloride of zinc, pure carbolic acid, 
etc.; others divide the internal wall that assists in forming the wall of 
the anus, in a similar manner to the operation for fistula; others go 
farther and dissect out the glands. All such methods are unnecessary 
and. irrational. 

Catarrh of the anal glands is likely to recur, especially in dogs denied 
sexual intercourse and bones, or in those suffering from senile changes, 
such as enlarged prostate, enlarged liver, cirrhotic kidney, etc. 

Grey powder, calcined magnesia, or other mild laxative, should be 
administered on the tongue, or, better, in the food, morning and evening. 
These should be given in small doses—viz., + to 1 grain of the former 
to 25 to 10 grains of the latter to dogs up to the size of a fox-terrier. 

Impaction of the Anal Pouches.—Sometimes these culs-de-sac become 
impacted with a thick brownish, putty-looking material, which causes 
discomfort in the anal region. 

The pouches should be compressed and their contents (which come 
out in the form of a long worm-like mass) evacuated, and their cavities 
syringed out with a mild antiseptic solution. 

The anal glands frequently form the starting-point of adenomata 
and other malignant growths. | 


INTESTINAL PARASITES. 


These are of marked interest to the canine practitioner, and will be 
found fully described in the section on Parasites. 


DISEASES OF THE DIGESTIVE SYSTEM IN 
THE CAT 


By G. H. LIVESEY, M.RB.C.V.S., 
Hove, Sussex. 


General Remarks.—Diseases of the digestive system in the cat vary 
to some extent from those occurring in the canine species, and up to 
recent years have not been studied to the same degree, it having been 
assumed that what was correct treatment for certain conditions in the 
dog would be right if applied to the cat when similarly affected. The 
cat differs from the dog in many characteristics. By nature this animal 
is suspicious, he resents being constrained or even handled, and thus is 
not so amenable to treatment. Moreover, he is very susceptible to the 
action of drugs, so that great caution is necessary in prescribing for his 
ailments. Further, the solitary life he is ready to live and his instinctive 
habit of hiding away when he feels unwell prevent his maladies being 
noticed in their early stages. Again, in some instances he remains 
secluded until death occurs, so that the owner does not even know that 
the animal has been ill, and believes him to have been stolen or acci- 
dentally killed. It is only by the closest observation that the less 
obscure symptoms are noticed, even by cat fanciers; while to those who 
care little or nothing for him, the cat is more often than not, a sealed book. 

It seems probable that the cat must be insusceptible to many diseases, 
particularly from infective sources, as his habits of great personal cleanli- 
ness expose him to numerous risks of infection. When one remembers 
the amount of licking a cat does in cleaning his coat, of the dust and 
hair that must be swallowed during the performance, it is remarkable 
that a greater number do not succumb to various affections. Further- 
more, it has been repeatedly proved that the cat is a carrier of a variety 
of infections in his fur. 


DISEASES OF THE MOUTH. 


GeNERAL Remarxs.—The dental formula of the adult cat is 

} ‘ Sales 

eae the formula for the deciduous or milk teeth being D 3 19° 

The milk teeth fall out about the seventh month, but the permanent 
507 


508 SYSTEM OF VETERINARY MEDICINE 


true molars erupt before the deciduous molars are shed. Of the per- 
manent teeth, the second premolar is much larger than the first, and has 
two diverging fangs. The third premolar is much larger, and is named 
the sectorial tooth. It has three fangs (the largest posteriorly placed), 
and is the most useful tooth the cat possesses. The true molar is very 
small, and is placed close behind the sectorial tooth. In the lower jaw 
the canine is a strong tooth, its point coming up in front of the upper 
canine into the space between the latter and the upper incisors. The 
first premolar “bites” slightly in front of the second upper premolar, 
the second lower premolar is somewhat larger, while the last tooth—the 
true molar—is the sectorial tooth, and is much larger and has two large 
fangs. It “ bites” with a sharp cutting edge against the upper sec- 
torial. 

The tongue over its middle portion is covered by conical papille, 
which are horny and directed backward towards the throat. It is also 
furnished with other papille, but the conical form is of most importance, 
as it is by means of these appendages to the tongue that the cat is enabled 
to scrape shreds of meat from bones which could not be removed by the 
teeth, and also to act as a kind of comb for cleaning the fur. 

The salivary glands consist of the parotid, with two accessory parotids, 
one in front of and the other behind the main gland; the submaxillary, 
also with two accessories; the facial gland, with its opening into Stenson’s 
duct; the buccal glands; and the zygomatic or orbital gland. This 
latter is rather a large pyramidal gland, and lies on the orbital plate of 
the maxillary bone beneath the eye in the orbit. Its opening is in the 
mouth immediately behind the upper true molar. At the back of the 
mouth on either side of the pharynx is a well-developed tonsil. 

It is difficult to one not accustomed to handling cats to make a 
thorough examination of the mouth, but this should always be attempted. 
The writer finds the best way is to take the cat’s head in the left hand 
from above, with the finger and thumb under the zygoma on each side, 
then gently depress the front of the lower jaw with the right forefinger. 
If the cat refuses to keep the mouth open, it may be held so by means of 
a small spring gag fitting on the canine teeth above and below. In this 
way toreign bodies lodged in the mouth (commonly across the roof, 
between the teeth, or in the tongue) may be easily seen and extracted, 
loose or diseased teeth detected and removed, or the throat examined. 
For the surgical conditions of the mouth and their treatment the reader 
is referred to “ Surgical Diseases of the Dog,” by Cecil French. 

Stomatitis—1. Catarrhal Form.—This condition of the gums, lips, and 
tongue, more especially the latter, is frequently seen, and beyond causing 


DISEASES OF THE DIGESTIVE SYSTEM: CAT 509 


some slight temporary inconvenience, is of little consequence, except 
when occurring as one of the symptoms of feline distemper. The lesions 
are commonly noticed on the tongue, which is whiter than normal, and 
shows irregular patches denuded of epithelium, varying in size from a 
mere point to practically the whole area of the upper surface of the 
organ. Except in cases of feline distemper (see Vol. I., p. 720), healing 
takes place quickly without active treatment. Soft food, such as fine 
white fish boiled, and mashed with milk, is a suitable diet, though any 
food may be given which the cat will take, provided that no biting or 
lapping is necessary in ingesting it. | 

2. Ulcerative Form.—This also occurs during distemper, but apart 
from that disease is a common ailment of old cats, being in such animals 
mainly due to debility (from any cause), associated with a septic condition 
of the mouth. The commonest cause of septic mouth is dental trouble, 
such as large accumulations of tartar causing sore gums; also loose teeth. 
One loose tooth is sufficient to render the whole mouth foul. When such 
is present, the cat will not bite on that side on which the loose tooth is 
situated ; food-particles gather in the cheeks and around the necks of the 
teeth, and there ferment. As a result, the gums become inflamed and 
spongy, and ulcers readily form, especially where the foul teeth are in 
contact with mucous surfaces. A frequent situation for the lesion is the 
gum and lip at the front of the lower jaw. 

TrEeATMENT.—This is preferably as simple as possible. The general 
health must be attended to, and local remedies, such as peroxide of 
hydrogen (24 vols.), used freely if the cat does not markedly resent the 
procedure. No strong smelling or tasting mouth-wash should be applied, 
or the cat may afterwards refuse to feed. Chlorate of potash in glycerine 
(1 in 60) may be used, but with caution, and not for any length of time. 
All loose teeth should be extracted at the earliest opportunity. The 
cat will thrive much better, even if all the teeth have to be removed, 
than with one or two loose or painful ones left. 

Ranula.—See same condition in the dog (p. 460). 


DISEASES OF THE SALIVARY GLANDS. 


So far as the writer is aware, a specific parotitis, or “ mumps,” is not 
known in the cat. Acute inflammation of the salivary glands may 
follow injuries, such as blows or bites. The one condition which calls 
for special attention is abscess formation in the orbital gland. In this 
affection pus may escape into the mouth, but more frequently great 
swelling takes place, and the eye is protruded from the orbit. Surgical 


510 SYSTEM OF VETERINARY MEDICINE 


treatment is urgently necessary, as abscesses in this situation frequently 
prove fatal. The treatment of inflammation of the other glands follows 
the general lines mentioned for similar conditions in the dog (see p. 463). 


DISEASES OF TONSILS AND PHARYNX. 


Acute Pharyngitis and Tonsillitis—The cat is especially liable to 
troubles under this heading, generally termed “sore throat.” The con- 
_ dition may follow the lodgment of some foreign body in the back of the 
tongue, or in the fauces, or even in the crypt of the tonsil. The writer 
has found a head of barley-grass in this latter situation, causing a severe 
inflammation of the tonsil. Needles and fish-bones are the commonest 
objects to become lodged in the above regions. 

Symproms.—the first symptom noticed as a rule is dribbling at the 
mouth, followed by refusal of food; or, if food is taken, symptoms of 
choking and often retching are observed. ‘The cat will hide away, and 
lie hunched up on its chest, sometimes near water, as if anxious to drink, 
but frightened to make the effort. Breathing is often carried on through 
the partly opened mouth, and is raucous, as if the throat were obstructed 
with mucus. The cat also cannot be induced to purr, and manipulation 
of the throat and neck causes evident pain. An examination of the 
mouth and throat will show the conditions described under Diseases of 
the Pharynx in the Dog (see p. 464). 

TREATMENT.—After removal of foreign bodies no treatment is re- 
quired beyond rest to the part, and this is best obtained by solitary con- 
finement and milk in small quantities to drink. In other cases the throat 
may be swabbed with chlorate of potash in glycerine (1 or 2 in 60), or 
glycerine of tannic acid. 

An acute pharyngitis is seen in distemper, and is very fatal (see 
Vol. L., p. 724), while an even more severe form is seen in the so-called 
“diphtheria ” of the cat. The writer thinks that this membranous or 
diphtheritic pharyngitis is very likely only a more severe manifestation 
of the pharyngeal form of cat distemper. It is highly contagious to 
other cats, but not to human beings (see Vol. I., p. 317). See also Vol. L., 
The Relationship between Human Diphtheria and Certain Diseases of 
Animals. Pharyngeal tubercular abscesses and ulcers have been 
recorded at various times. Treatment is not advised. 


DISEASES OF THE G&SOPHAGUS. 


These are mainly due to swallowing foreign bodies, such as bones, 
needles, etc. The writer has seen cases of spasm of the esophagus from 


DISEASES OF THE DIGESTIVE SYSTEM: CAT 511 


unknown causes. The symptoms were—Vomiting immediately after 
swallowing any food, sometimes even after liquids, and consequent rapid 
loss of weight. There was no loss of appetite, but an evident fear of 
swallowing. No foreign body could be detected, and there was no 
reason to suppose the mediastinal glands to be enlarged. The condition 
remained, varying in severity, for nearly three months. Friedberger and 
Frohner refer to such cases as following on the swallowing of a pin. If 
choking depends on the presence of foreign bodies, treatment is con- 
ducted on similar lines to those advised for the dog. Medicinal treat- 
ment of spasm is unsatisfactory, but bromides may be tried, or chloretone 
in 1 to 2 grain doses. (See “ Diseases of the (Hsophagus in the Dog,” 
p. 467; also “Canine and Feline Surgery,” by F. Hobday, for further 
details on cesophageal affections.) 


DISEASES OF THE STOMACH. 


These diseases are not so frequently met with in the cat as in the 
dog. Probably this is due to the fact that the former animal lives a less 
artificial lite than the latter, and retains the power of vomiting offending 
substances with even greater ease than the dog. 

Acute Gastritis—Compared with the dog, the cat seldom suffers from 
acute gastritis, except in the form of infectious gastro-enteritis (feline 
typhus), which, however, is very fatal. The commonest cause of gastritis 
in the cat is the swallowing of some form of poison, such as beetle-paste, 
or rat and mouse poison (phosphorus, arsenic, and strychnine), or the 
retention in the stomach of a captured mouse or bird, which ordinarily 
would have been vomited. 

SymptToms.—These include very severe vomiting, rapid collapse, and 
a great desire for water, which the cat will even lie in when unable to 
drink. When the malady is less intense in severity, the only symptoms 
noticed may be the desire for seclusion, lying persistently on the elbows, 
great depression, refusal to be roused or to be fed, thirst, vomiting, 
and pain on being handled. This latter symptom is much more 
marked than in the dog; otherwise, both symptoms and treatment are 
very similar to those already described in the dog, with the exception that 
sedatives such as morphine and chloretone do not act satisfactorily in 
the cat. Morphine is liable to cause delirium, even in small doses, while 
chloretone acts as a hypnotic in doses of 1 to 3 grains. The latter agent 
does, however, frequently arrest troublesome vomiting. As a rule the 
cat responds well to treatment by bismuth salts. All coal-tar derivatives 
should be carefully avoided. 


512 SYSTEM OF VETERINARY MEDICINE 


Chronic Gastritis——This condition is not often observed, probably 
because the owner has the cat destroyed long before the disease has had 
time to become established. It is, however, seen associated with chronic 
endometritis, cirrhosis of the liver, and diseases of the kidneys; also with 
the presence of Spiroptera sanguinolenta (see Parasites). 

It should be noted that cats, when suffering from ear troubles, wounds 
or injuries to the neck and throat, nasal affections causing loss of smell 
and taste, injuries to the eyes, retention of urine, etc., all causing 
discomfort or distrust and fear of movement, will refuse food, and will 
frequently not eat unless food is gently placed in the mouth. Such cases 
are easily mistaken for diseases of the digestive system, and careful 
examination 1s necessary in order to arrive at a correct diagnosis. Further, 
a cat is easily nauseated by drugs possessed of a strong taste or smell, 
and these should be avoided, for instances are not wanting of voluntary 
starvation in consequence of the administration of such agents. 


DISEASES OF THE INTESTINES. 


Apart from feline distemper and acute infectious gastro-enteritis, 
little is known of the diseases of the intestine. Cats suffer frequently 
from diarrhoea and constipation, and the former is often tubercular in 
origin. 

Chronic Diarrhoea is a common ailment of the old cat, and is very 
obstinate to treatment, as we are very limited in the choice of cies 
suitable for the condition. 

Acute Catarrhal Enteritis follows similar causes to those found in the 
dog. The symptoms are also similar, but the cat becomes exhausted 
much sooner than the dog, partly owing to its very clean nature, for, 
with the constant soiling of the fur from dejecta, the animal is continually 
licking itself. The continual effort and the constant swallowing of the 
offensive matter all help to aggravate its condition and to prevent 
nourishment being taken. Treatment is best started (if seen early) by 
a drachm dose of hydrated magnesia, followed by abstinence from food 
for a day or two, and the administration of albumin water and bismuth 
preparations. If there be much straining, and especially if 1t be accom- 
panied by the passage of blood-stained mucus, a rectal injection of 
5 grains of copper sulphate or cuprol in an ounce of mucilage or starch 
paste may do much to alleviate the distress. 

Chronic Enteritis is almost invariably tubercular. It is observed in 
old or at least adult cats. It may also be seen associated with a chronic 
exanthematous rash, sometimes found in old neuter cats, when the cause 


DISEASES OF THE DIGESTIVE SYSTEM: CAT 513 


may possibly be the continual irritation of the bowel set up by the 
swallowing of hair and the ichorous discharge from the skin. 

In tuberculous cases the motions are always semi-liquid, pale or 
watery, sometimes frothy, and generally very foul-smelling. Some- 
times they may be flecked with spots of blood. There is apparently no 
pain, but there is always the appearance of distress and sadness about 
the animal. The coat is harsh, thin, and open; there is progressive 
general wasting, most apparent in the supra-orbital region and cheeks, 
the back of the neck, the chest, and the thighs. The abdomen, on the 
contrary, 1s not drawn up or pinched, but remains at the normal size or 
even larger. There is always increased thirst, occasional vomiting, and 
a most unpleasant odour from the mouth. There is lttle tendency 
for sores and wounds to heal. Ulcers and sinuses easily form and 
resist treatment. On palpation of the abdomen, enlarged mesenteric 
glands may be felt, and tubercle bacilli may be discovered in the 
dejecta. Treatment is not advised, owing to the dangerous nature of 
the complaint both to human beings and to other animals. Such cases 
should be destroyed and the bodies cremated (see Tuberculosis in the 
Cat, Vol. I.). 

Constipation is also a disease more commonly seen in the old cat, and 
especially in the long-haired varieties during the coat-changing period. 
Hair is swallowed, and should normally be passed in the form of balls 
of fur or thin ropes. If the bowel from any cause (such as inaction of 
the liver) is torpid, these masses agglomerate, and cause more or less 
obstruction, or become so large that it is impossible for them to pass 
through the anus. They have then to be removed by surgical means. 
Simple cases give way after the administration of 4 or 5 grains of com- 
' pound rhubarb pill or feeding with sardines in oil. Castor oil should 
generally be avoided. 


DISEASES OF THE ANUS. 


The cat has two anal glands, but, unlike the dog, these seldom become 
the seat of catarrh or abscess formation, probably owing to the cat’s 
cleaner propensities. These glands, however, are often the seat of tumour 
formation, both adenomata and epitheliomata having been noticed by 
the writer. 

For other conditions and treatment of affections of the cat’s digestive 
system the reader is referred to similar diseases in the dog (see pp. 493- 
504); also to Feline Distemper and Infectious Gastro-Knteritis (sec 
Vol. T.). 


VQL. II. 33 


DISEASES OF THE DIGESTIVE SYSTEM 
IN BIRDS | 


By EK. WALLIS HOARE, F.R.C.V.S. 


General Remarks.—These diseases are of great importance in birds. 
Owing to lack of space, it will be only possible for us to give a brief 
outline of the subject, and for further information the reader is 
referred to works on avain diseases, such as Mégnin’s ‘“‘ Médecine des 
Oiseaux.” 

Generally speaking, the most common causes of these diseases are 
irrational feeding and various microbial affections. Another common 
source of digestive disorder in graminivorous birds kept in captivity is 
lack of access to sand or grit, which material is necessary for the function 
of digestion in the gizzard. Coccidiosis accounts for a large proportion 
of diarrhcea, chronic diarrhoea, and dysentery in birds, while many cases 
of enteritis depend on fowl plague, fowl cholera, tuberculosis, and parasitic 
infestations. 

In the administration of medicines to birds some skill is required. 
Small birds should have medicinal agents in the form of glycerole or 
similar liquid menstruum; this can be administered through the beak, 
by means of a cut quill, a toothpick, or a fountain-pen dropper. Castor 
oil may be given from the end of a probe. When the bird has a desire 
for water, medicines can often be given in it. Some drugs can be given 
in a small quantity of hard-boiled egg, sponge-cake, etc. The larger 
birds are more readily managed. In all instances birds require to be 
gently but firmly handled. 

It is important to remember that birds take relatively very large 
doses of nux vomica or strychnine, and Gray has given pills containing 
7s grain of strychnine without any toxic results. 

This authority approximates the doses of strychnine for the various 
birds as follows: | 





Fowl pA 1s ‘i ie .. gz to x5 grain. 
Pigeons and birds of similar size . . -. so tO zoo grain. 
_ Canaries and birds of similar size. . -. ro00 tO sto >> 


514 


DISEASES OF THE DIGESTIVE SYSTEM: BIRDS 515 


The agent should be administered to small birds either mieten 
ously or in the drinking-water. 

The doses of the extract and of the tincture of nux vomica may be 
computed by remembering that 14 grains of the extract, or 33 minims 
of the tincture, is equivalent to ;'; grain of strychnine. 

Catarrhal Stomatitis —This is popularly known as “pip.” It mav 
occur as a disease per se, or be associated with respiratory affections, in 
which instance it is believed to depend on the beak being persistently 
open, owing to difficulty in breathing. The epithelium of the buccal 
mucosa and of the tongue then becomes desiccated, and stomatitis results. 
It is often associated with infectious processes, such as bird-fever, 
diphtheria, epitheliosis, and aspergillosis. Bad hygienic surroundings 
are said to act as a primary cause of the affection. 

Symproms.—The bird keeps the beak open, and at intervals emits a 
shrill sound, accompanied by a jerk of the head. On examining the 
mouth, the tip, borders and freenum of the tongue are found covered by 
a hard, dry, adherent coating, which also extends to the buccal mucosa. 
If this be forcibly removed, a bleeding and ulcerating surface results. 

TREATMENT. ises to carefully remove the adherent 
pellicle with a needle, so as not to wound the normal tissues. The parts 
are then dressed with a solution of chlorate of potash (5 per cent.). Law 
prefers the application at frequent intervals of a solution of hyposulphite 
of soda in glycerine. Glycerine of iodine, or glycerine of sodium sali- 
cylate, is also useful. 

Parasitic Stomatitis, also known as “ thrush,” “ muguet,” “ stomatitis 
oidica,” is met with in poultry and pigeons. It is caused by the mycelium 
of Oidium albicans or Moniliac andida (see p. 18). According to Cadéac, 
it may occasion extensive losses amongst pigeons. The lesions consist 
of soft, white or greyish-white deposits on the buccal mucosa, which 
extend to the cesophagus, pharynx, and crop. The above-mentioned 
author states that the mucosa beneath the lesions is inflamed, and more 
or less eroded and ulcerated; but, according to Hutyra and Marek, no 
inflammation is observed in the underlying tissue. The fungi have an 
intimate connection with the tissues. Dilatation of the crop is often 
present. 

Symproms.—Dulness and rapid emaciation are observed, and in 
many instances diarrhoea and violent cramps occur, terminating in death. 
The diagnosis is based on the detection of the typical fungi by micro- 
scopical examination. 

TREATMENT.—The mouth should be Panes with a solution of borax 
(10 per cent.) or peroxide of hydrogen. When the crop is involved, 





516 SYSTEM OF VETERINARY MEDICINE 


irrigation of the organ with a 2 per cent. solution of boric acid is advised 
(see p. 517). Cadéac. points out that the solution should not be allowed 
to remain in the crop, otherwise toxic effects may be produced. He also 
directs attention to the risk of infection to children if they handle affected 
birds. 


DISEASES OF THE CROP AND STOMACH. 


The ingluvies, or crop, corresponds to the rumen of the ox, being a 
temporary receptacle for food, the ingesta being subjected to a softening 
process during its sojourn in the organ. The crop is an ovoid pouch, 
and its walls are similar in structure to the cesophagus. The food passes 
from the crop into the succentric ventricle, which is regarded as the first 
division of the stomach. This is accomplished by contractions of the 
external layer of the crop, assisted by a wide subcutaneous cervical 
muscle which covers the organ. The succentric ventricle is also known 
as the “‘ proventriculus ” or “ olandular stomach.” It is inconsiderable 
in size, and its cavity is narrow. Its mucosa secretes gastric juice, but, 
according to Jobert, the true gastric juice is secreted in the gizzard. 
The food merely passes through the succentric ventricle, carrying with 
it the gastric secretion. The gizzard or muscular stomach is the second 
compartment of the stomach ; it is oval in form, and is succeeded by the 
duodenum. Its walls are strong and muscular, and normally it contains 
a number of pebbles for the purpose of triturating the food. The crop 
is present in the Gallinacee and in parrots, canaries, and pigeons, but 
in Palmipeds it is represented by a dilatation in the cervical portion of 
the cesophagus, which, when distended with food, forms a long fusiform 
cavity. In the pigeon the crop is divided into two lateral pouches, and 
its interior shows glandular eminences towards the common opening of 
these pouches into the gullet. These are sometimes termed the “ aqui- 
parous glands,” and when pigeons are rearing their young these glands 
secrete a milk-like material, which is regurgitated by the gullet, and 
serves as nourishment for the young birds. Finches, parrakeets, and 
some other birds, als ofeed their young from the crop. 

In birds of prey the stomach is simple, consisting of a single sac 
provided with a thick zone of glands around the entrance of the gullet, 
which secrete the gastric juice. 

Ingluvial Catarrh—Synonyms.—Catarrh of the crop; Ingluvitis; 
““ Soft crop”; “ Crop-sick.” 

This is a catarrhal inflammation of the mucosa of the crop. 

ErtoLogy.—Cases are recorded in chickens as the result of feeding 
on dry oats. Decomposing or fermenting food and the presence of 


DISEASES OF THE DIGESTIVE SYSTEM : BIRDS NG 


sharp-pointed foreign bodies are regarded as etiological factors. Toxic 
agents, such as phosphorus, mercury, and arsenic, may also produce the 
condition. It is often accompanied by gastro-enteritis. As a secondary 
affection, it occurs In association with parasitic stomatitis (thrush), and 
from the presence of parasites. In pigeons the disease is observed when 
they are deprived of their young. The engorgement of the aquiparous 
glands due to the secretion not being removed leads to a catarrhal 
inflammation. 

Symptoms.—The crop becomes distended by gas, the beak is kept 
open, appetite is in abeyance, the bird stretches the neck, and dysphagia 
is present. Nausea is observed, and occasionally vomiting, a greyish 
sour fluid being expelled through the beak and partly through the nostrils. 
In parrots vomiting is a common symptom. On palpation of the region 
of the crop a marked protrusion of the organ is detected. It is soft to 
the touch, and tympanitic on percussion, or it may feel like a perforated 
india-rubber ball when collapsed—i.e., it has no tendency to regain its 
resiliency. If pressure be applied to this region, foetid gases escape by 
the beak. Emaciation and weakness set in, and unless relief be afforded 
death results. Cadéac remarks that in the pigeon the distended crop feels 
hard and firm. 

In chronic cases the walls of the crop become hypertrophied, and the 
organ becomes voluminous, so that it often forms a hanging pouch 
externally. This is termed “ pendulous ” crop. 

In “crammed” birds the disease may be associated with aspergillosis, 
the cesophagus as well as the crop showing caseous centres, containing 
Aspergillus fumigatus (see Aspergillosis, Vol. I.). 

TREATMENT.—An attempt should be made to empty the crop by 
holding the bird’s head downwards, and carefully massaging the organ 
in a direction towards the mouth. Cadéac advises that if abundant 
contents are present a small amount of fluid should be administered 
prior to adopting massage, so as to facilitate the evacuation of the 
ingesta. Various antiseptic and astringent agents are advised after the 
above treatment is carried out, such as solution of boric acid (2 per cent.), 
sulphate of iron (1 per cent.). Sulphocarbolate of soda (2 per cent.) 
is useful; also peroxide of hydrogen. Cadéac recommends small doses otf 
sulphate of soda (5 per cent.), also lemon-juice, solution of salicylic acid, 
etc. Klee advises a 5 per cent. solution of Carlsbad salt, and in obstinate 
cases employs irrigation of the crop by means of a funnel placed at the 
end of a thin rubber tube, 40 c.c. in length. The free end of the tube is 
passed into the crop through the beak. A 1 per cent. solution of boric 
acid is poured into the funnel, and the latter is then elevated, so that the 


518 SYSTEM OF VETERINARY MEDICINE 


fluid enters the crop. After this the funnel is lowered, so that the fluid 
escapes, and during this process careful massage is carried out. 

Irrigation may also be carried out by means of a syringe attached to a 
small catheter. In using this care should be taken to see that the instru- 
ment does not enter the trachea, an accident that may easily happen, as 
in birds the epiglottis is absent. 

In cases where the above treatment fails, or when the ingesta are in 
a putrid condition, an incision should be made into the crop, and the 
contents removed (see p. 519 for details). In pendulous crop, when the 
catarrh has disappeared, a similar operation is advised. 

In the pigeon, when suffering from ingluvitis due to being deprived 
of its young, a young pigeon should be placed with the bird. If this is 
not possible, Cadéac advises that the bird should be kept from food, and 
water slightly acidulated with vinegar should be allowed. 

Nux vomica, bismuth, and charcoal may be prescribed. 

Impaction of the Crop—Synonyms.—lIngluvial indigestion; “ Hard 
crop ’’; “‘ Crop-bound.” 

This is a condition of engorgement of the crop associated with dilata- 
tion and paralysis of the organ and a varying degree of tympany. 

Et1oLogy.—Overfeeding, especially with dry grain, bran, chopped 
straw, fibrous grass, etc., is a common cause, particularly when the bird has 
been kept some time fromfood. Foreign bodies may also produce the con- 
dition. According to Mégnin, young pheasants and young partridges some- 
times contract the disease after the ingestion of numerous larve of insects. 
The presence of parasites may in some instances bring about the affection. 

Symptoms.—The bird is dejected and listless, the appetite is lost, the 
beak is open, the feathers ruffled, and in some cases a foetid fluid is 
expelled from the beak. On palpation of the region of the crop the 
organ is found enlarged, and may be either hard, doughy, or tense, 
according to the nature of its contents and the amount of tympany 
present. The swelling may be quite prominent, and in severe cases, 
owing to pressure exerted on the trachea and bloodvessels, asphyxia is 
produced. Ingluvitis may occur, also a necrotic condition of the in- 
gluvial walls, and cases of rupture of the organ are met with. Sharp 
foreign bodies may burrow outwards, and form an abscess or fistulee. 

TREATMENT.—Massage may succeed in relieving the condition, pro- 
vided the contents are not too hard. If this fails, operative measures, 
must be adopted, and are generally successful if carried out early, except 
in the case of pigeons, as in these birds the mortality is very high. The 
technique is as follows: The feathers are removed from the region of the 
crop, and an incision is made in the middle line parallel with the long 


DISEASES OF THE DIGESTIVE SYSTEM: BIRDS 519 


axis of the neck. The contents are removed, the edges of the wound in 
the crop and skin are irrigated with an antiseptic solution, and all blood 
swabbed away, and the wound is then sutured. Mayall* recorded a case _ 
in a Leghorn hen in which the crop was distended to the size of a cricket- 
ball with hard wheat-grains and fibrous grass. He operated as above, 
and sutured the walls of the crop with interrupted sutures of sterilised 
silk, and the skin with a continuous suture of the same material. ‘The 
bird was fed for the first day or two on brown bread crumbled up fine, 
and milk. Afterwards plenty of water was allowed, and soft food for 
several days. The recovery was uninterrupted. Hutyra and Marek 
advise that on the first day after the operation the bird should only be 
allowed stale white bread soaked in claret. After thirty-six hours 
abundant water is given, but only a small amount of soft food. 

Pills containing nux vomica, gentian, and ginger, prove useful in 
mild cases and in after-treatment. 

Parasites of the Crop.—lhese include several species of thread- 
worms, also Dipharagus nasutus, D. sprralis, and D. laticeps. Trichosoma 
contortum is found in the crop of ducks and geese, causing severe catarrh, 
and subsequent impaction, paralysis, and dilatation of the organ. 

Diseases of the Gizzard.—According to Cadéac, little is known with 
reference to the diseases of this organ. Birds should be allowed free 
access to sand or grit, so as to Insure a proper amount of this material in 
the gizzard for the purpose of triturating the food. Too much stress 
cannot be laid on the importance of this point, as neglect of this precau- 
tion 1s one of the commonest causes of digestive disturbances in gallinaceous 
birds kept confined. Coarse gravel, granite, broken-up earthenware, 
should always be within reach of the birds. Tumours of the gizzard 
have been met with, especially encephaloid sarcomata, which involve 
in some cases the crop at the same time. Myomata have also been 
recorded in this organ. 

The parasites affecting the gizzard are S: renee nasuta and S. pectin- 

f era. 

Gastritis—In birds, the lesions of acute gastritis are found chiefly in 
the crop and proventriculus, and are less marked in the gizzard, owing to 
the resisting nature of its mucosa. The affection is often associated with 
acute infectious diseases. . It is occasionally due to the ingestion of toxic 
agents, such as arsenic, lead, copper, phosphorus; also sodium chloride, and 
sodium nitrate (used as manures). Exposure to draughts, chills, etc., 
is a common predisposing cause in parrots. The intestines are frequently 
involved. The symptoms observed are diarrhcea, trembling, convulsion, 


* Veterinary Journal, July, 1913. 


520 SYSTEM OF VETERINARY MEDICINE 


followed by coma, and death. Treatment is very rarely successful, and 
the bird succumbs in a short space of time. 

Indigestion in Parrots.—This depends on a variety of causes. The 
most important are improper feeding and a lack of access to sand or 
crit, which is essential for the function of digestion in the gizzard, so 
as to prepare the food for assimilation in the intestines. Indigestion 
may be associated with tuberculosis of the liver, etc. Some parrot 
fanciers recommend as the most suitable diet for these birds, maize, 
hemp-seed, oats, canary-seed, fruit, and nuts (walnuts, chestnuts, filberts) 
in moderation. A portion of dry crust of bread or plain biscuit and a 
lump of sugar may be allowed occasionally. Bread soaked in water, 
milk, or tea, as a regular diet is condemned, as the birds are apt to take 
too much, and thus induce distension of the crop. Animal food should 
never be given, as it produces skin irritation, feather-picking, etc., and 
similar remarks apply to cheese. With reference to water, it is advised 
to allow it in the cage. 

Sand or grit should always be allowed, and this is a point which 1s 
often neglected, the result being chronic indigestion. Parrots should 
also be allowed pieces of wood, such as beech-sticks, to whittle. 

Symproms.—Frequent yawning, dulness, lack of appetite, vomiting, 
and in some cases nervous symptoms, are present, such as an unsteady 
gait or the occurrence of a “ fit.” 

TREATMENT.—When nervous symptoms predominate, from 5 to 10 
drops of castor oil should be given, either by floating it on a teaspoonful 
of warm water and offering it to the bird, or pouring it on a lump of 
sugar. If refused, it must be carefully administered by force. Small 
doses of bicarbonate of soda (5 grains) may be given in the drinking- 
water for a few days. Sulphocarbolate of soda (2 per cent.) in glycerine 
and water is useful. Tonics, such as nux vomica, are indicated. 


DISEASES OF THE INTESTINES. 


Enteritis—The lesions of this condition are found in several of the 
infectious diseases of birds (see Vol. I., pp. 421-470). 

According to Hutyra and Marek, a primary croupous enteritis is met 
with in chickens, ducks, geese, turkeys, and pheasants, and the etiology 
is unknown. Cases are recorded by Roll, Johne, Kitt, and other ob- . 
servers. The symptoms described were loss of appetite, marked prostra- 
tion, stifiness in progression, a brown discoloration of the skin of the 
inferior abdominal region, and violent diarrhoea, with yellowish-coloured 


DISEASES OF THE DIGESTIVE SYSTEM: BIRDS 521 


feces. The course was rapid, death taking place within a few hours or 
in twenty-four hours. If the ceca alone were affected, the birds did not 
succumb for seven or eight days. Treatment of any kind proved use- 
less. | 

Enteritis often occurs in parrots and cage finches, either associated 
with gastritis, or as a disease per se, following exposure to draughts, 
chills, etc. Coccidiosis is a common cause in canaries, finches, etc. 
In gangrenous enteritis a haggard expression of countenance is observed, 
and also a purple discoloration of the skin of the abdomen is common. 
Blood-stained faeces also occur in enteritis. 

Intestinal Obstruction.—This is a rare affection in domestic fowls 
kept in the open, but is met with in birds subjected to a sedentary life 
and fed on dry indigestible foods. It occasionally oecurs in birds con- 
fined in cages. : 

EtroLogy.—In cases of diarrhcea, fecal accumulations matted by 
feathers may form around the cloaca, and increase progressively, so as 
to obstruct the opening and bring about intestinal obstruction. 

Gravel and sand, pieces of rag, etc., may be ingested and enter the 
intestine when atony of the gizzard is present. These may accumulate 
in the anterior region of the bowels, giving rise to a sausage-like disten- 
sion. Other seats of obstruction are at the ceca and at the opening of 
the cloaca. Imperfect trituration of the food in the gizzard, owing to 
the bird not being supplied with sand or grit, is also regarded as an 
etiological factor in the production of feecal impaction. An obstruction 
at the level of the cloaca, due to an accumulation of fecal matter mixed 
with a large amount of uric acid, is said not to be uncommon. In young 
_ turkeys fed on improper food engorgement of the ceca is not rarely met 
with. : 

Symproms.—The bird is observed to pass dry, hard feeces in small 
amounts and with straining, and after defecating frequent movements of 
the tail and anus are often made. Marked depression is present, a stiff 
gait, loss of appetite, and rapid emaciation. On palpation of the abdom- 
inal region the distended bowel may be felt. Unless relief be afforded 
death occurs from auto-intoxication. The affection must not be mistaken 
for the condition known as “ ege-binding ”’ (see p. 528). 

TREATMENT.—If the obstruction be within reach, it can be removed 
by means of a blunt curette, assisted by the injection of warm olive oil. 
In small birds enemata of glycerine administered with a syringe -are 
indicated. In carrying this out in the female care should be taken that 
the enema enters the rectum and not the oviduct. When, however, the 


522 SYSTEM OF) VETERINARY MEDICINE 


obstruction is situated more anteriorly, castor oil is to be given in a dose of 
from 1 to 2 drachms for the large species of birds. Hither Epsom salts or 
Glauber salts in weak solution (1 in 200) may be added to the drinking- 
water. Rhubarb (6 to 10 grains) in the form of a pill is advised by some 
authors, also calomel (1 to 3 grains). Pills containing nux vomica are also 
indicated. The diet should be restricted to green food and soaked grain. 

Tumours.—-Cases of carcinomata, epitheliomata, and adeno-carcino- 
mata of the small intestine have been recorded, also sarcomata. They 
are of more interest to the pathologist than to the clinician. 

Parasites.—These include a number of species, and for information 
thereon the reader is referred to the section on Parasites. Parrots are 
affected by tapeworms and round-worms. 

Avian coccidiosis, which is a common cause of intestinal disorder 
in birds, will be found fully described in Vol. I. under the Coc- 
cidioses. 

Diarrhoea in Parrots.—This may be due to improper diet or sudden 
changes of food, excess of soft fruit, green food, etc., or it may depend 
on the so-called “ ship fever,” or septic fever of parrots (see Psittacosis, 
Vol. I.). Gray has observed that the condition is often due to exposure 
to draughts, especially in chilly weather. It may also depend on tuber- 
cular enteritis. When due to dietetic causes, a small dose of castor oil 
is indicated in the early stages, followed by a small amount of prepared 
chalk in the drinking-water should the symptoms continue. In obstinate 
cases some authors recommend small doses of the Pulv. Cretee Aromaticus 
cum Opio (B.P.). Aromatic chalk powder is composed of — 


Prepared chalk a aN .. 11 parts. 
Cinnamon ay oe ee: 
Nutmeg 2 Ke a3 Le ATO CLs 
Cloves vf Ke ae ae ee 
Cardamoms .. ap ip ce) PL paras 
Refined sugar of. i .. 25 parts. 


One part of powdered opium in 39 of the above forms the preparation 
mentioned. The dose is from 5 to 10 grains, and may be given in the 
food or drinking-water, or forcibly administered if these are 1efused. 
Sulphocarbolate of soda (2 per cent.) may also be tried. 

Constipation in Parrots.—This 1s evidenced by straining during de-— 
feecation. The feeces are hard in consistency and pale in colour. Treat- 
ment consists in administering a dose of castor oil and regulating the 
diet. 


~ 


DISEASES OF THE DIGESTIVE SYSTEM: BIRDS . 523 


In the aged female bird, uneasiness, swelling in the region of the 
cloaca, and straining, are observed on rare occasions, and may be due to 


“ ego-binding.’”’* 


* «6 Hoo-Binding.’’—This is a condition in which, owing to inertia of the oviduct, 
the egg is not propelled outwards and is retained. It is common in foreign finches, 
parrakeets, as well as in canaries kept in cages, prize poultry confined in pens, doves, 
pigeons, pheasants, etc., kept in aviaries, and is a source of much loss to fanciers. 
It is rarely met with in birds at liberty. The bird is mopy, breathes quickly, and 
remains on the floor of the cage, and, unless relieved, soon dies. It is more commonly 
observed during the prevalence of cold winds (east, north, or north-east). The 
effect of chill is to weaken, or to induce a condition of cramp in the oviduct. In 
some instances similar symptoms are observed, although no egg is present, but the 
oviduct is in a high state of activity. Egg-binding may occur before the egg is 
matured—.e., before it has become covered with shell. The condition has no con- 
nection with the shape, size, or maturity of the egg. 

Egg-binding is diagnosed by gentle pressure of the soft parts of the abdomen 
between the finger and thumb, as the presence of the egg is then detected. 

The complications of egg-binding are—Inflammation of the oviduct, which 
may spread to the peritoneum and set up peritonitis. Rupture of the oviduct may 
occur, and the egg, either entire or ruptured, enters the peritoneal cavity, and peri- 
tonitis is induced. Attempts to break the egg in an unskilful manner are also 
followed by peritonitis. 

Gray has observed the presence of several shell-less but albuminated ova in the 
oviduct at the same time. This is due to a chronic calcareous inflammation of 
that part of the oviduct whose function is to form the shell, and it results from 
previous injury during attempts made to break the egg by mechanical means in a 
case of egg-binding. 

TREATMENT.—Gray advises that the bird be put in a wooden cage, and the latter 
placed close to a hot-water boiler and covered with flannel. It is left in this posi- 
tion until the bird is relieved. Birds can withstand exposure to a comparatively 
high degree of heat without suffering any apparent injury. ‘This probably depends 
on the fact that their normal temperature is very high as compared with animals. 
Bird fanciers steam the hinder parts of the bird over a jug containing hot water, 
but Gray finds the dry heat method simpler and more efficacious. In some instances 
‘under this treatment the egg may not be passed for twenty-four to forty-eight hours, 
and yet the bird recovers. 

In more robust birds a probe can be passed into the oviduct and the egg pierced, 
so that itsooncomesaway. But great skill is required in carrying out this procedure, 
and the simpler method is far preferable. In cases where it is necessary to puncture 
the egg, the latter should be seized by the index-finger and the thumb extra-abdom- 
inally, and pushed gently towards the cloacal opening or “vent,” so that the 
opening of the oviduct, or perhaps the egg, may be rendered visible. A probe 
should then be carefully passed through the shell of the egg. As soon as the egg 
is ruptured it should be gently pressed; it then comes away shortly afterwards. 
Rupturing the egg by extra-abdominal pressure is to be avoided, as injury to the 
oviduct may result, followed by death of the bird. 

Egg-binding is liable to recur, and often appears as an enzootic during the pre- 
valence of cold winds. 


DISEASES OF THE PANCREAS IN THE 
HORSE, OX, PIG, AND DOG 
By E. WALLIS HOARE, F.R.C.V.S. 


HORSE. 


General Remarks.—Very little is known with reference to diseases of 
the pancreas, and but few cases are recorded in veterinary literature, - 
Judging by the importance of the organ to the function of digestion, one 
would be justified in expressing surprise that it should possess an apparent 
immunity from disease. It seems probable, however, that owing to the 
obscure nature of the symptoms as exemplified by the recorded cases, 
and to the fact that careful and systematic autopsies are not generally 
carried out in veterinary practice, diseases of the pancreas may occur, 
and yet not be recognised. Moreover, we must admit that, as compared 
with human medicine, examination of the urine has not yet assumed its 
proper place of importance in clinical veterinary medicine. The presence 
of sugar in the urine is one of the suggestive features in the diagnosis of 
pancreatic diseases in man, but we find scanty reference to urinalysis in 
the recorded cases in animals. Again, it must be admitted that in post- 
mortem examinations as conducted by the general practitioner, little, 
if any, attention is paid to the condition of the pancreas unless a marked 
enlargement of the organ is present. 

The frequency with which jaundice is associated with disease of the 
pancreas in the recorded cases make it possible that, when disease of 
this organ does occur, the symptoms are more likely to be attributed to 
hepatic disorder. According to Siedamgrotzky, as the horse possesses a 
relatively small stomach, and the period of gastric digestion is short, 
the loss of the pancreatic function cannot be compensated for by other 
glands, and gives origin to a fatal cachexia. 

Up to the present time, diseases of the pancreas are of more interest . 
to the pathologist than to the clinician, as the lesions in every instance 
recorded were only recognised as a surprise at post-mortem examinations. 
Care should be taken not to mistake for disease the alterations occurring 
in the pancreas as the result of post-mortem changes due to decomposi- 

524 


DISEASES OF ‘THE PANCREAS: HORSE 525 


tion. The normal pancreas is of a greyish-yellow colour, but it speedily 
changes to an almost black colour after death. 

Pancreatitis (Inflammation of the Pancreas).—Three forms have been 
met with in the horse—viz., (1) Catarrhal ; (2) Suppurative ; (3) Sclerotie. 

Catarrhal Pancreatitis —This form has been observed by Mégnin and 
Nocard. 

Errotogy.—The disease is believed to arise from infection either 
entering the gland from the duodenum by way of the duct, or from the 
blood-stream. It may arise as a disease per se, or be associated with 
hepatic or renal lesions in general infections of the system. 

Morsip Anatomy.—The lesions occur in the duct of Wursung, in its 
ramifications, and in the structure of the gland itself. . The lumen of the 
duct is obstructed by an exudate of a white granular appearance, com- 
posed of pus globules, fibrous filaments, and granular epithelial cells. 
The duodenal opening of the duct is dilated, and obstructed by a plug of 
a similar exudate to that mentioned. This may also occlude the open- 
ing of the bile-duct. The ramifications of the pancreatic duct- are 
dilated, thickened, and filled with exudate. Sclerotic changes occur in 
the gland, and the pancreatic cells undergo fatty degeneration. Hepatic 
lesions, such as fatty degeneration of the central cells of the lobules, 
hypertrophic cirrhosis, and dilatation of the bile-duct and its principal 
ramifications, may also be present. 

_ Symproms.—These are not suggestive of lesions in the pancreas. 
The symptoms recorded were dulness, unfitness for exertion, slight glyco- 
suria, and emaciation. Phenomena attributable to a disorder of the 
liver predominate, such as jaundice, scanty urine containing bile, clay- 
coloured dry feces, and loss of appetite. The course is slow, and may 
extend to two months, the animal ultimately dying from inanition owing 
to interference with the functions of the pancreas and liver. According 
to Cadéac, an examination of the feces may show the presence of un- 
digested fat due to fatty materials not being emulsified, but other 
authors are silent on this point. This, however, is observed in the dog. 

TREATMENT.—Therapeutic measures directed to the pancreas are 
hardly likely to be employed, as the disease is overlooked unless an 
examination of the urine suggests its presence. Pilocarpine is advised 
in order to increase the pancreatic secretion, and thus to liquefy the 
exudate which obstructs the duct and its divisions. It is obvious that 
when organic changes occur in the gland itself treatment of any kind 
is useless. 

Suppurative Pancreatitis —In this condition an abscess forms in the 
pancreas, and may be of considerable size. When extensive, the walls 


526 SYSTEM OF VETERINARY MEDICINE 


of the abscess cavity are very hard, and the lesion compresses the tissue 
of the gland, atrophy occurring as a result. The chief etiological factor 
is an attack of strangles, and the peripancreatic lymphatic glands are 
said to be first involved. Foreign bodies, such as portions of straw or 
of metal, may enter the gland from the duodenum by way of the duct, 
and induce suppuration. 

Symproms.—In the cases recorded the symptoms observed were 
emaciation, colicky pains, and evidences of intestinal obstruction when 
the duodenum was compressed by the abscess; also pain on palpation 
of the abdominal wall. The abscess may rupture into the abdominal 
cavity, and then septic peritonitis results. 

Treatment cf any kind is useless. 

Sclerotic Pancreatitis—SynonyM.—Cirrhosis of the pancreas. 

In this lesion the size of the organ may be greatly increased and 
its tissue indurated, or complete atrophy of the gland may be 
present. Cases have been recorded by Wheatley, Siedamgrotzky, and 
Kitt. 

Et1otocy.—The disease may occur as a sequel to catarrhal pan- 
creatitis and to other pathological conditions of the organ. It may be 
associated with cirrhosis of the liver. 

Morsip Anatomy.—lIn the case recorded by Wheatley* the pancreas 
was enormously enlarged, and weighed 13 pounds. The excretory ducts 
were greatly dilated; the duct of Wursung before leaving the gland easily 
admitted two fingers. The ducts were filled with a stringy mucus, but 
were not obstructed at their openings into the duodenum, which were 
unusually wide. On histological examination, interstitial inflammation 
of the gland was observed. There was marked excess of the interstitial 
connective tissue, and a large portion of the gland tissue was compressed 
or destroyed by the abundant formation of cells between the acini. 
Interstitial changes were absent from portions of the lobules here and 
there, but the acini were much dilated, and their epithelium was under- 
going mucoid transformation. The other organs were normal. 

In other cases recorded, the gland was atrophied to a marked extent, 
and of the thickness of a fibrous cord in some places, showing raised 
portions of gland tissue filled with a viscid product or a calcareous 
material. The sclerosis was specially marked in the interlobular spaces 
around the excretory canals. W. Williams stated that on making post- 
mortem examinations of horses which had either been slaughtered on 
account of old age or incurable lameness, or had died from some ordinary 
disease not associated with the pancreas, that he had often observed the 


* Journal of Comparative Pathology and Therapeutics, vol. ix. 


DISEASES OF .THE PANCREAS: OX 527 


major portion of the pancreas absent, and only a few shreds of the gland 
could be detected. 

Symptroms.—In Wheatley’s case the patient was a four-year-old 
gelding. The clinical history showed that, although the appetite was 
good, emaciation was present. A slight oozing of blood was observed 
from the coronets of all four feet, and the “ castors ” (chestnuts) appeared 
to be shedding. Later on blood and serum exuded from the coronets, 
frogs, and soles, and in places the horn was loose and under-run with pus. 
The temperature was 102° F. After three months the skin of the legs, 
abdomen, and sheath became swollen, and the case resembled one of 
purpura hemorrhagica. The temperature fluctuated, the skin showed 
an eruption in several parts, and a few discharging sores appeared on the 
hind-limbs. The skin also was depilated from the elbows and hocks 
downwards, also from the forehead and cheeks. The course of the disease 
extended from March to December, and the animal was then destroyed. 

In the other cases recorded the symptoms were also obscure, and 
included emaciation, cedematous swellings, enlargement of lymphatic 
glands, alopecia, cutaneous excoriations, and cachexia. No mention 
was made of an examination of the urine in any of the cases. 

Treatment of any kind is useless. 

Tumours of the Pancreas.—These are seldom met with, and occur as 
a surprise at autopsies. They include adenomata, carcinomata, and 
melanomata. | . 

Parasites of the Pancreas.—Cases are recorded in which echinococci, 
larval sclerostomes, and intestinal worms have been found in the organ. 


OX. 


Catarrhal Pancreatitis.—This resembles the analogous disease in the 
horse. It is generally associated with pancreatic calculi and with sclero- 
tic changes in the gland. 

Pancreatic Calculi (Pancreatic Lithiasis)——This condition is not un- 
common in cattle according to the observations of Guret, Bar, Johne, 
Scheunert, Bergholz, and others. According to Cadéac, these calculi 
are not met with in other species of animals, but this statement is not 
confirmed by Hutyra and Marek. 

The mode of origin is not definitely determined. Some observers 
believe that these calculi develop under similar conditions to salivary 
calculi—viz., from the presence of foreign bodies, infectious agents, and 
as the result of stasis of the glandular secretion. It is unusual to find 
a single calculus. A variable number—from ten to thirty-six, or even 


528 SYSTEM OF VETERINARY MEDICINE 


more—are generally present, and a sandy incrustation of the canals or 
an accumulation of a similar material in the dilated canaliculi is not 
uncommon. They vary in size from a pin’s head to a cherry. In shape 
they are generally angular or tetrahedral, and resemble small dice when 
occurring in the duct, but are cylindrical and smooth when developed in 
the fine canaliculi, and may correspond to the shape of the latter. Their 
colour may be whitish, greyish-white, or sometimes a yellowish-red. 
They are composed of carbonate and phosphate of lime and a small 
proportion of organic material, such as fatty matter, cholesterin, etc. 
In some instances the calculi are formed chiefly of organic material. The 
lesions produced are a dilated condition of the excretory duct and its 
ramifications, but its opening into the duodenum is constricted. An 
increase of connective tissue and atrophy of the glandular cells are also 
observed. 

Symptoms.—There are no symptoms suggestive of the presence of 
pancreatic calculi, and the condition is only discovered at autopsies. 
This being so, it follows that no treatment can be advised. Even if it 
were possible to diagnose the condition, therapeutical measures of any 
kind could not be adopted. 


PIG. 


Nodular Fat Necrosis of the Pancreas.—This is not an uncommon 
affection in the pig, but only occurs rarely in the horse and dog. Ac- 
cording to Marek and Ronai, it may be observed in normal lobules of the 
pancreas in fattened pigs. The lesion consists in the transformation of 
the fat in the adipose cells of the pancreas and of the abdominal cavity 
into crystals of fatty acids, either free or united to alkaline salts. The 
affection occurs more frequently in fat pigs, either adults or aged animals, 
and the lesions are chiefly found in the large fatty mass surrounding the 
pancreas. The actual cause of the condition is not definitely determined. 
Some authorities consider that the diffusion of the pancreatic secretion 
in the parenchyma of the gland and in the surrounding tissue may pro- 
duce the lesion. According to Truhart, the necrosis is due to the diffusion 
of the pancreatic ferments. Opie states that the condition occurs when- 
ever the pancreatic juice, obstructed from any cause and dammed back 
in the gland, infiltrates its tissue, or, escaping by the lymph spaces, finds 
its way to structures at some distance from the gland. The necrosis is 
due to.the fat-splitting ferment in the secretion.* 

Briefly speaking, the lesions generally consist of small nodules in the 


* Qsler’s Practice of Medicine. 


DISEASES OF THE PANCREAS: DOG 529 


interlobular spaces of the gland. The organ is much enlarged and hard- 
ened. In some instances softened foci, with deposits of a chalky material 
of the size of a pin’s head, are observed in the parenchyma and the fatty 
tissue of the gland. In others, and more frequently, the pancreas is 
surrounded by a hard, friable, fatty tissue, containing necrotic foci cir- 
cumscribed by a reddish-brown heemorrhagic zone (Cadéac). On micro- 
scopical examination, the fatty cells are filled with more or less numerous 
fine needles of fatty acids, and occasionally necrosis of the parenchyma 
or multiple hemorrhages of the gland are observed. Symptoms are not 
observed, and death may take place suddenly. No effective treatment 
can be adopted. 


DOG. 


Hzemorrhagic Pancreatitis.—This lesion occurs more frequently in the 
dog than in other animals. It may follow an acute inflammation of the 
pancreas, or be associated with distemper, hemorrhagic gastro-enteritis, 
pizoplasmosis, etc. 

Morgip Anatomy.—The organ shows a reddish or blackish colour, 
either of a patchy or a diffuse character. Multiple hamatomata may be 
present. When acute inflammation is absent, the glandular tissue is 
not involved. Nodular fat necrosis has been observed in some cases, 
with considerable enlargement of the pancreas. The omentum and > 
mesentery were involved by fat necrosis in a case recorded by Ball. 

Symproms.—There are no characteristic symptoms. In the cases 
recorded, vomiting, abdominal pain, and sudden collapse, were observed. 

Obviously, no treatment can be suggested. 

Suppurative Pancreatitis—The presence of sharp-pointed foreign 
bodies in the gland is recognised as the cause of this condition. In a 
case recorded by Bruckmiiller a needle was found in a fibrous sac in the 
pancreas in the midst of a thick greenish material. 

The symptoms are obscure. Loss of appetite, emaciation, and occa- 
sional evidences of abdominal pain, may be observed. Death may occur 
from septic peritonitis. Occasionally the foreign body may become 
encysted, and no effects are produced. As it is hardly likely that the 
condition can be diagnosed, the question of treatment does not merit 
consideration. 

Sclerotic Pancreatitis (Atrophy of the Pancreas).—This is sometimes 
termed “ Pancreatic Diabetes.” Cases have been recorded by Liénaux, 
Eber, Almy, Sendrail, and Lafon. The cause suggested by some authors 
is the presence of infectious micro-organisms in the duct of Wursung. 

VOL, I. 34 


530 SYSTEM OF VETERINARY MEDICINE 


Morpip AnAtoMy.—The lesions are most commonly observed in the 
vicinity of the head of the organ. The atrophy may be extreme. In the 
case recorded by Liénaux the length of the pancreas was 3 centimetres, 
and the breadth 1 centimetre, and in Sendrail’s case the organ was 
reduced to a nodule the size of a haricot bean. On histological examina- 
tion, an increase in the connective tissue was observed, the walls of the 
arteries were surrounded by fibrous layers, an obliterating endarteritis 
was present, there were marked alterations in the glandular epithelium, 
and the excretory canals presented irregular dilatations. 

Symproms.—In cases where the pancreas is extensively diseased, 
glycosuria occurs. Polyuria, marked thirst, jaundice, and emaciation, 
may be present. In some of the recorded cases emaciation was observed, 
although the appetite was maintained, and an examination of the feces 
showed that the meat ingested was not assimilated, as undigested muscle 
fibres we:e present. In other instances an intense diarrhoea followed by 
coma was observed. 

According to Hutyra and Marek, the feeces are grey in colour, and 
have a characteristic greasy appearance. The presence of undigested 
portions of meat in the feces, also of undigested fat, is suggestive of 
pancreatitis. As regards treatment, pancreatin and potassium iodid emay 
be prescribed. 

Tumours of the Pancreas.—Adenomata have been observed by Lié- 
naux. Carcinomata of the head of the pancreas have also been recorded. 
Petit met with sarcomata which originated in the bowel, involved the 
ampulla of Vater, and brought about icterus as a complication. 

Parasites of the Pancreas.—These include cysticerci and distoma. 
Nencioni observed chronic pancreatitis in a cat due to the presence of 
Distoma felineum in the gland. 


DISEASES OF THE LIVER IN THE HORSE 
By E. WALLIS HOARE, F.R.C.V.S. 


GENERAL REMARKS. 


PuysioLoey teaches us that the functions of the liver are complex, 
manifold, and of great importance. From this, one would infer that 
diseases and disorders of the organ would cause serious effects on the 
system, and be accompanied by well-marked symptoms. Yet we find 
that in general practice but little attention is devoted to hepatic affec- 
tions, and in the majority of instances the existence of the lesions is only 
discovered post mortem. As compared with the human subject, it must 
be admitted that diseases of the liver in the horse are of far less frequent 
occurrence. But post-mortem evidence demonstrates that they occur 
with greater frequency than is imagined by many practitioners. 

The obscure nature of the symptoms is one of the reasons why so few 
cases of hepatic disease are recognised, and so little interest taken in the 
subject from a clinical point of view. It is often imagined that unless 
jaundice be present, the liver may be regarded as free from disease. As, 
however, this symptom may be absent in many cases, such an assump- 
tion is erroneous. No doubt a popular form of diagnosis is sometimes 
given, such as “liver out of order,” or “liver derangement,” when a 
horse shows dulness and lack of spirit, although having a good appetite 
and being in prime condition. The association of indigestion with hepatic 
disorder is well recognised. On the one hand, the products of imperfect 
digestion exert a deleterious action on the liver, and on the other hand 
affections of the liver interfere with the digestive functions of this organ, 
so that a vicious circle is established. 

In order to understand the effects of hepatic disease, it is necessary 
to be acquaiuted with the functions of the liver. 

According to F. Smith,* the numerous and complicated changes 
produced by the liver may be summarised as follows: “It forms bile, 
regulates the supply of sugar to the system, and stores up as glycogen 
what is not required. It guards the systemic circulation against the 

* Veterinary Physiology.” 
531 


532 SYSTEM OF VETERINARY MEDICINE 


introduction of certain nitrogenous poisons, such as ammonia, by trans- 
forming them into urea, and against other poisons of proteid origin by 
converting them into harmless products by conjugation with alkaline 
sulphates.” 7 

It will thus be seen that the hepatic functions include more than the 
formation of bile and the storing up of glycogen, and that under condi- 
tions of disease the effects exerted on the system are complex and far- 
reaching. It is also apparent that the liver must be regarded as both a 
secretory and an excretory organ. An anatomical peculiarity in the 
horse is deserving of mention—viz., the absence of the gall-bladder, the 
result being that the bile is poured into the intestine as fast as it is pre- 
pared. So far as is known, this peculiarity has no effect as regards the 
occurrence of hepatic diseases. 

Bile may be described as both a secretion and an excretion. It 
possesses important uses from a digestive point of view, but if absorbed 
into the system it exerts serious toxic effects. Its chief uses as a diges- 
tive secretion are as follows: (1) It has a solvent and emulsifying effect 
on fats, and assists in the absorption of fat. (2) It is said by some 
authorities to exert an antiseptic effect on the intestinal contents, and 
thus to prevent putrefaction. But F. Smith points out that bile is not 
a true antiseptic, and that its real action in this direction consists in 
promoting peristalsis, and thus preventing stasis and putrefactive decom- 
position in the ingesta. According to the same author, “ the choles- 
terin found in the bile must be regarded in the light of an excretion. 
This substance is collected from the various tissues of which it forms a 
part. It reaches the liver, and is eliminated through the bile, and thus 
reaches the intestine, and is removed from the body. Lecithin is another 
waste product of the body excreted from the system through the medium 
of the bile.”’ 

From this brief consideration of the functions of the liver we can 
comprehend in a general manner the results of disease of this organ. 
These include digestive disturbances, interference with the secretion of 
bile or with its passage into the intestine; effects produced on the system 
owing to toxic materials not being transformed and removed by the 
liver, and thus entering the general circulation; interference with the 
nutrition of the tissues owing to derangement of the glycogenic function 
of the organ. To these we may add alterations induced by mechanical 
interference with the portal circulation, such as occurs in hepatic cirrhosis, 
and have far-reaching effects on various abdominal organs. 

As already mentioned, the general symptoms of hepatic disease are 
usually obscure, and, with the exception of jaundice, they are likely to 


DISEASES OF THE LIVER: HORSE 533 


be attributed to derangement of other organs. No doubt if systematic 
examinations of the urine were carried out in veterinary practice, the 
diagnosis of diseases of the liver would be much facilitated. The presence 
of bile-pigments in the urine is an important symptom of hepatic dis- 
order. 

The association of jaundice with morbid conditions of the blood, 
independent of hepatic disease, is an important point in connection with 
the subject. Such a condition is observed in piroplasmosis and in certain 
infectious diseases. The occurrence of jaundice under these circum- 
stances is attributed to the presence of a large amount of blood-pigment 
in solution in the blood-plasma, from which excessive quantities of bile- 
pigment are manufactured by the liver cells, and becomes reabsorbed 
into the system (see p. 534). 


ICTERUS. 


SynonyM.—Jaundice. 

This term signifies a coloration of the skin, mucous membranes, and 
fluids of the body by bile-pigment. It has aptly been described as a 
symptom with symptoms, and, properly speaking, it cannot be regarded 
as a disease per se. Some authors describe icterus as occurring in certain 
forms—viz., Catarrhal, and Icterus Gravis or Malignant Jaundice. But 
as the former depends on acute catarrh of the bile-duct and its larger 
ramifications, while the latter is associated with the lesion known as 
‘“ acute yellow atrophy of the liver,” it seems more desirable to describe 
the diseases named under separate headings, and to regard jaundice as 
one of the symptoms associated with them. Here we shall deal with 
jaundice in a general manner with regard to its etiology and the effects 
produced on the system. 

The characteristic yellow coloration of the mucous membranes and 
of the unpigmented parts of the skin, etc., is associated with a variety 
of hepatic affections, and also with certain infectious diseases and morbid 
alterations of the blood. It is important, however, to point out that 
many organic diseases of the liver may not present Jaundice as a symp- 
tom. Of late years the views held concerning the mode of origin of 
jaundice occurring in connection with pathological conditions of the 
blood have been considerably modified. Formerly, this type was termed 
‘‘ hematogenous,” as distinguished from “ hepatogenous,” jaundice asso- 
ciated with obstructive changes in the bile-passages. It is now held that 
the bile-pigments in all instances are produced by the liver, and doubt 
is expressed as to the existence of true non-obstructive cases. The 
jaundice associated with piroplasmosis, certain infectious diseases, and 


534 SYSTEM OF VETERINARY MEDICINE 


with alterations in the blood due to unknown causes, is explained as 
follows: Destruction of blood occurs by hemolysis, and a large amount 
of hemoglobin is liberated, from which excessive quantities of bile-pig- 
ment are formed by the liver cells (polychromia). The bile becomes 
viscid as its fluid constituents are not increased in proportion, and, 
owing to the low pressure at which it is secreted, its passage through the 
liver is accomplished with difficulty or temporarily obstructed, so that 
reabsorption occurs and jaundice results. 

Nevertheless, some authors for clinical purposes still retain the term 
“ obstructive” jaundice, and group under it conditions associated with 
obstructive changes in the bile-passages. These may be classified as 
follows: (1) Gastro-duodenal catarrh associated with tumefaction of the 
duodenum or of the lining membrane of the bile-duct, and of its branches 
(catarrhal jaundice). (2) Compression of the duct due to enlarged portal 
lymphatic glands, chronic inflammation in the vicinity of the portal 
fissure, the presence of neoplasms either in the liver or in neighbouring 
organs, etc. Compression of the small bile-passages may result from 
passive hypereemia of the liver associated with acute or chronic hepatitis. 
(3) The presence of gall-stones, parasites, or foreign bodies in the bile- 
duct. As rare causes of jaundice we may mention impaction of the 
duodenum, chronic inflammation of the portal vein, or thrombosis of 
this vessel, and volvulus of the left lobe of the liver. 

In cases of obstructive jaundice it is held that the pressure within the 
biliary capillaries is increased, and the bile is absorbed by the lymphatics 
of the liver, and not by the blood-capillaries. In jaundice produced by 
the action of poisons, such as arsenic, phosphorus, lupinosis, etc., the 
condition depends, according to Hutyra and Marek, on plugging of the 
minute primary bile-ducts with débris of liver cells. Cadéac regards 
microbial infection as playing a very important part in the etiology of 
icterus, infection taking place from the intestine by way of the bile-duct, 
especially in cases associated with gastro-duodenal catarrh. The micro- 
organisms incriminated are the Bacillus coli, also staphylococci and 
streptococci, and according to this author all the phenomena of catarrhal 
icterus can be produced by the above microbes. Exposure to chills is 
also said to be an etiological factor, and cases were observed to follow 
clipping in cold weather, and also general washing of the body. 

Morsip Anatomy.—The lesions present will vary according to the 
affection on which the jaundice depends. The striking feature is the 
yellow staining of all the organs of the body with the exception of the 
central nervous system. According to Friedberger and Fréhner, the 
tissue of the cornea is free from the staining. The intensity of the colour 


DISEASES OF THE LIVER: HORSE 535 


varies, and in some instances it may be of a deep yellow or even a greenish- 
yellow tint. It is best marked in tissues containing fat, such as the 
omentum, etc., but may also be observed in blood-clots, in fluid exudates 
that may be present, and in the muscular tissue. In emaciated animals 
the subcutaneous connective tissue may be infiltrated in parts with a 
yellow serum. Hutyra and Marek draw attention to the fact that in the 
horse the fat is yellow under normal conditions. 

Symproms.—These include the yellow coloration of the visible mucous 
membranes and of the unpigmented parts of the skin, and also certain 
phenomena associated with the presence of bile in the blood, but the 
true nature of the toxic agent has not yet been determined. The yellow 
staining first occurs in the conjunctive, and later on, although less 
marked, in the buccal and nasal mucosz, and also in the unpigmented 
parts of the skin. It varies in intensity according to the severity and 
duration of the existing disease. The urine contains bile-pigments, and, 
according to Hutyra and Marek, jaundice can be recognised in the very 
early stages by an examination of the urine. But Friedberger and 
Froéhner state that in the horse staining of the visible mucous membranes 
may occur without the presence of bile-pigments in the urine. 

The urine may be of a dark yellow, lemon, brownish-yellow, or 
ereenish-yellow colour, and if a portion of white filter-paper be dipped 
into it, a yellow stain is produced. Bile acids may also be detected in 
the urine. The following tests are recognised for the detection of bile- 
pigments : 

Gmelin’s Test—A portion of the suspected urine is slowly added to 
some nitric acid containing a few drops of nitrous acid, so that the urine 
forms a layer above the acid. If bile-pigments be present, a play of 
colours is observed where the liquids meet, green being most marked. 

Rosenbach’s Test.—This is a modification of Gmelin’s test. A portion 
of filter-paper moistened with the suspected urine is placed upon a white 
porcelain slab, and is touched with a glass rod previously dipped in 
fuming nitric acid. If bile-pigments be present, a ring of colours is 
observed at the point of contact. These colours from within outwards 
are yellow, violet, brown, and green. The green colour only is obtained 
in some cases. 

According to Latschenberger and other observers, the presence of 
bile-pigments in horse’s urine is difficult to demonstrate by Gmelin’s test, 
as a dark brown zone is formed which obscures to a great extent the 
green tint. The above-named observer advises that the urine be diluted 
with water, and then mixed with a solution of baryta, and allowed to 
stand for twelve to twenty-four or forty-eight hours. Gmelin’s test is 


936 SYSTEM OF VETERINARY MEDICINE 


then applied to the clear supernatant fluid. The colour reaction, how- 
ever, 18 said not to be well marked. 

The sweat, milk, and exudates may also contain bile-pigments, but, 
according to Hutyra and Marek, these are completely absent from the 
lachrymal secretion and the saliva. 

In obstructive jaundice, owing to the absence of bile from the intes- 
tine, constipation is present, the faeces are pale in colour and very foetid. 
but in hemolytic jaundice the intestinal contents are bile-stained.. 

The toxic action of the bile on the system may induce functional 
derangements in other organs. According to Friedberger and Frohner, 
the more serious symptoms are due to the biliary acids. The animal is 
dull and sleepy, easily fatigued, the appetite is in abeyance, and the pulse 
becomes slow, and a subnormal temperature may be present. In per- 
sistent cases emaciation occurs and nervous symptoms appear. A 
staggering gait, or cramp-like convulsions of the muscles, either localised 
or general, may be observed. Delirium and dyspnoea may occur in some 
instances, and in severe cases death may take place more or less sud- 
denly. The course varies according to the nature of the existing disease. 

TREATMENT.—The indications for treatment vary, and depend on the 
disease with which the jaundice is associated. Hence they will be con- 
sidered under the various hepatic disorders in which icterus is one of the 
Symptoms present. 


ICTERUS NEONATORUM. 


Synonym.—Icterus of new-born animals. 

This is occasionally met with in foals a few days old, and in excep- 
tional instances the affection is present at the time of birth. It appears 
to be more prevalent in some districts than in others, and instances are 
recorded in which a number of cases were observed in the same locality. 
Schéttler recorded a case where four foals of one mare developed the 
disease upon the first day after birth. The affection may sometimes be 
of a mild type, and associated with derangement of digestion or intes- 
tinal impaction due to retention of the meconium. But in severe cases 
the tissues are deeply stained by bile, exhaustion becomes extreme, and 
is soon followed by a comatose condition and death. Nervous symp- 
toms, such as constant movements of the jaws, may be observed. Diar- 
rheea is present in some cases, and constipation in others. Nothing 
definite is known with regard to the etiology of the affection. Accord- 
ing to Hartmann, the jaundice is due to inflammation of the umbilical 
veins. Hutyra and Marek are of opinion that several factors are con- 
cerned in the production of the disease, such as extensive destruction of 


DISEASES OF THE LIVER: HORSE 537 


red blood-corpuscles leading to-a condition of polychromia (see p. 534); 
also some of the bile-pigments which are not decomposed in the intestine 
may be absorbed into the branches of the portal vein and pass directly 
by way of the ductus aurantii into the posterior vena cava, and from 
thence into the general circulation. Cadéac and other French authors 
describe a septico-pyzeemia of umbilical origin associated with icterus, 
and term the affection “‘ ictére infectieux grave des nouveau-nés.” Inthe 
human subject it is found that, in contradistinction to other forms of 
jaundice, the brain and spinal cord may be stained yellow in cases of 
icterus neonatorum. No observations with reference to this point are 
recorded in animals. 

TREATMENT.—In the mild form an aperient is indicated; also enemata, 
if retention of the meconium be present. A dose of grey powder may be 
administered, or, as advised by Hartmann, carbonate of magnesia and 
rhubarb. In the grave cases treatment of any kind is useless. 


ACUTE YELLOW ATROPHY OF THE LIVER. 


Synonyms.—Malignant jaundice; Icterus gravis; Toxi-infectious 
icterus. 

This affection is not mentioned by Williams or Robertson. It must 
be regarded as a comparatively rare disease, at any rate, in the British 
Isles. The prominent lesion consists of a widespread necrosis of the 
liver cells and a reduction in the volume of the liver. 

Eriotocy.—According to Friedberger and Fréhner, the disease is a 
very acute and pernicious form of parenchymatous hepatitis, most fre- 
quently observed in cases of lupinosis (Lupine-Poisoning, see p. 556). 
But this form of poisoning is rare in the horse, and, so far as we are 
aware, does not occur in the British Isles. The same authors state that 
parenchymatous hepatitis may change into acute yellow atrophy in 
connection with septicemia, phosphorus-poisoning, or various infectious 
diseases. Other German observers attribute the affection to the inges- 
tion of sour potato-peelings, pea or vetch straw, green vetches, hay from 
flooded land, etc. Cadéac believes that the disease depends on microbial 
infection when not due to toxic agents. Hutyra and Marek state that 
in some instances the coincident existence of septicemia or gastro- 
enteritis suggests the possibility of a toxin being the cause of the affec- 
tion. 

Morsip ANAtomy.—The liver is greatly reduced in size and weight, 
has a flattened appearance, is soft or flabby, but in some cases may 
cut with considerable firmness. In colour it is ochre yellow, or may be 


538 SYSTEM OF VETERINARY MEDICINE 


of a greenish-yellow. On section, yellow and dark red areas may be 
observed. The red areas are a more advanced stage of the disease, and 
are somewhat firm in consistence. On histological examination, necrosis 
of the liver cells is observed, and in certain spots the cells are completely 
destroyed, being converted into fatty débris. The smaller bile-ducts may 
show catarrhal inflammation, and hemorrhages may occur between the 
liver cells. Complications are generally present, such as fatty degenera- 
tion of the kidneys, enlargement of lymphatic glands and of the spleen, 
gastro-intestinal catarrh, and extensive bile-staining of the various 
organs. . 
Symptoms.—These are obscure, the only one pointing to a hepatic 
affection being intense jaundice. Amongst other symptoms observed 
are depression, loss of appetite, colicky pains in some cases, a slow pulse, 
a diminution in the amount of urine, which is of a reddish-brown colour, 
and contains bile-pigments and albumin. Cerebral phenomena may 
occur, such as a staggering gait, vertigo, and a sleepy appearance, fol- 
lowed by coma. Diarrhoea may be observed in the later stages. All 
the symptoms may appear within twenty-four to forty-eight hours, and 
death usually takes place in about six or eight days. According to 
Cadeéac, the duration depends on the extent of the renal complications 
that are present, and for the first two or three days no evidences of 
jaundice may be observed in some instances. This author also states 
that the intensity of the icterus is not in proportion to the gravity of the 
case. 

TREATMENT.—Antiseptics, mild purgatives, and diuretics are advised, 
but up to the present time every form of treatment has proved useless. 


ACUTE CATARRH OF THE BILE-DUCT. 


Synonyms.—Catarrhal jaundice; Simple-jaundice. 

Some authors describe under the heading of “ Angiocholitis”’ an 
inflammation of the biliary passages, both intra- and extra-hepatic, and 
attempt to differentiate this from catarrhal icterus. But the extent of 
catarrh in the bile-passages is not definitely known, and the presence of 
catarrh of the finer ducts within the liver is assumed rather than proved. 
At any rate, it is very probable that the terminal portion of the duct is 
first involved. . 

Et1oLogy.—Gastro-duodenal catarrh is regarded as the most common 
cause of the conditions, and the catarrhal process is most marked in the 
duct as it enters the duodenum. The mucous membrane is swollen, and 
a plug of inspissated mucus may occlude the ampulla of Vater, causing 


DISEASES OF THE LIVER: HORSE 539 


complete obstruction of the opening of the duct. Exposure to chills is 
also regarded as an etiological factor, while the condition may also be 
associated with chronic cardiac disease and certain microbial affections, 
such as influenza and contagious pneumonia. Cadéac regards infection 
from the intestine as playing the most important part in the etiology of 
the affection, and incriminates bacilli of the coli type, streptococci, and 
staphylococci. Gall-stones may cause a general inflammation of the 
bile-duct (see p. 547). Friedberger and Fréhner describe chronic cases 
in which the bile-passages and the duct are dilated. 

Symptroms.—Hvidences of obstructive jaundice are generally present, 
but in mild cases without complete obstruction of the duct, icterus is 
slight or absent. The feces are pale in colour, and the urine contains 
bile-pigment. Colicky pains may be present. The symptoms are by no 
means diagnostic, as the jaundice may result from various causes. Loriot, 
observed conjunctivitis and epistaxis in one case. A grave form of the 
disease is described by some authors, in which the parenchyma of the 
liver became involved, and renal complications set in. In mild cases 
the duration is from eight to fifteen days, and when the biliary flow 
becomes re-established the symptoms disappear. 

TREATMENT.—Calomel is indicated, and should be followed by sul- 
phate of soda and bicarbonate of soda. The diet should be light, and 
restricted to oatmeal gruel, milk, linseed tea, hay tea, bran mashes, etc. 


CONGESTION OF THE LIVER. 


SynonyM.—Hypereemia of the liver. 

This condition is not described by Hutyra and Marek, but is recog- 
nised by the majority of authors. In the Report of the Army Veterinary 
Service, 1911, seven cases of congestion of the liver are recorded, and for 
1912, four cases; while according to the Report of the Army Veterinary 
Service in India, 1911-12, thirty-one cases of the affection were admitted 
for treatment, and in the Report for 1912-13, forty-seven cases are 
recorded. From a clinical point of view it cannot be regarded as an 
important affection, as its presence is surmised rather than recognised. 

Two forms are described—viz., Active and Passive. 

Active Congestion.—A transient congestion of the liver occurs after 
each feed, but this is purely physiological. The condition becomes 
pathological when it is intense and of long duration. Idleness and 
excessive feeding, especially on highly nitrogenous food, are believed to 
act as predisposing causes. Exposure to chills after the animal is heated 
from work is also regarded as an etiological factor, the explanation given 


540 SYSTEM OF VETERINARY MEDICINE 


being that the blood is driven from the vessels of the skin to the internal 
organs, and tends to accumulate in the liver. The effect of a tropical 
climate on the incidence of the affection is evidenced by the number of 
cases occurring in army horses in India, as mentioned above. According 
to Cadéac, altered or mouldy forage may produce the condition. Blake- 
way recorded a case of congestion of the liver in a foetus. Delivery had 
to be accomplished by embryotomy, and the organ weighed 22 pounds. 

Morsip Anatomy.—The liver is much enlarged and increased in 
weight; it is dark in colour, and slightly friable. On section the paren- 
chyma is of a deep red colour, and presents hemorrhagic foci, especially 
in the vicinity of the capsule. Microscopical examination shows dilata- 
tion and engorgement of the bloodvessels, while the hepatic cells are 
swollen and pigmented. The periphery of the acini shows the deepest 
red colour, indicating a congested condition of the tributaries of the 
portal vein. According to Friedberger and Fréhner, in intense hyper- 
emia, rupture and hemorrhage of the liver may occur. 

Symproms.—These are not characteristic. An increase in the area of 
liver dulness is said to have been detected by some authors, but it is 
doubtful if such can be recognised in the horse. Dulness, half-closed 
eyes, slight colicky pains, icterus, lying on the left side, polyuria, etc., 
have been recorded, but cannot be regarded as suggestive of the affec- 
tion. 

TREATMENT.—If the condition is suspected, a purgative is indicated, 
to be followed by repeated doses of salines. Some practitioners advise 
free venesection. 

Passive Congestion.—This occurs more frequently than the active 
form. It results from an increase of pressure in the efferent vessels or 
sublobular branches of the hepatic veins, and is associated with every 
condition leading to venous stasis in the right side of the heart. The 
affection may thus occur in connection with chronic valvular disease, 
fatty degeneration of the heart, pericarditis, pulmonary emphysema, 
intrathoracic tumours, etc. 

Morsip ANAToMy.—The liver is enlarged, firm in consistence, and 
of a deep red colour. On section, marked engorgement of the hepatic 
vessels is observed, this alteration being most apparent in the central 
vein of each lobule and its adjacent capillaries. Owing to the hepatic 
territories being deeply congested, while the portal areas are anzemic, the 
organ presents a mottled appearance, and the condition is termed “‘ nut- 
meg” liver. Atrophy of the liver cells results from excessive distension 
of the central capillaries. The centre of the lobules shows a brown pig- 
mentation, and the connective tissue is much increased. The term 


DISEASES OF THE LIVER: HORSE 541 


b 


‘* cyanotic induration,’ or “ cardiac liver,” is sometimes applied to this 
condition. In the later stages the organ may become contracted. 

Symptoms.—lThe symptoms of the associated disease usually predom- 
inate, and unless jaundice be in evidence the presence of hepatic lesions 
will be overlooked. 

TREATMENT.—The principles of treatment will vary according to the 
nature of the primary disease. In the majority of instances, so far as 
equine patients are concerned, treatment is not desirable, as there is 
little hope of a permanent recovery. 


RUPTURE OF THE LIVER. 


SynonyM.—Hemorrhage of the liver. 

This lesion may occur either in the form of small punctiform hemor- 
rhages due to the rupture of several small vessels, or there may be exten- 
sive breaking down of the liver tissue, with profuse hemorrhage. 

Etiotoay.—The following conditions are recognised as predisposing 
causes: 

1. Degeneration of the liver. Amyloid degeneration is admitted 
to be the most important. Fatty degeneration is also an etiological 
factor. 

2. Certain hepatic diseases, including neoplasms of the organ, “‘ nut- 
meg” liver, hepatic abscess, embolism of the hepatic artery or portal 
vein. 

3. Acute infectious diseases, inducing abnormal conditions of the 
bloodvessels of the organ. 

Exciting Causes—These include external injuries, severe struggling, 
falls, fractured ribs, etc. Willams was of opinion that such factors were 
not likely to bring about rupture except some degenerative disease of the 
liver was in existence, and he found that the lesion was more frequently 
observed in fat horses with sleek coats. 

Morsip ANAtoMy.—The lesion may occur in the form of small 
extravasations in the parenchyma or subjacent to Glisson’s capsule. 
In other instances the hemorrhages are more extensive, and the blood is 
enclosed in fibrous capsules. Large cavities may be formed in the 
parenchyma. These-contain coagulated blood, and appear in the form 
of hematomata of various sizes. They may extend to the capsule of the 
organ and elevate it. Rupture of these hematomata may occur, and 
blood escapes into the peritoneal cavity, death resulting from internal 
hemorrhage. The liver is greatly increased in weight, and may present 
various lesions. Williams observed in some cases marked congestion, 


542 SYSTEM OF VETERINARY MEDICINE 


great enlargement of the organ, distension of the vessels with dark semi- 
fluid blood, and infiltration of the parenchyma; in others, only shreds of 
the capsule and small portions of liver substance were found. In others, 
again, the organ was friable and clay-coloured, or stained a deep yellow 
tint. Small hemorrhages may become absorbed, and their presence 
may only be shown by fibrous cicatrices. 

According to Cadéac, the seat of the lesion is generally the right lobe 
or the middle lobe, and it is only in rare instances that the left lobe is 
involved simultaneously with the right. The peritoneal cavity contains 
a large amount of blood. 

Symproms.—In the case of small hemorrhages no symptoms are 
observed. Recorded cases show that remittent attacks may occur, suc- 
ceeded by an extensive lesion causing death, the autopsy revealing the 
presence of old hemorrhages, with stratified blood-clots. Percivall men- 
tioned a case that occurred in the practice of Siddall, in which “ the horse 
had been ill and subject to frequent faintings for upwards of three weeks 
before he died.” ‘The autopsy showed small ruptures of the peritoneal 
covering of the liver in different places, and one large rupture of the 
organ. 

In cases that succumb to an extensive rupture the symptoms observed 
are those generally occurring in internal hemorrhage, but unless jaundice 
be present, it is impossible to attribute the source of the hemorrhage to 
the liver. The countenance is anxious, the surface of the body and the 
extremities are cold, local or general sweating is present, the pulse is 
weak and thready and soon becomes imperceptible, the visible mucous 
membranes are pallid, muscular tremblings, staggering, dilated pupils, 
and nystagmus are observed, and death occurs in from one to ten hours. 
Williams observed colicky pains, slight tympany, and violent cardiac 
action, in addition to the symptoms mentioned. 

Less severe cases are met with in which disturbance of the pulse, 
jaundice, a stiff gait, and loss of appetite, are present. Weber found the 
area of hepatic dulness increased, but in our opinion this diagnostic 
feature would be difficult to detect in the horse. Cases are recorded 
which presented obscure symptoms for some time, and ultimately suc- 
cumbed to an extensive rupture of the liver. 

DIFFERENTIAL D1aGnosis.—Except in cases where jaundice is present 
and the history points to the existence of an hepatic disorder, a correct 
diagnosis is not possible. In the majority of instances the lesion is only 
discovered post mortem. 

T'REATMENT.—In cases of extensive rupture of the liver treatment is 
hopeless. 


DISEASES OF THE LIVER: HORSE 543 


When the condition is less severe, the usual treatment for internal 
hemorrhage is indicated—viz., the intravenous or subcutaneous injection 
of adrenalin, and the administration of large amounts of normal saline 
solution by subcutaneous injection. Perfect rest is essential. 


ACUTE HEPATITIS. 


This condition is of rare occurrence in the horse. Although Percivall 
gives a full clinical description of it, which is also quoted by Williams, it 
must be admitted that with the exception of one symptom—viz., jaundice 
—there is nothing characteristic of hepatic disease in the clinical picture 
depicted. Robertson described two forms—viz., perthepatitis, or inflam- 
mation of Glisson’s capsule, and inflammation of the component gland 
structure—but he admits that in both instances a definite diagnosis is 
rarely possible, and the conditions are generally found at post-mortem 
examinations without their existence being suspected. Willams stated 
that perihepatitis with adhesion of the liver to the diaphragm is not rare 
in old horses, and is not accompanied by any symptoms during life which 
point to its presence. Friedberger and Frohner describe parenchymatous 
hepatitis and perihepatitis together. 

As regards the incidence of the affection in army horses, we find in 
the Report of the Army Veterinary Service, 1911, that only two cases 
are recorded, and none in 1912; while according to the Report of the 
Army Veterinary Service in India, 1911-12, seven cases were admitted 
for treatment, and in 1912-13 only three cases were recorded. 

It seems desirable to discuss the disease under the heading of Acute 
Parenchymatous Hepatitis, and to consider suppurative hepatitis under 
a separate heading (see p. 044). 


ACUTE PARENCHYMATOUS HEPATITIS. 


ETIoLoGy.—German authors state that this affection is rarely ob- 
served as a primary disease. It may be associated with gastro-enteritis, 
or with the effects of toxic agents, such as phosphorus and arsenic. 
According to Friedberger and Fréhner, damaged fodder, excessive heat, 
and infectious diseases may be etiological factors. 

Morpip ANatomy.—The organ is enlarged and friable in consistence. 
It is of a pale yellow or clay colour. Perihepatitis with adhesion of the 
lobes of the liver to each other, or of the liver to the diaphragm, may 
be observed. On section, hemorrhagic foci may be present in the 
parenchyma or under the capsule. Histological examination shows 


544 SYSTEM OF VETERINARY MEDICINE 


granular and fatty degeneration of the liver cells, with pigment infiltra- 
tion; also hyperemia of the interacinous connective tissue (Pntedbergen 
and Frohner), 

Symproms.—There are no characteristic symptoms. Fever, loss of 
appetite, and jaundice may be present. Pain may be evinced during 
defzecation, probably caused by compression of the liver by the diaphragm 
and abdominal muscles (Friedberger and Fréhner). Lameness of the 
off-shoulder has been recorded as a symptom, but Williams considers 
that it is rarely present, and is more especially associated with the 
existence of abscesses or of foreign bodies in the liver. 

TREATMENT.—If the presence of the affection be suspected, the prin- 
ciples of treatment mentioned in connection with congestion of the liver 
are indicated. But, as already remarked, it is very seldom that the 
condition can be diagnosed, and, unless jaundice be present, the symp- 
toms will very likely be attributed to other sources and treated accord- 


ingly. 
SUPPURATIVE HEPATITIS. 


Synonym.—A bscess of the liver. 

This is considered by some authors as a rare affection in the horse. 
It is, however, of comparatively common occurrence in connection with 
omphalophlebitis (joint-ill) in foals. In the majority of instances it is 
a metastatic lesion. Some observers state that the affection is more 
frequently met with in tropical climates, but in the Report of the Army 
Veterinary Service in India, 1911-12, we do not find any cases of it 
recorded, and’ in the Report for 1912-13 tags one case was admitted 
for treatment. 

Eit1oLocy.—T'he affection depends on microbial infection. The 
micro-organisms are streptococci and staphylococci. The infective 
agents may reach the liver—(1) by way of the hepatic artery, when the 
original focus of infection is in the area of the systemic circulation; 
(2) by the portal vein, in cases of gastro-enteritis; (3) by the umbilical 
veins in cases of omphalophlebitis in foals; (4) by the bile-duct, depend- 
ing on inflammation due to foreign bodies, gall-stones, or parasites; 
(5) foreign bodies, such as thorns, needles, etc., which gain entrance to 
the gland from the stomach or duodenum. 

Amongst other conditions with which suppurative hepatitis may be , 
associated are strangles, tuberculosis, ulcerative endocarditis, gangrenous 
pneumonia, suppuration of the spleen, intestinal wall, and mesenteric 
glands. External injury to the liver is also regarded as an etiological 
factor, more common, however, in cattle than in horses, the explanation 


DISEASES OF THE LIVER: HORSE 545 


of the infection, according to Hutyra and Marek, being that the liver 
tissue is broken down at the seat of injury, and any micro-organisms 
circulating in the blood may localise in this region. 

Morsip AnatomMy.—Three types of abscesses are recognised by 
Cadéac—viz.: 

1. Biliary, resulting from a suppurative angiocholitis. The abscess 
develops in a biliary canal, and varies in size from that of a pea to a nut. 
The contents consist of pus, epithelial cells, pigment, etc. A number of 
abscesses are generally present. This form is rarely met with in the horse. 

2. Metastatic_—These consist of a number of abscesses disseminated 
through the liver, and varying in size from a pin’s head to a hen’s egg. 
The lesions start by infective emboli becoming arrested in the arterial, 
portal, or capillary vessels of the organ. They induce proliferation of 
vascular endothelium, blood-stasis, and coagulation and obstruction of 
the vessels. Abscesses are formed, and these are surrounded by a 
hemorrhagic infarct which shows central softening. 

3. Large Abscess —This lesion may be single or multiple, and may 
depend on strangles or on the presence of foreign bodies. The abscess 
may be very extensive, and project beyond the surface of the liver. It 
is generally associated with perihepatitis and circumscribed peritonitis, 
and is joined by adhesions to the diaphragm, and in some instances to 
the stomach, large colon, and right abdominal wall. Occasionally the 
abscess ruptures into the peritoneal cavity, and a fatal peritonitis is then 
produced. In rare instances the pus may enter the portal vein. 

According to Hutyra and Marek, the contents of hepatic abscesses 
may be creamy, or dry and crumbling. The colour varies from yellow 
or reddish to green, and occasionally the pus is foetid. In recent cases, 
in addition to the abscesses, parenchymatous or fatty degeneration of the 
liver tissue is observed, while in cases of longer standing chronic inter- 
stitial hepatitis 1s present. 

Symproms.—These are generally obscure. The lesions, when slight 
in extent, may produce no apparent symptoms. According to Hutyra 
and Marek, it is only in rare cases that a moderately rapid process of 
abscess formation causes visible symptoms, while in instances where 
suppurative hepatitis occurs as a complication of another disease the 
symptoms of the former are completely masked. Friedberger and 
Fréhner state that the affection is often only discovered post mortem. 
Amongst the symptoms recorded are digestive disturbances, either 
persistent fever of obscure origin or intermittent elevations of tempera- 
ture, slight colicky pains, and either constipation or diarrhea. Icterus 
may or may not be present. Palpation of the right hypochondriac 


VOL. Il. 1-530 


546 SYSTEM OF VETERINARY MEDICINE 


region may elicit pain, and the enlarged liver may be detected. Pain 
during defecation, coughing, and straining have been observed. The 
urine may contain bile-pigments. Percivall recorded a case in which 
extreme lameness was observed in the off fore-leg, for which no cause 
could be assigned, and on post-mortem a thorn of considerable length 
was found sticking in the substance of the liver. Williams met with 
similar instances, a thorn being discovered in one case, a needle in another, 
while in a third a calcified exudate surrounded by purulent material 
was found. All the above cases showed lameness in the off fore-limb. 
F. Smith* records three cases of uncomplicated abscess of the liver which 
occurred in India. The symptoms observed in Case 1 were intense dul- 
ness, loss of appetite, jaundice, and fever. In about three weeks slight 
improvement set in, but the visible mucose were paler and more anemic, 
considerable body wasting had occurred, the urine was of a brownish 
colour and very offensive but free from bile or albumin; the feces were 
normal. In a short time the feces became very offensive, dark in colour, 
and contained much mucus. The animal stood persistently for about a 
month, and then fell down, but got up again in two hours. The wasting 
of the muscles became extreme, and the animal walked round the box; 
the pulse was imperceptible, and death occurred. The period of illness 
was from September 7 to October 19. The autopsy showed the liver 
enlarged and weighing 20 pounds, and its anterior surface was adherent 
to the diaphragm. A large abscess was found in the right lobe; this 
had ruptured into the peritoneal cavity. In addition to the above, 
seven abscesses were found in various stages in the right lobe, and 
throughout the liver there were at least twenty yellow cheesy deposits. 
In Case 2, which lasted from June 28 to July 21, the symptoms 
observed were dulness, a mournful expression of countenance, and great 
loss of flesh. For a time he improved, but then lay down and died quickly. 
The autopsy showed an enlarged and calcareous liver, with enlarged and 
thickened bile-ducts.. Several abscesses were found in the right lobe; 
one was larger than the others, and contained about 5 ounces of pus. 
Microscopically the liver cells were found to be fatty. In Case 3 
the horse was treated for hepatitis on June 17, and on June 28 was 
reported as doing well. On July 1 a relapse occurred; the temperature 
was 107° F., and the pulse 80. On July 6 the temperature and pulse 
fell, but purplish spots were observed on the conjunctiva and nasal 
mucosa, The horse was dull and stupid, and on July 10 great muscular 
wasting was observed, the visible mucose were of a yellow tint and 
covered with maroon spots, marked weakness appeared, and death 


* Journal of Comparative Pathology and Therapeutics, vol, iv., p. 355. 


DISEASES OF THE LIVER: HORSE DAT 


occurred on July 24. The autopsy showed several abscesses in the liver, 
principally in the left lobe, one being large and filled with grumous, dark, 
inspissated pus. This abscess was adherent to the double colon. 

Coursr.—The disease always terminates fatally, either from cachexia, 
rupture of the liver, or rupture of the abscess into the peritoneal cavity. 

DIFFERENTIAL D1aGnosis.—Unless jaundice be present and bile-pig- 
ments be detected in the urine, a diagnosis is not possible. When, how- 
ever, these phenomena are observed in addition to the other symptoms 
mentioned, the nature of the case may be suspected. According to 
F. Smith, persistent dulness, loss of flesh, foetid faeces, and yellowish 
conjunctiva, are suspicious symptoms. 

TREATMENT.—Medicinal treatment is useless. Surgical measures are 
suggested when the condition is diagnosed. Griffault advises that in 
order to locate the position of the abscess a trocar and cannula be in- 
serted in the sixteenth or seventeenth intercostal space close under the 
costal arch. If the abscess is superficial, infection of the peritoneum is 
likely to occur from this procedure, but this risk must be taken. Having 
located the abscess, an incision is made through the abdominal wall 
immediately below the costal arch on the right side, and the peritoneum 
is exposed. The peritoneum is then carefully pressed against Glisson’s 
capsule, so that its inner surface is in contact with the wall of the abscess. 
The abscess is then opened, drained, and irrigated, and antiseptic dress- 
ings applied. Griffault claims that two cases were cured by this method. 
Needless to remark, the operation is hardly likely to be undertaken by 
the general practitioner. Moreover, it is seldom that a diagnosis of the 
condition can be made. 


GALL-STONES. 


Synonyms.—Biliary lithiasis; Cholelithiasis; Biliary calculi. 

As the horse is not provided with a gall-bladder, the location of gall- 
stones is either in the bile-duct, or in some of its larger branches, or more 
rarely in the interhepatic biliary canals. The majority of authors state 
that the condition is rare in the horse, but, according to Hutyra and Marek, 
it occurs more frequently in the horse and ox than in other animals. 
Friedberger and Fréhner state that the rarity of gall-stones in the horse 
is partly due to the regularity with which the animal is fed and exercised, 
and partly to the absence of a gall-bladder in the equine species. The 
presence of the gall-bladder is regarded by these authors as predisposing 
to the formation of biliary calculi, as in this reservoir stagnation and 
decomposition of the biliary secretion may readily take place. They 
also hold that the condition is of more interest to the pathologist than 


548 SYSTEM OF VETERINARY MEDICINE 


to the clinician in consequence of the absence of diagnostic symptoms, 
and with this view we are in agreement, as in the majority of recorded 
cases the lesions have been discovered post mortem. 

ET1oLtogy.—Many theories have been advanced to account for the 
formation of biliary calculi. The theory which is now generally accepted 
is that brought forward by Nauyn. This observer held that the origin 
of the cholesterin of the bile as well as of the lime-salts is from the 
mucosa of the biliary passages, and he also pointed out the association 
of micro-organisms with biliary calculi. Cholesterin and lime are now 
regarded as being in great part a production of the mucosa of the bile- 
ducts (and of the gall-bladder in animals provided with such). This 
production is increased when catarrhal inflammation of these structures, 
excited by the presence of micro-organisms, occurs. The result is that 
the chemical constitution of the bile becomes materially modified, and 
there is a tendency for the deposition of insoluble salts of lime, choles- 
terine, and bile-pigments around epithelial débris and bacteria. Micro- 
organisms have been demonstrated in the centre of gall-stones, and 
biliary calculi have been produced experimentally by injecting micro- 
organisms into the gall-bladder of animals. 

Catarrh of the bile-duct must thus be regarded as an important 
etiological factor, plus bacterial infection derived from the duodenum. 
Partial or complete stasis of the bile is a predisposing cause, also old age, 
excessive feeding, and lack of proper exercise. According to Hutyra and 
Marek, in cases of catarrh of the bile-duct and its major branches, a large 
amount of mucus is secreted, which acts upon the bile, and especially on 
the salts of the bile acids, decomposing them. A large quantity of 
cholesterin derived from the desquamation of epithelial cells is added 
to the bile. As the cholesterin and bile-pigments are held in solution 
by the bile acids, the effect of decomposition of the latter is to cause 
precipitation of the former. Carbonate of lime is also precipitated, or is 
derived from the disintegration of desquamated epithelial cells. The 
nucleus of a true gall-stone, according to the above authors, is in the 
majority of cases a mass of desquamated epithelium, mucus, and bac- 
teria, around which the precipitated bile salts and cholesterin are de- 
posited in layers. Dead parasites, or occasionally a foreign body which 
has entered the bile-duct from the duodenum, may also act as a nucleus. 

Morsip Anatomy.—Some authors describe precipitations and in-, 
crustations in the bile-ducts as a condition distinct from true gall-stones. 
True gall-stones in the horse occur in the bile-duct, or in its principal 
divisions. They vary considerably in size and in number. In some 
instances they are very small in size, but are present in large numbers, 


DISEASES OF THE LIVER: HORSE 549 


and recorded cases show that from 90 to 500 or 600 were present. 
Avérous met with a case in which the small calculi numbered more than 
1,000, and, in addition to these, a large calculus weighing 258 grammes 
was found in the terminal portion of the bile-duct. Other cases are 
recorded in which the calculus was single, and attained the size of an 
apple. Faulkner met with a case in which a large number of gall-stones 
varying in size from a pea to a hazel-nut were present, Thompson (As- 
patria) recorded an instance where a single large calculus was found, and 
Sumner a case in which innumerable small gall-stones existed in the 
bile-duct. _ In all these cases the calculi were discovered post mortem. 

Gall-stones vary in shape. They may be round, oval, polyhedral, or 
pytitorm. In some instances they may occur in the form of cylindrical 
tubes in the bile-duct, and enclose grumous bile. Their surfaces may be 
smooth, or rough and mulberry-like, or polyhedral, and showing smooth 
facets, owing to attrition. In colour they may be yellowish-brown, 
greenish, grey, or reddish-brown, and when in the form of cylinders they 
may be white and chalk-like. Their consistence is generally not hard, 
and the specific gravity is low. When dried, they will float on water. 
On section, they show lamine of various colours, and the centre is more 
or less soft. The inner layers are composed chiefly of cholesterin, and 
the outer of bile-pigments and calcium salts. The chemical composition 
varies to a great extent, especially as regards the amount of cholesterin. 
Furstenberg, on analysis, found lime, mucus, fat, and bile-pigments. 
Bourgoin met with a calculus weighing 330 grammes, which was com- 
posed entirely of cholesterin. In some instances recorded by Lewin, 
gall-stones were found in the intestine, having made their exit from the 
bile-duct into the duodenum. 

Bilary calculi may produce certain lesions as follows: Dilatation and 
sclerosis of the obstructed biliary passages, with catarrhal inflammation 
and even ulceration of the mucosa; hypertrophic cirrhosis of the liver; 
dilatation of the affected ducts associated with atrophy of the surround- 
ing liver tissue. In some cases suppurative hepatitis results. 

Symproms.—According to Williams, the symptoms are similar to 
those that may occur in other diseased conditions of the liver. As 
already mentioned in the cases met with by Faulkner, Thompson, and 
Sumner, the condition was only discovered post mortem. Colicky pains 
associated with vague symptoms of digestive disorder are sometimes 
observed. According to Hutyra and Marek, when a large gall-stone 
lodges in the bile-duct, cramp-like contractions of the wall of the latter 
are produced, giving rise to colicky pains, which may persist, with 
remissions for some days, and then disappear. Atter a few days, or even 


550 SYSTEM OF VETERINARY MEDICINE 


earlier, jaundice occurs, and this disappears when the pain ceases. If, 
however, complete obstruction of the duct occurs, the jaundice persists, 
increases in intensity, and death results. 

Dracnosis.—The diagnosis is said to be based on the history of the 
case, the repeated attacks of colicky pains, associated with the presence 
of jaundice, marked depression, and weak pulse. It is quite evident, 
however, that unless jaundice be present, the nature of the case will 
not be suspected. In the human subject cutaneous biliary fistule are 
sometimes observed, by which large numbers of gall-stones are discharged 
externally. We have not met with any recorded cases of this condition 
in the horse or in other animals. 

TrEATMENT.—Chloral hydrate is indicated in cases showing colicky 
pains. Olive oil in large doses is said to assist in moving the calculus by 
increasing the flow of bile, but we doubt very much whether it has this 
effect. Some authors advise sulphate of soda and bicarbonate of soda. 
Salicylate of soda is recommended as a cholagogue, but we fail to see its 
value in cases where complete obstruction of the duct is present, as the 
bile cannot reach the intestine. 


FOREIGN BODIES IN THE LIVER AND BILE-DUCT. 


These are more frequently found in cattle than in horses (see p. 564). 
St. Cyr recorded a case in which a portion of straw was found in the 
liver of a horse, the portal vein was perforated by the foreign body, 
and thrombosis resulted. Mégnin met with an instance in which some 
awns of barley were discovered in the gastro-hepatic ligament, and 
caused a fatal hemorrhage. Under Suppurative Hepatitis (see p. 546) 
we have already referred to cases in which thorns and other sharp- 
pointed foreign bodies were found in the liver. Sand has been found in 
the bile-duct, due to the ingestion of food containing this material. 
Cases are recorded in which the bile-duct was much dilated and con- 
tained a large amount of sand. 

In these conditions a definite diagnosis cannot be made, and even if 
it were possible to discover the condition, treatment of any kind could 
not be attempted. 


CHRONIC INTERSTITIAL HEPATITIS. 


Synonyms.—Currhosis of the liver; Hepatic cirrhosis. 

This is an interstitial inflammation characterised by proliferation of 
the connective tissue of the liver, and associated with lesions in the 
parenchyma of the organ. Various forms of the affection are described, 


DISEASES OF THE LIVER: HORSE 551 


but all have one feature in common—viz., an increase in the connective 
tissue of the liver. In veterinary practice, more especially as regards 
the larger animals, cirrhosis of the liver is of more interest to the path- 
ologist than to the clinician, as in the majority of instances, owing to 
the lack of diagnostic symptoms, the affection is seldom recognised. 
Moreover, even when there are symptoms present which lead us to 
suspect its existence, the disease is so far advanced that treatment 1s of 
no avail. Hence, as compared with the human subject, the affection 
cannot be regarded as one of importance, and a brief description oi it 
must suffice. For full details of the various forms which have been met 
with and recorded from time to time, the reader is referred to works on 
veterinary pathology. 

As regards the incidence of the disease, it cannot be described as of 
common occurrence in the British Isles, so far as the larger animals are 
concerned. We must admit, however, that as post-mortem examina- 
tions are seldom carried out in a systematic manner, it is probable that 
many cases are overlooked. Robertson* regarded the condition as 
occurring more frequently than any of the forms of acute hepatitis, and 
stated that ‘“‘ many cases of anemia with ascites in young horses which 
have proved fatal have, on examination after death, shown well-marked 
cirrhosis of the liver.’ Percivall remarked: “ Although the dissection of 
dead horses furnishes us with ample evidence of the occasional existence 
of inflammation of the liver in a chronic form, still it is a disorder whose 
presence during life is apt to be veiled in much obscurity, if not, indeed, 
passed over altogether unobserved.” In certain parts of the Continent 
the disease occurs in an enzodtic form (see Schweinsberg Disease, p. 555). 
A similar affection is met with in South Africa, New Zealand, Nova 
Scotia, and South Dakota. 

From a clinical point of view, the following forms of hepatic cirrhosis 
merit description, although, as we shall point out later on, their differ - 
ential diagnosis is attended with marked difficulty: 

1. Hypertrophic Cirrhosis, also termed ‘“‘ Hyperplastic Indurative 
Hepatitis.” In this the new tissue does not contract until a long period 
has elapsed, or contraction may fail to occur, and the liver is then found 
enlarged. According to Cadéac, this form is more commonly met with 
in young horses. , ; 

2. Atrophic Cirrhosis. This type is characterised by early shrinkage 
of the newly formed connective tissue, the liver is much reduced in size > 
and the hepatic parenchyma becomes atrophied and destroyed owing to 
pressure exerted thereon by the contraction of the new tissue. 


* “ Practice of Equine Medicine.” 


552 SYSTEM OF VETERINARY MEDICINE 


3. Capsular Cirrhosis, also termed “‘ Perihepatitis,” in which Glisson’s 
capsule is much thickened, and the liver is contracted; but the connec- 
tive tissue of the organ may not of necessity be specially increased. 

Etiotogy.—The etiological factors have not been definitely deter- 
mined. Various theories have been advanced, such as damaged fodder, 
toxic materials present in the bowel and conveyed to the liver by the 
portal blood. These are said to induce proliferation of connective tissue 
in the organ. Biliary engorgement is believed to cause cirrhosis, either 
by impairing the nutrition of the epithelium of the bile-ducts, and so 
permitting bacterial invasion from the intestine, the result being the 
production of fibrous tissue in the surrounding hepatic parenchyma, or 
the new tissue may be produced by the biliary engorgement acting on 
the liver cells themselves (Hutyra and Marek). Chronic inflammation 
of the bile-duct and its tributaries may extend to the interstitial tissue, 
and lead to the growth of new tissue. Chronic venous congestion asso- 
ciated with certain affections of the heart and lungs is also recognised as 
a cause of cirrhosis. Parasites (larvee of sclerostomes) are believed to 
induce the condition in some cases. The presence of purulent foci and 
of tuberculosis are also regarded as etiological factors. In the enzodtic 
form of cirrhosis (see p. 555), the ingestion of certain plants for long 
periods is believed by some authorities to be the cause of the affection. 
Wilhams observed cases of hepatic cirrhosis both in foals and adults to 
follow insufficient nutrition, the animals being fed on damaged and 
mouldy corn. McFadyean observed cirrhosis of the liver in one case of 
equine tuberculosis. 

Morsip ANAToMy.—The morbid process may commence in the inter- 
lobular branches of the portal vein. This is attributed to the presence 
of some irritant circulating in the portal blood. A cellular infiltration 
occurs, followed by an increase in the connective tissue. surrounding 
several lobules. This new tissue contracts or shrinks, and as the result 
of this process the included lobules and the branches of the portal vein 
in the affected area are subjected to pressure. Degenerative changes 
next occur in the hepatic parenchyma, and in far advanced cases the new 
tissue may extend to the centre of the lobules. The liver is reduced in 
size, 18 tough in consistence, and on section grates under the knife. The 
surface of the organ is irregular and granular, and in some instances 
may be nodular. On section, the compressed lobules appear as islands | 
of a greenish-yellow colour, and are surrounded by a greyish-white con- 
nective tissue. 

In the hypertrophic form of cirrhosis the disease is believed by some 
authors to originate in the biliary vessels or in their vicinity, and the 


DISEASES OF THE LIVER: HORSE 553 


condition has been termed “* biliary cirrhosis,” or “‘ cholangioitic cirrhosis.” 
Inflammatory changes occur in the bile-vessels (catarrhal and productive), 
and new biliary canaliculi are developed. There is also cellular infiltra- 
tion of the connective tissue. The liver is enlarged, its surface is smooth, 
but in some instances small granulations are present, and the colour of 
the organ is of a deep yellow or greenish-yellow. The section is smooth 
and uniform, and occasionally granular. Nothing abnormal is detected 
in the bile-duct or its main branches. 

In capsular cirrhosis two varieties are met with—viz., (1) The so- 
called “‘ dry” perihepatitis not uncommon in old horses, and charac- 
terised by fibroid thickening of Glisson’s capsule in the form of irregular 
patches; (2) exudative perihepatitis, in which a fibrinous exudate occurs 
on the surface of the liver, false membranes are formed, which become 
organised, and adhesion of the organ to the costal wall, the diaphragm, 
or the intestine is brought about. The capsule may be extensively 
thickened, but the degree of cirrhosis present is seldom well marked, or 
this latter lesion may be absent. | 

Symproms.—There are no characteristic symptoms present, and as 
jaundice is very often absent in this condition, the phenomena observed 
will probably be erroneously ascribed to disease of other organs rather 
than to an hepatic affection. The symptoms point to disturbance of the 
digestive organs, and in some cases to cerebral disorder. The following 
have been recorded: capricious appetite, either constipation or diarrhea, 
loss of condition, colicky pains after the ingestion of coarse food, inapti- 
tude for work, a sleepy appearance, followed in some instances by a 
staggering gait and a tendency to push the head against surrounding 
objects. An icteric tint of the visible mucous membranes may or may 
not be present. According to Hutyra and Marek, when enlargement ot 
the liver is present, it is only exceptionally that the organ encroaches on 
the hypochondriac region, and when an increase in the area of liver 
dulness can be detected, it is bilateralin the horse. Only in rare instances 
can the enlarged organ be detected by rectal examination, and in these 
it is found as a firm body in the vicinity of the last rib, and lying against 
the abdominal wall on the right side. It moves in concert with the 
respirations, and is tender to the touch. According to the same authors, 
when the liver is considerably enlarged, the area of dulness is found on 
the right side immediately behind the edge of the lung, from the tenth to 
the seventeenth intercostal spaces, and it may extend downwards to 
below the costal arch. On the left side the area is smaller, and extends 
from the eighth to the tenth intercostal space. When the liver is con- 
siderably atrophied, it may be possible to detect a decrease in the area 


554 SYSTEM OF VETERINARY MEDICINE 


of hepatic dulness. Enlargement of the spleen may occur as a complica- 
tion. 

The urine is generally high-coloured, or may be dark in tint. Its 
specific gravity is increased, it contains less uric acid than in health, and 
in some instances bile-pigments are present. In the later stages evidences 
of ascites may be observed, and well-marked nervous phenomena. In 
the cases recorded by Williams, the following symptoms are mentioned: 
Dulness, gradual emaciation, disturbance of pulse and respirations, foetid 
breath, icterus, light-coloured, very offensive, glazed feeces, marked. 
thirst, high-coloured urine passed in large amounts, in some instances 
being of a reddish-brown colour, pain on pressure being applied to the 
false ribs on the right side. In the case of a foal, nervous phenomena 
were present, such as hanging down the head, or resting it on the lower 
jaw in the manger, death finally occurring in a comatose condition. 

CoursE.—This is slow, and the patients may live for several months. 
In the later stages dropsical swellings appear on the dependent parts of 
the body, and evidences of ascites may be present. Complications of 
various kinds may occur, and bring about death rather suddenly. 

DIFFERENTIAL D1aGNnosis.—Owing to the insidious development of 
the disease, a definite diagnosis is not possible—at any rate, in the earlier 
stages. The history of the case, the presence of jaundice and of ascites, 
and of bile-pigments in the urine, are suggestive; but, as already remarked, 
jaundice is often absent, and the real nature of the case is not suspected. 
According to Friedberger and Froéhner, cases presenting nervous symp- 
toms have often been mistaken for affections of the brain and spinal cord. 
The differentiation of the atrophic from the hypertrophic form of cirrhosis 
is rarely possible, but from a clinical point of view this is of little im- 
portance. 

Prognosis.—In the early stages temporary improvement may occur, 
but sooner or later the disease proves fatal. 

TREATMENT.—When the disease is established, palliative measures 
only can be adopted; but it is very doubtful whether in a chronic affec- 
tion of the kind it is desirable to carry out a long course of treatment, 
with little chance of rendering the animal useful. However, there are 
instances in which treatment is demanded by the owner, and in these 
the therapeutist must direct his attention to the prominent symptoms 
presented. Generally speaking, saline aperients, such as sulphate of | 
soda, are indicated. ‘These may be combined with bicarbonate of soda. 
Some authors advise potassium iodide. Attention to diet is necessary. 
Highly nitrogenous foods should be avoided, but green foods prove 
useful. 


DISEASES OF THE LIVER: HORSE 559 


Schweinsberg Disease.—A form of chronic hepatitis in the horse, 
occurring either sporadically or more frequently as an enzoétic affection, 
is met with in certain countries. It was first observed in Schweinsberg, 
and later in many other parts of Germany. It has also been met with 
in South Africa, New Zealand, South Dakota, and Virginia (U.S.A.). 
A similar affection in cattle was investigated in Pictou, Nova Scotia. 
According to Hutyra and Marek, the disease varies in severity from 
year to year, and attacks freshly imported horses more frequently than 
native animals. 

As regards the etiology of the affection nothing definite is known. 
Long-continued feeding with plants of the senecio group (Senecio Jacobea, 
5. latefolva, S. Burchelli) is found to induce the disease, and this has been 
demonstrated experimentally. According to Schlegel and Adelmann, 
the affection is probably due to a generalised sclerostomiasis, the chronic 
inflammatory changes in the liver being produced by the migrations of 
the larvee of sclerostomes. 

The lesions, according to Mugler, consist of an inflammation involving 
the liver parenchyma, and especially the bloodvessels, a perilobular 
hypertrophic cirrhosis being produced. Kitt described the liver as at 
first enlarged, with an uneven surface, and a “ granite-like ”’ appearance. 
Owing to the development and shrinkage of connective tissue, the con- 
dition known as “ granular atrophy” is produced. Lesions of chronic 
gastro-intestinal catarrh are also present. 

Symproms.—According to Friedberger and Froéhner, the first notice- 
able signs are a diminished or a depraved appetite, a tendency to lick 
and gnaw any woodwork within reach, the visible mucose are of a dirty 
red colour, the animal is dull and depressed, yawns frequently, and shows 
intermittent attacks of colicky pains. These depend on the gastro- 
intestinal catarrh that is present. After some weeks or months, jaundice 
may set in (but in some cases it is absent). Nervous phenomena now 
appear, such as a staggering gait and a sleepy appearance. Hmaciation 
is marked, periodical attacks of colic occur, and cedematous swellings 
appear on the extremities. The urine is alkaline and albuminous. The 
duration of the disease is slow, being usually from three to six months. 
In the later stages complications may occur, such as hemorrhages in the 
mucous membranes, and occasionally dilatation of the stomach followed 
by rupture of the organ, or rupture of the liver. 

Temporary signs of improvement are sometimes observed, especially 
after a change of pasture, but the symptoms return with increased severity. 

TREATMENT.—Up to the present time no successful line of treatment 
has been discovered for this malady. Intratracheal injections of Lugol’s 


556 SYSTEM OF VETERINARY MEDICINE 


solution of iodine were advised by Imminger, but other practitioners did 
not obtain good results from this treatment. | 

Lupinosis.—This is an intoxication due to the ingestion of certain 
species of lupine (Lupinus flavus, L. ceruleus, and L. albus). The plant 
is used as fodder in certain districts in Northern Germany, and in these 
districts lupinosis is met with. The affection is rarely encountered in 
horses, as, in consequence of the bitter taste of the plant, it 1s generally 
avoided by equines. The toxic material first exerts its action on the 
mucosa of the alimentary canal, and then causes fatty degeneration of the 
hepatic cells, followed by sclerotic changes in the liver. As the condi- 
tion is far more commonly met with in sheep than in the horse, and as 
the pathology is similar in both, the reader is referred to Ovine Lupinosis 
(p. 573). 

With reference to symptoms, according to Hutyra and Marek the 
phenomena presented resemble those occurring in sheep, the more 
prominent being refusal of food, intense depression, and jaundice. A 
yellow mucous discharge from the nostrils, an erysipelatous inflamma- 
tion of the skin of the nostrils and lips, which may become gangrenous, 
and inflammatory cedema of the limbs, have also been recorded. Ac- 
cording to Cadéac, the disease rarely proves fatal in the horse, although 
the symptoms may show great intensity. Nervous phenomena pre- 
dominate, the animal is sleepy, pushes his head against the wall, or rests 
it on the manger. He grinds his teeth, and may show slight colicky 
pains. The faeces are very foetid, and are covered with mucus. The 
urine 1s passed frequently in small amounts, and isalbuminous. Jaundice 
is less marked than in the case of lupinosis in sheep. 

Treatment is similar to that advised for the disease in sheep (see 
p. 574). 


FATTY LIVER. 


Most authors include under the above heading the conditions known 
as “fatty infiltration”? and “fatty degeneration,” the former term 
signifying that the fat reached the liver from without. and the latter 
being applied when the protoplasm of the liver cells is so altered that fat 
is produced. According to Hutyra and Marek, it is preferable to regard 
the condition of fatty liver as depending on either destruction of the 
liver cells or on a fatty state of the organ unassociated with any cell | 
destruction. 

ET1oLocy.—Overfeeding and insufficient exercise. especially in aged 
horses, may produce the condition. It may also occur in cases of ex- 
hausting diseases, infectious maladies, septic or pyemic affections, and 


DISEASES OF THE LIVER: HORSE 557 


in any conditions in which the oxidation processes are interfered with. 
_ Bacterial toxins are believed to induce fatty liver in acute infectious 
diseases. The lesion also occurs in acute yellow atrophy of the liver 
(see p. 537), in lupinosis, and as the result of the toxic action of arsenic, 
antimony, lead, and phosphorus. 

Morsip Anatomy.—The liver is greatly enlarged, and its edges are 
rounded. Its surface is smooth, and its colour varies from a pale yellow 
to yellow ochre. It is soft in consistency, and on section is anzemic, and 
the blade of the knife is rendered greasy. According to Hutyra and 
Marek, when the protoplasm of the liver cells is involved, the organ may 
be smaller than normal, owing to the absorption of the altered hepatic 
cells. 

SyMpToms.—There are no diagnostic symptoms, and the lesion is 
usually found as a surprise at the post-mortem. Digestive disturbances 
may be present, but jaundice does not occur. Rupture of the liver 
may occasionally result, followed by sudden death from internal 
hemorrhage. 

No suggestions for treatment can be made, as the affection is not 
amenable to therapeutic agents, nor can its presence even in the early 
stages be recognised. 


AMYLOID LIVER. 


Synonym.—Waxy, or lardaceous liver. 

This lesion, like fatty liver, is of more interest to the pathologist 
than to the clinician, as it is not associated with any diagnostic symp- 
toms. .A marked difference of opinion exists with reference to the 
frequency of the condition in the horse. Thus, Bohl found the lesion 
in 4 per cent. of all the horses he examined post mortem, and Rabe met 
with it in about 50 per cent. of horses that had suffered from chronic 
diseases of the serous membranes. Griiner observed the affection in 
forty-six horses that had died from contagious pneumonia. Noyer 
found the condition associated with rupture of the liver in about 20 per 
cent. of horses used for the production of antidiphtheritic serum. On 
the other hand, Joést, Pflug, Forster, and others, state that the affection 
is very rare (Hutyra and Marek). Amyloid degeneration may also occur 
in cases associated with chronic suppuration, especially when it involves 
bone; also in connection with chronic abscesses, and glanders. McFadyean 
observed amyloid liver in two cases of equine tuberculosis. The same 
author recorded a case of amyloid degeneration of the liver accompanied 
by rupture and fatal hemorrhage.* 


* See Journal of Comparative Pathology and Therapeutics, vol, iv., p. 241. 


558 SYSTEM OF VETERINARY MEDICINE 


The manner in which amyloid degeneration is produced has not been 
definitely determined. 

Morsip Anatomy.—In well-marked cases the liver is much enlarged. 
On section, it is found anzmic, and has a semitranslucent, infiltrated 
appearance. The colour varies from light brown to yellow or grey. 
According to Hutyra and Marek, the consistency of the organ is reduced, 
and may be more or less dough-like, and in the later stages it crumbles 
like half-dried mortar. In a case recorded by McFadyean (vide supra) 
the liver weighed 63 pounds. The liver tissue was pale yellow or ochrey, 
doughy in consistence, and easily lacerated with the fingers. The 
amyloid substance was almost uniformly distributed throughout each 
lobule. Atrophy was so marked that at most places the breadth of the 
columns of liver cells was not more than one quarter of the normal. The 
liver cells were free from amyloid substance and from fat. If Lugol’s 
solution of iodine be applied to the cut surface, the areas infiltrated with 
the amyloid material assume a rich mahogany brown colour. 

Symptroms.—As already remarked, there are no diagnostic symptoms. 
Digestive disturbances, emaciation, and albuminuria, have been recorded. 
Jaundice and ascites are rare symptoms. Palpation may reveal an in- 
creased area of dulness, but this is said to occur in many hepatic affec- 
tions, and, moreover, is by no means easily detected in the horse. Rup- 
ture of the liver is not an uncommon sequel. 

Treatment of any kind is useless, even if the condition could be 
diagnosed. 


CALCAREOUS DEGENERATION OF THE LIVER. 


According to F. Smith, this is one of the most common affections of the 
liver met within India. The morbid change may affect certain tissues and 
organs of the body in different degrees, and the author mentioned gives 
a very full description of the disease.* The following is the order in 
which the tissues and organs are liable to become affected: Liver, lungs, 
intestines, and joints. The lesions of the liver are fully described in 
the article mentioned. The most striking include white bodies the size 
of grains of sago, and composed of lime, studded over the surface and 
throughout the substance of the organ; or these bodies may be of the size 
of a pea, and occurring throughout the entire hepatic substance and also 
on the surface. In advanced cases the calcareous nodules may be so ' 
extensively distributed that the entire liver structure is altered. The 
nodule is yellowish-white in colour, generally of stony hardness, encap- 


* See Journal of Comparative Pathology and Therapeutics, vol. iv., p. 125. 


DISEASES OF THE LIVER: HORSE 559 


suled. and readily removed from the capsule by the point of a knife. In 
acute cases the liver is rigid and cuts with extreme difficulty; in slighter 
cases every deposit cut through imparts a gritty feeling to the knife. 
The bulk of the organ may or may not be increased, but the weight is 
greater than normal. The deposit of lime generally occurs in the inter- 
lobular tissue. Compression and destruction of the lobules result, owing 
to the irritation causing an increase in the interlobular connective tissue 
(cirrhosis). 

There are no special symptoms, and the existence of the lesions is 
only discovered post mortem. When the joints are involved, obscure 
lameness 1s observed, but otherwise the health of the animal is not 
affected. 

F. Smith has also met with slight calcareous degeneration of the liver 
and lungs of horses in Great Britain. For further particulars of this 
disease, the reader is referred to the article mentioned above. 


NEOPLASMS OF THE LIVER. 


These include carcinomata, sarcomata, and angiomata. 

Carcinomata.—Cancer of the liver is seldom met with in the horse. 
According to Cadéac, primary carcinoma is rare. The secondary form 
is generally found, and follows primary growths in the stomach and 
intestines, the ampulla of Vater, the peritoneum, the testicle, the lung, 
the pancreas, etc. According to Hutyra and Marek, primary cancer of 
the liver is usually adeno-carcinomatous in type. When the lesions are 
numerous and of large size, the weight of the organ is increased accord- 
ingly. The surface is uneven, and the parenchyma is interspersed with 
new growths, varying in size from a millet-seed to a man’s fist, or even 
larger. These are either isolated or confluent, and are white or pale red 
in colour. On section, they are of a yellow colour, and may be either 
soft in consistency or fibrous, and in some instances their centres may 
be calcareous. In the majority of cases the portal lymphatic glands are 
involved. 

The symptoms are obscure. Gradual emaciation, anemia, loss of 
appetite, and in some cases \icterus, are recorded. Benjamin observed 
gastro-enteritis evidenced by intermittent colicky pains; also diarrhoea 
and ascites. Friedberger and Fréhner met with instances in which 
rupture of the cancerous growths occurred, followed by internal heemor- 
rhage. 7 

Nothing can be done in the way of treatment. The affection always 
terminates fatally, although its course is generally slow. 


560 SYSTEM OF VETERINARY MEDICINE 


Sarcomata.—Primary sarcoma of the liver is extremely rare. The 
secondary form is that usually met with, metastasis having taken place 
from growths in the peritoneum, intestine, or mesentery. Cases of 
melanomata and melanotic sarcomata are also recorded. There are no 
diagnostic symptoms. 

Angiomata.—These are of rare occurrence in the horse. Cases are 
recorded by Trasbot and Blanc. The tumour may be very extensive 
and heavy. It is usually single, but in exceptional cases may be mul- 
tiple and affecting the various lobes of the organ. Rupture of the lesion 
may occur, followed by death from internal hemorrhage. According 
to Cadéac, angioma of the liver may be found on histological examina- 
tion to be formed of a system of capillary vessels, with large cavernous 
dilatations. 7 

Tuberculosis of the liver is occasionally met with in the horse, but is 
usually secondary to tuberculous lesions in the peritoneum, intestine, or 
mesenteric glands (see Tuberculosis in the Horse, Vol. I.). 

Glanders.—The nodules of glanders are occasionally found in the 
liver (see Glanders, Vol. I.). 


PARASITES OF THE LIVER. 


These will receive consideration in the section on Parasites. 


DISEASES OF THE LIVER IN CATTLE 
By E, WALLIS HOARE, F.R.C.V.S, 


General Remarks.—A perusal of current textbooks will show. that our 
knowledge on the subject of diseases of the liver is very limited, with the 
exception of parasitic affections of this organ, such as echinococcosis, 
cysticercosis, and distomiasis, which have been specially studied. The 
slight degree of importance attached to the subject of non-parasitic 
hepatic diseases may be judged from the fact that in Moussu and Dollar’s 
work (“ Diseases of Cattle, Sheep, and Pigs’’) only four pages are devoted 
to a consideration of these affections. In the work mentioned the authors 
state that the symptomatology of true diseases (non-parasitic) of the 
hepatic tissue is still very imperfectly understood, as in practice the 
urine is rarely tested for the presence of bile-pigments, or for glycosuria 
depending on disturbance of the glycogenic function of the liver. 

Some Continental authors describe various hepatic affections, but 
on considering the symptoms which are brought forward, one is com- 
pelled to admit that, when jaundice is present, a disease of the liver 
can be suspected, but the exact nature of the affection cannot be deter- 
mined. As, however, jaundice may be,.and often is, absent, we must 
confess that in ordinary practice hepatic diseases are seldom recognised 
during the life of the animal, but are generally observed as a surprise 
at post-mortems. Moreover, it must be remembered that for economical 
reasons it is not desirable for the practitioner to advise treatment in a 
type of diseases usually characterised by a chronic course, loss of con- 
dition, and an ultimately fatal termination, especially as bovines are 
only kept for the production ofmeat or of milk. It is thus quite apparent 
that, generally speaking, the majority of hepatic diseases are of more 
interest to the pathologist than to the clinician; hence in these pages it 
is neither necessary nor desirable to attempt an extended consideration 
of the subject. We think that the requirements of the practitioner 
will be sufficiently catered for by simply comparing the various diseases 
of the liver in cattle with the analogous affections in equines, which 


receive due consideration in the preceding section. 
VOL. I, 561 35 


562 SYSTEM OF VETERINARY MEDICINE 


Acute Yellow Atrophy of the Liver.—According to Cadéac, this con- 
dition is rarely met with in cattle. Various writers have recorded cases 
of the affection. Eletti observed it to follow foot and mouth disease; 
Haubner met with cases resulting from the ingestion of potato-stalks; 
Reinmann and Jansen observed instances due to feeding on pea or vetch 
straw; while Callot recorded an enzoétic of the disease amongst cattle 
in Uruguay, said to be caused by excessive feeding and very hot weather. 
Amongst other causes may be mentioned lupine poisoning, microbial 
infection from the intestine, and specific septiceemic affections. 

Morsip Anatomy.—lIn the cases recorded by Delage, Beauvais, and 
Cruzel, the liver was much enlarged and softened, the gall-bladder was 
greatly increased in size and filled with a dark brownish liquid, and the 
epithelium of the biliary canals was degenerated. The kidneys showed 
fatty degeneration. Other lesions observed were enlargement of the 
lymphatic glands, gastro-intestinal catarrh, and hemorrhages in various 
organs. 

Symproms.—These included salivation, grinding of the teeth, loss 
of appetite, emaciation, stupor, staggering gait, jaundice, constipation 
followed by a foetid diarrhcea, intermittent trembling of the muscles, 
sometimes followed by sweating; the animals assumed the recumbent 
position, and death generally occurred in from six to ten days. 

Treatment of any kind proved useless. 

Inflammation of the Biliary Ducts — Angiocholitis——According to 
some authors, this condition is of frequent occurrence in cattle. It may 
depend on parasitic affections, such as distomata, echinococci, cysticerci, 
also on biliary calculi, or incrustations in the ducts, microbial infection 
from the intestine, tumours of the liver, etc. 

The interlobular biliary canals as well as the bile-ducts are involved, 
and the obstruction to the flow of bile to the intestine may be more or 
less complete, according to the extent of the tumefaction and the seat 
of the obstruction. The lesions are catarrhal in character for an in- 
definite period, but tend to become proliferative or sclerotic; they 
resemble those described as occurring in the horse (see p. 538). As 
the liver in the ox is provided with a gall-bladder, this structure shows 
morbid alterations when the bile-duct is the principal seat of inflam- 
matory action. The gall-bladder then becomes gradually dilated, and 
may attain a very large size, and contain several pints of a liquid very’ 
rich in mucus. 

There are no distinctive symptoms. Jaundice is often present, and 
may be intermittent or continuous; but the condition cannot be differ- 
entiated from biliary calculi or from distomiasis. 


DISEASES OF THE LIVER: CATTLE 563 


The indications for treatment are similar to those mentioned for the 
analogous disease in the horse. 

Cholecystitis (Inflammation of the Gall-Bladder).—This affection is 
said by some authors to be rather common in bovines. The etio- 
logical: factors recognised are as follows: Catarrh of the biliary ducts, 
the micro-organisms from the intestine gaining access to the gall- 
bladder by way of the cystic duct. Any conditions which induce 
retention of the bile may bring about cholecystitis, such as_ biliary 
calculi, tubercular growths, and distomiasis. The affection has also 
been met with in some cases of pseudo-membranous enteritis and in 
cattle plague. An acute and a chrome form are recognised. In the 
acute the inflammation is of the catarrhal type. The exudate may 
be formed into a plug, and cause occlusion of the main bile-duct, icterus 
being then induced. In the chronic form the gall-bladder may be much 
dilated, or it may be atrophied and shrunken. Its external surface may 
be studded with prominences of various sizes, its extent much increased 
and its walls greatly thickened. The contents consist of thick bile of 
a dirty yellow or dull grey colour. The mucosa may be covered by a 
number of smooth growths resembling polypi. These are hollow, and 
float in the cavity of the gall-bladder; the capacity of the latter is then 
much reduced. According to Kitt, these polypoid growths originate 
from a dilatation of the mucous glands, and contain the products of the 
latter. 

SympromMs.—There are no characteristic symptoms. Cases are 
recorded in which the gall-bladder attained so extensive a size and 
contained such a large amount of contents that it caused a protrusion 
resembling a soft tumour in the hypochondriac region. 

TREATMENT.—Cholagogues such as salicylate of soda and calomel 
are advised, but it is obvious that as a diagnosis cannot be arrived at, 
it is difficult to suggest therapeutical measures. Moreover, treatment is 
useless when the disease 1s advanced, and it is more economical to have 
the animal destroyed. 

Gall-Stones (Biliary Lithiasis)—Beyond the fact that in bovines 
biliary calculi occur in the gall-bladder as well as in other portions of the 
biliary passages, there is little special to add to the description already 
given in connection with this condition in the horse. According to 
Friedberger and Frohner, the presence of the gall-bladder in bovines 
renders them more liable to biliary calculi than the horse, as stagnation 
and decomposition of the bile are more likely to occur in this reservoir. 
Cadéac states that the colour of biliary calculi in the ox varies according 
to their chemical composition. Thus they may be dark green, blackish, 


564 SYSTEM OF VETERINARY MEDICINE 


orange, or white. ‘They vary in size from that of a grain of hemp-seed 
to an orange. In some instances they attain a large size and weight. 
Messner met with an instance where a concretion in the gall-bladder 
weighed | pound 13 ounces. According to Hutyra and Marek, soft 
masses of precipitated bile salts, covering the inner surface of the bile- 
ducts to a variable thickness, and also mixed with the bile, are frequently 
met with in ruminants. These authors also state that true gall-stones 
are found more frequently in the gall-bladder, and as compared with 
those in the horse, they are lighter, and contain a greater proportion of 
organic matter. 

According to Cadéac, biliary lithiasis may occur in the form of 
biliary sand, biliary gravel, deposits of sediment, and true calculi. In 
the form of sand the condition consists of black or greenish grains 
adherent to the mucosa, and these may be the starting-point of a con- 
. cretion. The true biliary calculi, according to Malay, are composed 
of 25 to 45 per cent. of bilirubin, and only a small proportion of choles- 
terine. 

The following lesions may be produced by the presence of biliary 
calculi: Hyperplastic cirrhosis of the liver, well-marked dilatation of the 
common bile-duct, rupture of the dilated ducts, followed by acute diffuse 
peritonitis. Rupture of the gall-bladder due to an accumulation of bile, 
owing to obstruction by gall-stones, is recorded by Cagny. 

Symproms.—If the calculi are confined to the gall-bladder, there may 
be no apparent symptoms. In any case the symptoms are obscure, and, 
unless jaundice be present, they would be attributed to digestive dis- 
turbance. A capricious appetite, slight tympany, gradual wasting and 
anemia, offensive diarrhoea, alternating with constipation, colicky pains, 
etc., are recorded. Jaundice occurs when the common duct is com- 
pletely obstructed. According to Charlot, persistent icterus and scanty, 
high-coloured urine containing much sediment may be the only symp- 
toms observed in some cases. When rupture of the gall-bladder occurs, 
evidences of acute peritonitis appear, and death occurs in one or two 
days following the accident. 

As regards treatment, even if the presence of the affection is suspected, 
it is not desirable on economical grounds to attempt therapeutic measures. 

Foreign Bodies in the Liver and Bile-Ducts.—Cases are recorded in 
which sharp-pointed foreign bodies perforated the walls of the rumen ' 
or reticulum and entered the liver. The results produced were purulent 
hepatitis, hepatic abscess, and traumatic gastritis. Large quantities 
of sand have been found in the bile-ducts, which gained entrance from 
the duodenum, and depended on the ingestion of food containing this 


DISEASES OF THE LIVER: CATTLE 565 


material. Augenheister recorded a case in a cow in which the bile-ducts 
were greatly dilated and contained 10 pounds of sand. 

There are no characteristic symptoms for the above padtors. 
and treatment cannot be attempted. 

Congestion of the Liver—<According to Moussu, only passive con- 
gestion is recognised in cattle, and the etiology, morbid anatomy, and 
symptoms, are similar to the analogous condition in equines. 

Cadéac recognises two forms of hepatic congestion :—viz., (1) Semple 
or hemorrhagic congestion; (2) teleangiectasts maculosa, in which there 
is permanent dilatation of the capillary vessels. 

1. Simple Congestion —This resembles the analogous disease in the 
horse, and originates from similar causes. Traumatic pericarditis and 
tuberculosis are important etiological factors in the production of the 
passive type of hepatic congestion, especially of the lesion known as 
‘cardiac liver.” Tumours of the mediastinum, such as_ lympho- 
sarcomata and tuberculous growths, causing pressure on the posterior 
vena cava, may also induce the condition. 

Symptroms.—These are not characteristic. Cadéac remarks that the 
affection is generally unrecognised during life. Increase in size of the 
liver may sometimes be detected by palpation and percussion. Amongst 
other symptoms recorded are ascites, icterus, and scanty secretion of 
urine. 

2. Teleangiectasis Maculosa.—This is a condition in which there is a 
circumscribed hyperemia of the hepatic parenchyma associated with 
punctiform ecchymoses of various tints, and depending on a dilatation 
of the capillaries. It has been studied by various Continental observers, 
including Kitt, Stroh, and Chaussé, and is said not to be uncommon in aged 
cows in certain seasons. The etiological factors have not been definitely 
determined. According to Chaussé, it depends on a microbial infection 
which produces a weakening of the capillary walls, so that they dilate 
when subjected to the pressure of the blood. Punctiform hemorrhages 
of various sizes are observed beneath the capsule of the liver. The 
organ is more or less hypertrophied, it is increased in weight, and the 
hepatic tissue between the blood-spots is of a brownish-yellow tint. 
On histological examination, these extravasations consist of dilatations of 
the intralobular and interlobular capillaries in such a manner that small 
enclosed spaces containing blood, either normal or coagulated, are formed. 
These spaces consist of extremely dilated capillaries, bordered by more 
or less displaced or altered hepatic cells. Atrophy, to a variable extent, 
of the surrounding hepatic tissue occurs, resulting from obliteration 
or riipture of bloodvessels. Sclerotic changes may take place in the 


566 SYSTEM OF VETERINARY MEDICINE 


extravasations or hemorrhagic areas. The condition cannot be diagnosed , 
and is found as a surprise at autopsies. 

Heemorrhage of the Liver (Rupture of the Liver).—There is nothing 
special to record with reference to this condition in cattle, further than 
has been mentioned in connection with the analogous affection in the 
horse. According to Williams, the lesion is of rare occurrence in bovines. 
Hutyra and Marek state that foreign bodies passing through the walls 
of the rumen or reticulum may cause rupture of the liver. 

Acute Parenchymatous Hepatitis—We have not succeeded in ob- 
taining any record of this affection in cattle. 

Perihepatitis. — This may occur in cattle as the result of direct 
mechanical injury, in connection with the passage of foreign bodies from 
the rumen or reticulum and their entrance to the liver; also as the result 
of extension of inflammation in cases of peritonitis, and in cases of tuber- 
culosis and distomiasis. he symptoms are vague, and in the recorded 
cases the pulse and respirations were reduced in number; colicky pains 
were present, associated with diarrhoea and evidences of intestinal catarrh, 
and the respirations were accompanied by a moan or grunt. Lesions of 
perihepatitis are often found at autopsies, although their presence was 
not suspected during life. ) 

Suppurative Hepatitis (Abscess of the Liver).—This condition is not 
uncommon in cattle, but in consequence of the obscure character of 
the symptoms it is rarely recognised during life. 

Etiotogy.—In adult animals, one of the commonest causes is the 
penetration of the liver by sharp-pointed foreign bodies which have 
migrated from the rumen and reticulum. Pyogenic infection is thus 
introduced and an abscess results. External injury due to horning 
may have a similar effect, and even if there is no solution of continuity 
of the abdominal wall, it is believed that the liver tissue may be so injured 
that micro-organisms circulating in the blood may localise in the altered 
or damaged portion of the organ and set up suppuration. 

Amongst other etiological factors recognised we may mention: the 
presence of gall-stones, tuberculosis, ecchinococcus cysts, actinomycosis, 
suppurative conditions of any region of the body, especially of the 
extremities, leading to the formation of metastatic abscesses. According 
to Ernst, Kunemann, and Cuillé, caseous abscesses in the liver may be 
due to the bacillus of necrosis associated with pyogenic bacteria (see 
Nodular Necrosis, p. 567). But Hutyra and Marek point out that such 
lesions differ from true abscesses of the liver, as they contain only 
structureless débris. é 

In young calves abscesses of the liver may be associated with phlebitis 


DISEASES OF THE LIVER: CATTLE 567 


of the umbilical vein and the disintegration of thrombi therein, which in 
the form of infective emboli are carried to the hepatic capillaries, and 
induce metastatic abscesses in the organ. 

Morsip ANatomy.—The lesions resemble those described as occurring 
in the analogous condition in the horse. When depending on the presence 
of a foreign body or due to injury, a single abscess of large size may be 
present. When the abscess is situated on the anterior surface of the 
liver, it may cause an elevation of Glisson’s capsule, and become adherent 
to the diaphragm, the adhesion. extending gradually until the wall of 
the abscess becomes separated from the liver and remains attached to 
the diaphragm. In such instances a cicatricial depression on the liver 
marks the original seat of the abscess (Stubbe). 

Symproms.—Beyond the usual symptoms accompanying internal 
suppurative processes, nothing special may be observed. In some cases 
only gradual emaciation may be present. When the lesion is associated 
with the migration of a foreign body from the rumen and reticulum, 
symptoms of traumatic indigestion will be in evidence (see p. 368). 
Various complications may ensue. A physical examination may detect 
enlargement of the area of hepatic dulness and increase in size of the 
liver, with pain on palpation. Jaundice may or may not be present. 
According to Cadéac, diagnosis is impossible, unless some evidences of 
hepatic derangement can be recognised, and in the large majority of cases 
the affection is mistaken for disease of other organs in the vicinity. 

Treatment of any kind is useless. 

Nodular Necrosis of the Liver.—This condition is characterised by 
the presence in the hepatic parenchyma of slightly prominent dry 
nodules, which undergo a gradual softening due to necrotic changes. 
It is termed by French authors “infectious liver.’ The disease is 
said to be common in cattle, and according to Williams is met with 
particularly in young animals. In sheep, according to Hutyra and 
Marek, it is more rare, and enzodtic outbreaks of the affection are recorded 
by Berndt. In the horse, pig, and dog it is quite exceptional. 

Etrotogy.—T he disease has been investigated by McFadyean, Bang, 
Schutz, Kitt, and Meyer, and the cause shown to be the bacillus of necrosis. 
According to Cadéac, the lesions may depend on the presence of various 
micro-organisms. The disease may be associated with conditions such 
as chronic intestinal affections, suppurative and gangrenous mammitis, 
uterine infections, and in the young animal with omphalophlebitis. 
Infection of the liver is said to take place by way of the blood-stream, 
the bacilli in the majority of cases reaching the portal blood from the 
intestine. Berndt has found the bacillus of necrosis in the uterus of 


568 SYSTEM OF VETERINARY MEDICINE 


fifteen affected cows just prior to, or subsequent to, parturition. Dusty 
or mouldy food and insanitary surroundings are held to be etiological 
factors by some observers. 

Morsip ANAtomy.—According to McFadyean, the bacillus of necrosis 
is generally arrested in the smallest branches of the portal vein, or 
occasionally in the hepatic artery, and multiplies therein. The bacilli 
then pass through the vessel walls, and enter the liver tissue in the vicinity. 
Necrotic changes occur in the centre of the lesion, and an inflammatory 
reaction sets in around the necrotic area. This reaction is produced 
partly by the products of tissue destruction and bacterial toxins, and 
partly by the necrotic tissue, which acts as a foreign body. The surface 
of the liver shows a number of well-defined prominences of a yellowish 
or light brown colour. They vary in size, and may be as large as a nut 
or even a hen’s egg and are firmer in consistence than the surrounding 
tissue. Glisson’s capsule is observed to be thickened where it covers 
the superficial prominences, and some of the latter may show erosions 
and a covering of purulent material. Lesions of sero-fibrinous peritonitis 
may be observed, especially in the vicinity of the liver. In advanced 
cases changes occur in the nodules, the centre undergoes dry necrosis, 
and surrounding this is an area of softening, bounded externally by a 
capsule of fibrous tissue. Ultimately the centre is transformed into a 
viscid yellow material which resembles pus, and this is surrounded by 
a fibrous capsule with thick walls. 

Symproms.—These are not characteristic. When the lesions are 
limited in extent, and the subsequent changes therein are slow, no 
symptoms are observed. In other instances slight jaundice with high 
fever and marked constitutional symptoms appear. According to 
Hutyra and Marek, the disease may be suspected when there is pain on 
pressure over the region of the liver, jaundice and subsequent evidences 
of peritonitis, and the presence of suppurative processes in any other 
part of the body, more especially if the patient be a cow in the last stages 
of pregnancy or just subsequent to parturition. The above authors, 
however, point out that it is difficult to arrive at a correct diagnosis so 
as to exclude the possibility of purulent hepatitis. Treatment of any 
kind 1s useless. 

Chronic Interstitial Hepatitis.—This affection is seldom met with in . 
cattle, and, in consequence of the lack of characteristic symptoms, there 
is marked difficulty in diagnosis. The hypertrophic form of the disease | 
is said to occur more frequently than the atrophic. Attempts have been 
made to describe the various forms of hepatic cirrhosis, but however 
interesting this may be to the pathologist, it possesses little value for 


DISEASES OF THE LIVER: CATTLE 569 


the clinician. Hence we deem it advisable to consider the subject under 
one heading. 

Erroto¢y.—Similar causes to those mentioned in the analogous con- 
dition in equines may induce the disease in cattle. In some countries 
long-continued feeding with plants of the Senecio group produces chronic 
hepatitis; thus enzodtics of the affection have been met with in New 
Zealand, Pictou (Nova Scotia), and in South America, and the subject 
has been investigated by Gilruth, Robertson, Wyatt-Johnston, and others. 
Cadéac states that long-continued feeding on a diet containing large 
amounts of malt contributes to the production of hepatic cirrhosis. 
According to some authors, hypertrophic cirrhosis is not uncommon 
in calves in connection with omphalophlebitis and diarrhoea associated 
with enteritis, the infecting agents being bacilli of the coli type, which 
are capable of producing the hepatic lesions. Cadéac states that a 
diffuse tuberculous infection is capable of inducing cirrhosis without 
the formation of tubercular lesions in the liver. Amongst other etio- 
logical factors, we may mention compression of the gall-bladder or 
the principal biliary canals by a tumour, the presence of biliary calculi, 
intense catarrhal inflammation of the bile-ducts, and parasitic affections, 
such as distomiasis, etc. We have observed cases of hepatic cirrhosis 
in calves experimentally fed on a certain calf food, which was advertised 
as a perfect substitute for milk, but found on chemical analysis to be 
deficient in fat. The animals died of inanition, and there was an absence 
of fat in the body. 

Morsip Anatomy.—The lesions may be similar to those described 
as occurring in equines. In cases due to the toxic effects of plants of the 
genus Senecio, the evidences of cirrhosis are very pronounced, the centre 
of each lobule shows a well-marked fatty degeneration of the cells, the 
liver is atrophied, of a bluish tint, and perihepatitis is present. In 
addition to hepatic lesions, the mucosa of the abomasum is covered by 
a hemorrhagic effusion, and the submucosa is thickened and infiltrated. 
Effusions occur in the peritoneal, pericardial, and pleural cavities. 

Symptoms.—These are by no means characteristic, and unless jaundice 
be present, the symptoms are likely to be attributed to an indefinite 
digestive disorder. In the hypertrophic form it is said that the enlarge- 
ment of the liver can be detected by palpation, and an increase in the 
area of liver dulness can be discovered by percussion. In cases of cirrhosis 
due to the toxic effects of plants of the genus Senecio, diarrhoea, tenesmus, 
jaundice, emaciation, nervous excitement, a reddish-yellow colour of 
the urine, albuminuria, hematuria, with blood-clots in the urine, may 
be observed. In the cow blood-clots may hang from the vulva. In 


570 SYSTEM OF VETERINARY MEDICINE 


milch cows the milk has a peculiar smell and sour taste. Death may 
occur in a few days. 

In ordinary cases of hepatic cirrhosis the course is slow, and the disease 
may last for a long period. In the later stages various complications 
may occur. 

TREATMENT.—As the disease is invariably fatal, on economical 
grounds treatment is not desirable. 

Fatty Liver.—This does not present any special characteristics as 
compared with the analogous condition in equines. McFadyean observed 
a case in which the lesion extended deeply and was circumscribed, it 
presented a bright yellow colour, and the liver cells were transformed 
into fat cells, the rest of the organ being normal.* 

Amyloid Degeneration.—Very little is known with reference to this 
condition in cattle. Cases are recorded in which it was associated with 
tuberculosis, chronic nephritis, and osseous necrosis. 

Neoplasms of the Liver.—These include carcinomata, sarcomata, 
angiomata, tuberculosis, actinomycosis, and serous cysts. 

Carcinomata.—According to Hutyra and Marek, cancer of the liver 
is rare in all domestic animals, but Cadéac states that it is frequently 
met with in bovines, and that epithelioma is the type generally observed. 
Cancer of the gall-bladder is comparatively rare, but has been observed 
by Guret, Bruckmiiller, Kitt, and Johne. The organ is enlarged and 
nodular, its walls are thickened, and pedunculated or sessile growths 
are found on its inner surface. These growths may be ulcerated in 
places. Hutyra and Marek give instances in which villous-like outgrowths 
occur in the gall-bladder, which may be simple papillomata, or may 
have the structure of a villous cancer. In the latter instance secondary 
growths may be present in the liver. 

There are no definite symptoms in connection with cancer of the 
liver, the phenomena observed being rapid emaciation, cachexia, and 
cedematous swellings on the inferior abdominal wall and in the hind- 
limbs. <A moderate ascites is present in some cases. 

Sarcomata.—Primary sarcoma is very rare, but secondary forms are 
sometimes observed, being of metastatic origin. 

Angiomata.—These are said by Hutyra and Marek to be of fairly 
common occurrence in cattle, but rarely cause any symptoms. 

Tuberculosis —See Vol. I. 

Actinomycosis.—Ramussen has met with several cases of actino- 
mycosis of the liver in cattle. Jensen has also recorded instances of the 
affection, in which the growths extended from the liver to the diaphragm 


* See Journal of Comparative Pathology and Therapeutics, vol. iv., p. 239. 


DISEASES OF THE LIVER: CATTLE 571 


The lesions consisted of rounded tumours of variable sizes enclosed in 
a fibrous covering, and showing more or less softening in the centre. 
No special symptoms were recorded. 

Cysts.—Serous cysts in the liver of the calf and of the adult animal 
have been met with by several observers. They generally occupy the 
anterior surface or the inferior border of the organ, and are of various 
forms and sizes. Cases are recorded in which these cysts complicated 
cirrhosis of the liver or adenomatous growths. According to Cadéac, 
they are congenital in origin. In some instances they are voluminous 
owing to a number of small cysts becoming confluent, and the condition 
is then termed “ polycystic liver.” 

Parasites of the Liver.—See the Section on Parasites. 


DISEASES OF THE LIVER IN SHEEP 
By G. MAYALL, MR.GV:S. | 


Icterus or Jaundice.—This may, as in other species of animals, be a 
symptom of various hepatic affections. A special form of jaundice, 
however, is seen, chiefly in lambs that have been fed irregularly, or 
allowed an excess of nutritious food, or left too long on rich pastures, 
such as new grass. Congestion of the liver is produced, and the flow 
of bile to the intestine is checked. The lesions found are a yellow dis- 
coloration of the abdominal viscera, seen especially in the fatty tissues, 
whilst the muscular tissue in places may be flabby and infiltrated with 
fluid. The symptoms observed are jaundice, a yellowish or brownish 
coloration of the urine, the feeces may be either dry, foetid, and covered 
with mucus, or pale and watery; the animals are listless and the appetite 
is in abeyance. 

As regards treatment, sodium sulphate (1 to 4 ounces) should be 
administered in the form of a drench. The animals should be removed 
from luxurious pastures during the early and late parts of the day. 
Laxative and easily digested food is indicated. Exercise and good 
drinking-water aid recovery. 

Acute Diffuse Parenchymatous Hepatitis.—Several Continental ob- 
servers have seen this disease attacking stall-fed ewes during the last 
months of pregnancy, and one observer noticed it at this period in ewes 
pastured on damp sodden grass and clover. Hutyra and Marek describe 
the symptoms of the disease as follows: During the first few days the 
animals lay about with half-closed eyes, as if narcotised or stupefied. 
On the second or third day they recover somewhat, but rumination 
remains in abeyance, and on the next day the sleepy symptoms return. 
The temperature, at first normal, later on ascends to 104° or 106° F., 
heralding death. The heart-beats are accelerated, and later on become 
weak; the breathing is hurried. The affected subjects look round 
anxiously at the liver region, seek to avoid pressure applied to the hepatic 
zone, and groan if palpated. The urine contains epithelial cells, albumin, 
and leucin bodies. On the fifth or sixth day the animals become apathetic, 
grind their teeth, have muscular tremors, the wool comes out in tufts, 

572 


DISEASES OF THE LIVER: SHEEP 573 


and finally they die within a week, completely exhausted. In some cases 
a watery, foetid diarrhoea is present, and a discharge mixed with blood 
issues from the nose. On post-mortem the liver is found enlarged, softened, 
and anemic. Hemorrhages occur into the serous tissues, and paren- 
chymatous degeneration of the heart is observed. 

Acute Yellow Atrophy of the Liver.—According to Hutyra and Marek, 
this condition is met within sheep. In some instances lambs are attacked, 
in others adult animals. In addition to the hepatic lesions, the kidneys 
show evidences of nephritis. The affection may also depend on lupinosis. 
It has many points of resemblance to the acute diffuse parenchymatous 
hepatitis already described, and Cadéac considers both diseases under 
the same heading. ! : 

Lupinosis (Lupine Disease).—This is a condition due to the ingestion 
of various species of lupines (Lupinus flavus, L. ceruleus, L. albus). 
Although cattle, horses, and goats may be attacked, the affection is far 
more common in sheep. It is met with in certain districts in Northern 
Germany, where lupines are used as fodder, and extensive outbreaks 
are not uncommon. Outbreaks were also observed in Montana, U.S.A., 
in 1900, and were investigated by Wilcox. The species of lupine was 
the L. leucophyllus. Toxic effects occurred when the plant was ingested 
on the mountain ranges, or when it was made into hay. 

According to Hutyra and Marek the lupines are harmful only in 
certain years, and in any year the plants may be poisonous in certain 
fields only. In the fresh state they are seldom toxic, but after storage 
the poisonous action is well marked. Exposure to rain or frost renders 
the lupines inert. The yellow lupine (L. flavus) is said to be the most 
dangerous, and the seeds, pods, leaves, and straw are equally toxic. 
In the Montana outbreaks the seeds were found to be especially toxic. 
The toxic substance is known as “ lupinotoxin”’ or “icterogen.”’ An 
acute and a chronic form of the disease are recognised. The lesions 
produced in the acute form are severe inflammation of the abomasum, 
ileum, and large intestines, associated with ecchymoses; fatty degenera- 
tion of the liver; catarrh of the gall-bladder; parenchymatous or fatty 
degeneration of the kidneys, heart, and certain groups of muscles; 
hemorrhages in the serous membranes, skin, and subcutaneous connective 
tissue, and also cedematous infiltrations (Hutyra and Marek). In 
Montana the acute form only was observed. 

In the chronic form chronic interstitial hepatitis, often associated 
with a “‘ hob-nailed ” condition of the liver (due to shrinkage), enlarge- 
ment of the spleen, chronic nephritis, and effusions into the serous 
cavities of the body, were the lesions recorded. 


574 SYSTEM OF VETERINARY MEDICINE 


Symproms.—Nervous symptoms predominate, such as cerebral 
excitement, followed by grinding of the teeth, frequent chewing movements 
of the jaws, muscular weakness, and finally the animals fall down and 
become unconscious. In the Montana outbreaks convulsions were 
present which simulated those occurring in cases of strychnine-poisoning. 
Loss of appetite appears early. Jaundice is present in the majority of 
cases, especially in severe attacks. Constipation succeeded by a san- 
guinolent diarrhcea occurs. The urine is of a dark red colour, highly 
albuminous, and contains bile pigments, epithelial cells, and renal casts. 
Fever is observed in the early stages, but later on the temperature 
falls considerably. Occasionally the skin of the head, ears, and nose 
shows an erysipelatous swelling, and is covered with crusts. In the 
Montana cases death occurred in some instances within half to one 
and a half hours, in others in from two to four days. In the German 
outbreaks the majority of cases of the acute form lasted from nine to 
eleven days. If the toxic material be removed from the food on the 
appearance of the early symptoms, the animals improve on the fifth or 
sixth day and recover. Partial recoveries may occur, but later on death 
results from cachexia and complications due to chronic hepatitis. In 
the chronic form progressive anemia, cachexia, and slight jaundice 
are observed, but this latter symptom may be absent. 

TREATMENT.—Acid solutions are advised by Roloff in order to 
prevent absorption of the toxin. These are followed by oleaginous 
purgatives so as to remove the toxic agent from the alimentary canal. 
The use of lupines as fodder should be discontinued. Hutyra and Marek 
advise that the fodder can be rendered harmless by exposing it in small 
heaps to rain, and using only the superficial layers for feeding purposes; 
or it may be soaked in 1 per cent. soda solution (with renewal of the 
liquid every two days), and then dried. Another plan suggested is to 
submit the fodder to steam at a pressure of two atmospheres. Every 
fresh supply of lupine should be tested on a few sheep, and its effects 
observed before supplying it to the flock. It is said that slightly poisonous 
lupine can be mixed with good food in the proportion of 1 in 6 or 1 in 
10, without any risk of toxic effects. Cadéac advises that lupines should 
not be employed for fodder under any circumstances. 

Gall-Stones.—According to Kitt, large biliary calculi are not observed 
in sheep; but in animals affected with distomiasis concretions may: 
form, composed of carbonate of lime and biliary mucus. These originate 
from a chronic catarrh of the biliary passages. The mucose become 
covered by a soft deposit and hard incrustations, from which concretions 
in the form of a cylinder result, and are sometimes very adherent to the 


DISEASES OF THE LIVER: SHEEP 575 


internal wall of the duct. Morton recorded a case of biliary calculus 
-which weighed 12 grains. No pronounced symptoms are observed. 
The affected animals may gradually fall away in condition and some- 
times exhibit jaundice. | 

Suppurative Hepatitis—According to Cadéac, the most common 
cause of multiple hepatic abscesses in sheep is the bacillus of Preisz- 
Nocard (see Pseudo - Tuberculosis of Sheep, Vol. I.). The lesions 
consist of small abscesses, or of encysted nodules, varying in size from 
a nut to a pear, and filled with a greyish-yellow caseous material. 

Chronic Interstitial Hepatitis—This condition is observed in sheep 
in cases of chronic lupinosis (see p. 573). It also occurs in distom‘asis. 
We have not met with any records of cirrhosis of the liver in sheep in- 
dependent of the causes mentioned. 

Fatty Liver.—Cases are recorded by Neale of extreme fatty infiltra- 
tion of the liver in a number of Shropshire sheep. Death took place 
as the result of rupture of the liver. The condition is also observed in 
connection with lupinosis, and the presence of adenomata in the liver. 

Pigmentary Degeneration of the Liver.—This lesion was studied in 
1874 by Siedamgrotzky, and by Barrier in 1877 in Russian sheep. The 
etiology was not determined. On section of the liver and on its external 
surface, a black, brownish-black or bluish coloration is observed. On 
microscopical examination small sinuous lines of a black colour are 
detected, running close together, and forming angles, between which 
are a number of small polygonal spaces. The pigment is also deposited 
in the cells of the organ, and in the walls of the vessels as well as in the 
connective tissue. In some cases the coloration is so intense and so 
general that the specimens, if placed in water, render the latter of a 
black colour resembling ink. The pathological importance of this con- 
dition has not been determined. 

Neoplasms of the Liver.—These are rarely met with in sheep. Car- 
cinomata and sarcomata have been recorded, but the former are of 
quite exceptional occurrence. 

Adenomata, in the form of pedunculated tumours covered by peri- 
toneum and hanging from the surface of the liver, have been observed 
by McFadyean, Johne, and Kitt. These tumours were partly wedged 
into the liver substance and displaced the hepatic tissue and vessels. 
They are described as mixed fibro-adenomata. Simple adenomata were 
met with by Johne. They sometimes attained a large size, and were of 
a greenish colour. 

Parasites of the Liver.—See the section on Parasites. 


DISEASES OF THE LIVER IN THE PIG 
By G. MAYALL, M.R.C.V.S. 


Acute Diffuse Parenchymatous Hepatitis (Hinzodtic Hepatitis of Young 
Pigs).—This affection has been met with in Russia and in Hastern 
Prussia, and has caused great losses in young pigs of from two to four 
months old. In Russia it was investigated by Semmer and by None- 
witsch, and in Hastern Prussia by Kleinpaul, Braedel, Willerding, and 
others. The lesions found were an enlarged and mammillated condition of 
the liver. On section, the organ presented a variegated mosaic appear- 
ance, dark red patches alternating with. bright red or greyish-yellow 
areas. The hepatic cells were hypertrophied and infiltrated with fat, 
and between them were found small-celled infiltrations and extravasated 
red blood-corpuscles. Enteritis, albuminuria, and a serous exudate 
in the peritoneal and pleural cavities, were also observed. Nonewitsch 
found in the liver, spleen, and blood, micro-organisms in the form of large 
cocci. By inoculating cultures of these into young pigs, death occurred 
in from seven to eight weeks. The post-mortems showed similar lesions 
to the original disease. This investigator concluded that infection 
occurred immediately after birth, possibly by way of the umbilicus. 
The only symptoms observed were loss of appetite and debility, followed 
by a comatose condition a few hours before death. All treatment proved 
useless. 

Gall-Stones.—According to Hutyra and Marek, biliary calculi are 
rarely met with in the pig. Cadéac states that gall-stones in this animal 
are small in size, their surfaces are rugged or in the form of facets, they 
weigh from 3 to 5 grammes, and are sometimes found in large numbers 
in the gall-bladder. The symptoms are obscure, and may even be 
absent if the bile-duct is not completely obstructed. When complete 
obstruction occurs, loss of appetite, constipation, severe depression, 
and jaundice are observed. A foetid diarrhcea is present in some cases. » 
Gurlt recorded nervous symptoms characterised by irregular muscular 
movements and followed by death. The treatment advised is 5 to 
12 ounces of olive oil, followed by l-ounce doses of sulphate of soda, 
administered twice daily for a few days. Sand and small flints are 

576 


DISEASES OF THE LIVER: PIG 577 


occasionally found in the bile-ducts of swine fed on raw roots which have 
not been properly cleaned. 

Chronic Interstitial Hepatitis. — Cirrhosis of the liver occurs more 
frequently in the pig than is generally suspected. The causes recognised 
are—Feeding on spoilt, mouldy, or fermenting food. Inn-keepers’ pigs 
are not infrequently the subjects of the disease. Feeding largely on 
brewer’s grains is also an etiological factor. Swill composed of dish-water, 
particles of meat, and potato parings, etc., tends to produce the disease. 
According to Cadéac, the acidity of fermenting foods, especially if associ- 
ated with aliment containing alcohol, is the principal cause of hepatic 
cirrhosis in swine. Tschauner has met with 13 cases of the disease in 
350 pigs raised by hotel-keepers and brewers. Microbial toxins con- 
tribute to its production. Parasitic affections of the liver (Cystecercus 
tenuicollis, and the larval form of Strongylus paradoxus) are important 
causes of hepatic cirrhosis. 

With reference to the lesions, either the hypertrophic or atrophic 
form may be present. Cadéac points out “ that in the normal liver of 
the pig the perilobular connective tissue is so well developed that it 
forms a network of white lines, which separate the lobules clearly, 
and give to the hepatic tissue a mosaic aspect. In cirrhosis this dis- 
position is altered; the connective tissue accumulates in certain regions 
at the expense of the lobules, which are compressed and atrophied. In 
certain parts, of the size of a pea or of a franc, the hepatic tissue com- 
pletely disappears, and only disseminated, white, hard sclerotic spots 
are found, which seem to result in many cases from the irritation produced 
by a parasite, such as the Cysticercus tenuicollis.” 

- Symproms.—There are no symptoms which lead to a recognition of 
the affection. A diminished appetite, the presence of undigested food 
in the feeces, pain on pressure over the region of the liver, a “ pot-bellied ” 
appearance, and slight jaundice, have been recorded. Cadéac states 
that hepatic cirrhosis is only discovered as a surprise at the autopsy. 

Treatment of any kind is useless. | 

Parasites of the Liver.—See the section on Parasites. 


VOL. IL. a7 


DISEASES OF THE LIVER IN THE DOG, 
CAT, AND IN BIRDS. 
By E. WALLIS HOARE, F.R.C.V.S. 


DOG AND CAT. 


General Remarks.—Hepatic diseases are of common occurrence in 
the dog, the chronic types being more frequently met with than the acute 
forms. Although the diagnosis of these affections is much facilitated in 
the dog by the fact that palpation of the liver can be more readily carried 
out than is the case with the larger animals, yet there are many instances 
in which the symptoms are so obscure that hepatic disease is not sus- 
pected. The older writers recognised the frequency of such affections 
and the difficulties in diagnosis. Mayhew’s experience was that very 
few dogs had healthy livers. No doubt when jaundice is observed it is 
easy to assert that an hepatic disorder is present; but it is important 
to remember that icterus is only a symptom common to various affec- 
tions of the liver, that it may occur in the absence of any apparent 
morbid conditions of this organ, also that it may be, and often is, absent 
even when the liver is the seat of extensive disease. Practitioners who 
conduct a large number of autopsies on dogs bear testimony to the fact 
that the liver may show well-marked lesions, and yet there was no sus- 
picion of the presence of hepatic disease during life. No doubt if more 
attention were paid to examinations of the urine, it would greatly assist 
in the diagnosis of liver disorders. 

According to Friedberger and Fréhner, in the dog bile-pigments may 
occur in the urine in cases of intestinal catarrh, without any appearance 
of jaundice of the visible mucous membranes. 

In the cat diseases of the liver have not been specially studied, and 
little information on the subject is to be found in works on veterinary 
medicine. We are informed, however, by Gray and also by Livesey, that 
hepatic affections are by no means uncommon in this animal. The 
' similarity of the symptoms in the dog and in the cat renders a section 
for the latter unnecessary, but we shall draw attention to any special 


features in the feline diseases when such are worthy of mention, 
578 


DISEASES OF THE LIVER: DOG AND CAT 579 


In the present day some advancement in connection with the subject 
of hepatic affections can be claimed, more especially with reference to 
the significance of the term “‘ jaundice.” Many authors regard jaundice 
as a disease, but, as already remarked in the equine section, it is more 
properly described as “a symptom with symptoms.” No doubt when it 
is observed during the course of a hepatic disease, the yellow discolora- 
tion of the visible mucous membranes, skin, etc., with the symptoms 
usually associated with such a condition, constitute the most prominent 
clinical phenomena present. But this group of symptoms is common to 
a variety of hepatic disorders, and on its presence per se we cannot differ- 
entiate one disease of the liver from another. Some authors, indeed, 
describe “ catarrhal jaundice”? as a condition depending on catarrh of 
the duodenum, with which catarrh of the larger bile-ducts is often 
associated. Hutyra and Marek state that the most frequent cause of 
jaundice in the dog is the condition mentioned. While admitting that 
gastro-duodenal catarrh may at times be associated with jaundice, we 
cannot agree that the former condition is the most frequent cause of the 
latter; the statement is not in accordance with post-mortem evidence, 
and Gray, who has devoted special attention to the subject, holds that 
it is the exception to find catarrhal inflammation of the bile-duct in such 
cases. 

There is an important affection in the dog termed “ enzodtic or 
infectious jaundice,’ which attacks especially young animals of the 
sporting breeds, and is the source of enormous losses in certain districts. 
This we shall fully consider later on, but here it will suffice to remark 
that, although the affection mentioned is very common, and its clinical 
aspects familiar to canine practitioners, little or nothing is known with 
reference to its etiology or pathology, while its successful treatment has yet 
to be discovered; but one thing we do know—viz., that it does not depend 
on catarrh of the bile-duct, and so far as one can judge in the present state 
of knowledge it should be regarded as depending on morbid alterations 
in the blood, due to some cause not yet determined. 

We do not deem it advisable to discuss ordinary jaundice under a 
separate heading, but consider that it can be more properly referred to 
when dealing with the hepatic diseases in which it is one of the symptoms. 
The enzodtic form of jaundice, however, merits a special description. 

As regards the differentiation of jaundice depending on obstruction 
to the flow of bile (obstructive jaundice), and that due to morbid altera- 
tions in the blood, it was formerly held that the presence of biliary acids 
in the urine pointed to obstructive icterus. In the present day this test 
is not recognised, The examination of the feces is a more reliable 


580 SYSTEM OF VETERINARY MEDICINE 


method, and in cases of obstructive jaundice, owing to the absence of 
bile from the intestines, the feeces are clay-coloured, while in the other 
form they are normal in appearance; but this test is not free from fallacy. 

Enzootic Jaundice—Synonyms.—Infectious jaundice; The yellows. 

This affection has many features in common with biliary fever (Canine 
Piroplasmosis, see Vol. I.), but up to the present the examinations of the 
blood conducted in Great Britain have proved negative. The disease is 
described by Continental authors, but in British textbooks it receives 
very little attention, and is included under the heading of jaundice 
depending on diseases of the liver. Although the affection is of common 
occurrence in the British Isles, and, as previously remarked, is the source 
of enormous losses to breeders of dogs and to masters of hounds, we must 
confess that nothing definite is known with reference to its etiology, 
pathology, prevention, and treatment. The yellow discoloration of the 
visible mucose, skin, etc., is but a part in connection with the clinical 
picture, as the other phenomena present point to the action of a toxin 
on the blood and nervous system. Although the affection often occurs 
in enzootic form, attacking the greater number of young dogs in a kennel, 
yet it is not uncommon to find apparently sporadic cases even in isolated 
country districts. Thus we meet with instances in which a foxhound puppy 
has been sent to a farmer’s place to be “ walked,” and although no case 
of the disease existed in the kennels where the animal was reared, yet he 
contracts the disease at his new abode. If two puppies are sent together 
both become affected. There is little doubt but that the sporting breeds 
are those most subject to the disease, but at the same time we meet with 
many instances where other breeds, such as fox-terriers, are attacked. 
The connection between enzodtic jaundice and canine distemper is a 
vexed question. The older writers regarded the former affection as one 
of the phases of the latter (see Canine Distemper—Hepatic Complica- 
tions, Vol. I., p. 689). But while admitting that during an outbreak of 
distemper in a kennel cases presenting all the symptoms of enzootic 
jaundice may make their appearance, and also that in cases of ordinary 
catarrhal distemper evidences of jaundice may be manifested, yet the 
actual relation of the affections is by no means clear. Moreover, in some 
districts where distemper is prevalent a case of jaundice of the enzodtic 
type is seldom seen. The environment of foxhound kennels might be 
regarded as playing some part in the etiology of the disease, if it were not 
for the fact that enzodtics occur in young dogs far removed from such 
surroundings. In some kennels we have observed that in the years 
when distemper was prevalent jaundice did not occur, while in other 
years when the latter affection was in evidence distemper was absent. 


DISEASES OF THE LIVER: DOG AND CAT 581 


As already remarked, the prevalent idea that the condition depends on 
a catarrhal condition of the bile-ducts associated with gastro-duodenitis 
is not supported by post-mortem evidence, and is simply a dogma trans- 
ferred from one textbook to another. Amongst Continental observers 
who have devoted attention to the subject, we may mention Weber, 
Trasbot, Bouchet, and Cadéac. 

Weber observed that at the autopsy it was rare to find anatomical 
lesions of the liver sufficient to account for death or the gravity of the 
symptoms during life. The organ often showed no morbid alterations, 
but he always found an accumulation of yellowish-green, very thick 
bile in the gall-bladder. Trasbot stated that the affection is not essen- 
tially an alteration of the liver; in the majority of cases the organ was 
perfectly healthy and even less modified in its colour than many of the 
other tissues. When lesions such as slight congestion and ecchymoses 
do occur, they are secondary phenomena indicating a general alteration 
in the system, which is marked by a tendency to the production of 
capillary hemorrhages in different parts and by no special lesions. 
Bouchet found that in two-thirds of the cases inflammation and occlu- 
sion of the bile-duct as a result of gastro-duodenal catarrh were not among 
the post-mortem findings. He regarded the affection as depending on 
the presence of the Bacillus cols in the bile-ducts and liver, which induced 
disintegration of the hepatic cells. Cadeéac follows the views of Bouchet, 
and regards the entrance into the liver and development of the B. colz 
therein as the essential cause of the affection. He admits, however, 
that other micro-organisms may be associated with the above-men- 
tioned bacillus. The mode of entrance is not always the same, but in 
most cases the source of infection is the gastro-intestinal canal, and the 
micro-organisms reach the liver by way of the portal system or by the 
main bile-duct (ductus choledochus). The effects produced are: marked 
alterations in the hepatic cells; the latter become isolated and disinte- 
grated, and the toxins derived from the micro-organisms stimulate the 
nerve filaments in the cells, cause vaso-dilation, cedema, destruction of 
red blood-corpuscles, and increased formation of bile-pigment and of 
bile. The bile is thick and dark in colour, and tends to accumulate in the 
gall-bladder; besides, owing to alteration in the hepatic tissue, the finer 
biliary canals become distorted and interfere with the free passage of 
bile to the intestine, so that absorption takes place. The bacilli are found 
in abundance in the bile, and they multiply in the hepatic tissue. Ac- 
cording to Chierici, inoculations of the B. cola only occasionally succeed 
in producing jaundice, and all dogs are not equally susceptible. 

The above theory, although plausible, can be objected to on various 


582 SYSTEM OF VETERINARY MEDICINE 


grounds, and it is quite evident that further research is needed on the 
subject. Various predisposing causes are mentioned by Cadéac, of which 
exposure to chills 1s considered to be the most important; the latter 
probably acts by lowering the vital resistance of the animal. 

Judging by the observations we have made as the result of many 
autopsies, we are inclined to agree with the opinion held by some writers— 
viz., that enzodtic jaundice is a condition in which morbid alterations 
occur in the blood, leading to the presence of a large amount of hemoglobin 
in solution, from which excessive quantities of bile-pigment are formed 
by the liver. The viscid condition of the bile which may be observed 
depends on a lack of fluid constituents, and owing to this viscidity the 
bile tends to accumulate in the liver and become reabsorbed. As to the 
causes of the alterations in the blood, we know nothing definite. We 
must admit, however, that post-mortem evidence does not always 
demonstrate the viscid condition of the bile which is usually described 
as being present, as in many autopsies the bile may be normal in appear- 
ance and in quantity, and in some cases may be in small amount or even 
absent. 

Morsip Anatomy.—The usual icteric discoloration of the tissues is 
present, and the tint may be very deep. In some cases no morbid altera- 
tions can be detected in the liver. In others the organ may be congested, 
enlarged, and of a deep brown colour; again, it is not uncommon to find 
the liver anzemic, of a pale yellow tint, and very friable. Only in excep- 
tional cases do we find gastro-duodenal catarrh present. According to 
Cadéac, microscopical examination shows that the hepatic cells are smaller 
than normal and separated from each other, and the lobules appear to 
be fused together, so that the individual structures cannot be recognised. 
Many authors describe the presence of gastro-duodenitis with catarrh 
of the bile-duct and obstruction to the free passage of bile; but these 
lesions are by no means common, and in our experience are generally 
absent. The kidneys may be congested and show disseminated ecchy- 
moses. Some authors record the presence of yellowish-white infarcts 
and purulent or gangrenous foci. The lungs show multiple minute 
hemorrhages in the substance of the organs as well as on the superficial 
aspect; these are in striking contrast to the anzemic appearance of the 
pulmonary parenchyma. But in some cases the ecchymoses become 
confluent, so that the lungs present a congested appearance. ‘The spleen ' 
is generally normal, thus differing from the enlargement of this organ 
which is observed in canine piroplasmosis. Invagination of the intestine 
is a very common lesion, and was present in the large majority of the 
cases which we examined. 


DISEASES OF THE LIVER: DOG AND CAT 583 


Symptroms.—These are by no means regular in their development. 
_ In some cases the first symptom observed is jaundice, which appears to 
come on rather rapidly; in others loss of appetite, dulness, nausea, thirst, 
and vomiting occur as premonitory symptoms, and the jaundice develops 
gradually. Some authors describe a well-marked rise in temperature 
among the initial symptoms, but this is not in our experience a constant 
phenomenon. We have observed cases in which, after the jaundice had 
persisted for some days, the ocular and nasal phenomena of distemper 
appeared; the latter affection, however, was prevalent in the kennel at 
the time. Per contra, we have seen symptoms of catarrhal distemper 
precede the jaundice; but, as already remarked, in the majority of out- 
breaks of enzodtic jaundice, symptoms suggestive of distemper were 
absent. Gastric symptoms, such as retching, vomiting, excessive thirst, 
etc., may be prominent in some cases, while in others they may be 
absent during the entire course of the malady. The jaundice varies in 
intensity. In some cases the visible mucosz, the sclerotic, and the 
unpigmented portions of the skin, are stained a deep saffron yellow, the 
pupils are dilated and exhibit a bright yellow tinge. Constipation may 
be present from the outset, but may be succeeded by diarrhoea, the feeces 
being very foetid and containing blood; also they may be dark in colour, 
showing that no obstruction to the flow of bile is present. Vomiting 
and retching may occur throughout the course of the malady; the vomited 
material may contain bile. As the disease advances a subnormal tem- 
perature is observed, the pulse is weak, and the respirations are accel- 
erated. In many cases evidences of marked nervous prostration occur 
early, the animal is dull and sleepy, and constantly assumes the recum- 
bent position, and seems indifferent to his surroundings. The urine is 
scanty, and is of a deep yellow or brownish-yellow colour, owing to the 
presence of bile-pigments. In the later stages nervous phenomena 
predominate; clonic spasms of the temporal, scapular, and crural 
muscles are observed, succeeded by a comatose condition prior to death. 
Gray has observed clonic contractions of the diaphragm accompanied 
by a thumping sound and an undulatory action of the muscles immedi- 
ately posterior to the false ribs. 

Hemorrhage from the nostrils and from the gums, and the passage 
from the rectum of a slimy mucus containing blood, occur in some cases, 
and always prove to be evidences of a fatal termination. 

Cadéac has observed colicky pains, and attributes them to exagger- 
ated peristaltic action of the intestines; he also considers that they bring 
about invagination of the intestine, which is so common a complication 
in this malady. In our experience invagination may occur without any 


584 SYSTEM OF VETERINARY MEDICINE 


evidences of abdominal pain, and unless a very careful physical examina- 
tion of the abdominal cavity be made. this lesion will be overlooked. 
Judging by the condition of the invaginated portion of bowel, it would 
appear that the lesion was in existence for some time prior to death. In 
some cases distension of the abdomen and the passage of mucus contain- 
ing blood suggest the presence of the lesion. Probably the marked de- 
pression of the nervous system which is present masks the symptoms 
which otherwise would appear; at any rate, in the large majority of cases 
the invagination is found as a surprise at the autopsy. A short time pre- 
vious to death the Cheyne-Stokes type of respiration may be observed 
in some cases. (This consists of rhythmic variations in intensity occur- 
ring in cycles, each cycle showing a gradual decrease in the intensity of 
the respiratory movements, followed by total cessation for a space of 
from five to forty seconds. This is succeeded by a gradual increase of 
the respiratory movements until they reach a maximum and become 
dyspneeic in character.) 

The course of the disease is rapid in severe cases; death usually occurs 
in five or six days or even sooner. Except in mild cases, the mortality 
is very high, and we frequently find that an entire litter of puppies may 
succumb to the affection.- In the virulent form death may occur in two 
days. 

TREATMENT.—Various forms of treatment have been tried, but with 
little or no success. Drastic measures simply accelerate the fatal ter- 
mination. Every kennel-man possesses a supposed specific for the 
affection, and patent medicine vendors. dispose of large amounts of 
“sure cures” for “the yellows,” securing thereby large profits at the 
expense of gullible dog-breeders. The jaundice being only a symptom 
of the disease, it is clear that in order to adopt rational treatment the 
cause of this symptom must be ascertained. Hence, in our present state 
of knowledge, therapeutical measures are simply empirical and rarely 
prove of value. Calomel administered in alterative doses and repeated 
three or four times daily until purgation ensues has been regarded by 
some authors as a sheet-anchor in this affection. In some cases we have 
observed recoveries after its administration, but in the majority death | 
has followed its use. In the virulent form, accompanied by continuous 
vomiting, treatment of any kind is likely to fail. Obviously, when in- 
vagination of the intestine occurs, medicinal treatment is useless, and 
operative measures, even if the presence of the lesion were recognised, 
would not be indicated in the depressed and weakened state of the animal’s 
system. It is clear that any treatment to prove successful must be 
carried out early, before invagination develops or prior to the occurrence 


DISEASES OF THE LIVER: DOG AND CAT 585 


of profound intoxication of the nervous centres. In cases where vomiting 
is @ prominent symptom, chloretone may be administered in the form of 
powder placed on the back of the tongue; acetozone is also worthy of trial. 
In our experience, subcutaneous injections of normal saline solution 
administered in large amounts give better results than any other form 
of treatment; they act as a cardiac stimulant, and also promote elimina- 
tion of toxic materials from the system. When persistent vomiting is 
present, it 1s useless administering drugs per os. The long array of 
medicinal agents advised for the treatment of this affection is to be 
attributed to the erroneous idea that obstruction of the bile-duct is the 
etiological factor present, and that efforts must be directed to overcome 
this condition. a has had success with the following treatment: 
Apomorphine (gr. ;!; to gr. ;';) is first administered hypodermically, so 
as to empty the stomach of food, mucus, and probably also to cause 
evacuation of the contents of the gall-bladder, while by its secondary 
action it controls the retching. The following mixture is then prescribed: 


BR Liq. hyd. perchlorid. ty ee eel 
Tr. cinchone co. .. He i mda Ale 
Syr. rhamni . a: a Merit 
Aq. chloroformi .. ne u Bily adhgit 


F.M. Sig.: To be given every four hours for the first day until 
purgation is nduced, then the Syr. rhamni is to be omitted. 
After the first day the mixture is to be given three times 
daily. The above doses are suitable for a dog of the size of a 
fox-terrier. The dog should be kept warm, and the diet 
should consist of Brand’s essence of beef, and milk mixed 
with lime-water or soda-water. When diarrhoea associated 
with the passage of mucus and blood is present, enemata 
containing sulphocarbolate of zinc or dilute sulphuric acid may 
be given. 


Bissauge recommends the administration of boldine in the form of 
granules three times daily. .The dose advised is 5 to 8 milligrammes. 
Livesey has found the following agents useful in some cases: Hyposulphite 
of soda administered in solution, well diluted; salol in solution, with small 
doses of dilute phosphoric acid; solution of acetozone. The success 
which has attended the Re ere tion of trypan-blue in canine piro- 
plasmosis (see Vol. I.) suggests that this agent should be given a trial 
in enzootic jaundice. As, however, examinations of the blood in the 
latter affection have, up to the present, proved negative, it 1s not to 
be expected that the above agent would give good results. We have 


Veterinarian, 1897. 


586 SYSTEM OF VETERINARY MEDICINE 


tried it in one case without any success; but further investigation may 
demonstrate that enzodtic jaundice depends on the presence of a parasite 
in the blood. Researches in this direction are urgently required, as the 
affection causes enormous losses in the British Isles, and it is not to the 
credit of the profession that we are unable to advise either preventive 
measures or a successful method of treatment. 

Acute Yellow Atrophy of the Liver.—This may occur as the result 
of poisoning by phosphorus. Hutyra and Marek state that it is one 
of the pathological conditions of the liver which gives rise to jaundice 
in the dog, but they give no further details on the subject. Cadéac 
states that it may occur in the dog, and when met with it is usually 
associated with parenchymatous nephritis. Law records the following 
symptoms: Muscular tremors, a rise of temperature to 105° or 106° F., 
jaundice, panting, foetid breath, diarrhoea, bile pigments in. the urine, 
oliguria or anuria, extreme prostration, and, when suppression of urine 
is present, death occurs in two or three days. 

Treatment proves useless. 

Acute Catarrh of the Bile-Ducts—Synonyms.—Catarrhal He iMate: 
Angiocholitis. 

Under this heading are included catarrhal inflammation of the ter- 
minal portion of the common bile-duct, of the entire duct, and of the 
finer ducts within the liver. As to the frequency of the condition there 
is some difference of opinion. Some authors state that it is associated 
with the majority of cases of jaundice in the dog; others are positive that 
it is a comparatively rare cause of icterus. We have already remarked, 
when discussing enzodtic jaundice, that catarrh of the bile-duct associated 
with gastro-duodenitis was seldom present; but clinical experience 
teaches us that cases of gastritis presenting symptoms of doubtful etiology 
are met with, and during their course jaundice may develop; on post- 
mortem, catarrhal inflammation of the stomach and duodenum is found, 
but we have never observed any obstruction to the bile-duct, as de- 
scribed by the majority of authors, nor has bile been absent from the 
intestine, nor the gall-bladder distended, such as one would expect to 
find if the duct was obstructed by catarrhal inflammation and swelling 
of the mucosa, or from a swollen condition of the ampulla of Vater. 
However, the views of those observers who claim to have found catarrh 
of the duct due to extension of a gastro-duodenal catarrh must receive 
some consideration. Amongst other etiological factors which are 
alleged, we may mention obstruction of the common duct by a plug of 
mucus, the presence of gall-stones or of parasites, and obstruction of the 
ampulla of Vater by a malignant growth. Probably microbial infection, 


DISEASES OF THE LIVER: DOG AND CAT 587 


entering by way of the duct from the intestine, is the important factor in 
setting up catarrh of the ducts. 

Morsip Anatomy.—The following lesions are recorded by Cadéac: 
Catarrhal inflammation of the stomach and duodenum, which extends 
to the common duct and to the cystic duct. In chronic cases the biliary 
canals and the common duct are dilated, and the gall-bladder may be 
atrophied, and shows the presence of a thick mucus adhering to its walls. 
The biliary canals, in addition to being dilated, show a sclerotic thicken- 
ing of their walls, and contain an exudate very rich in mucin. Various 
alterations may occur according to the severity of the case, and include 
suppurative and ulcerative lesions of the canals, leading to perforation, 
perihepatitis, and peritonitis. 

In the cat the same author has observed a peculiar lesion of the liver, 
consisting of a large cyst on the posterior aspect of the organ. This 
originates from dilatation of the ductus choledochus and of the larger 
extrahepatic canals, associated with cystic transformation. 

Symptoms.—There are no special symptoms beyond those common 
to other hepatic affections. Jaundice is present when complete obstruc- 
tion of the common duct occurs. When gastro-duodenitis is the leading 
lesion, persistent vomiting is observed. 

TREATMENT.—Similar therapeutical measures to those advised for 
enzootic jaundice may be employed. If gastritis be present, treatment 
suitable to this condition should be prescribed. 

Cholecystitis—Inflammation of the gall-bladder is described by 
some authors as occurring in the dog, and depending on the presence of 
foreign bodies, biliary calculi, and parasites. The lesions are believed 
to depend on the entrance of micro-organisms. The condition is said 
to be also met with in cases of septic metritis. The affection cannot be 
recognised during life, and hence is of no clinical importance. 

Gall-Stones.—The majority of authors regard biliary calculi as of 
rare occurrence in the dog, but Woodroffe Hill states that they are not 
infrequently met with. C. French says they are extremely rare. Ac- 
cording to Friedberger and Froéhner, the condition occurs more frequently 
in the dog and ox than in other animals. Cases have also been met with 
in the cat. The calculi may be found in the gall-bladder, in the cystic 
duct, or in the common duct. They are generally of a greenish tint, and 
- vary in size from a pea to a small nut. 

Symproms.—When the calculi are of small size and do not cause 
obstruction of the ducts, no symptoms may be manifested. Colicky 
pains associated with vomiting and jaundice are observed when a calculus 
becomes lodged in one of the ducts, but if only the cystic duct be involved, 


588 SYSTEM OF VETERINARY MEDICINE 


the latter symptom may be absent. When the common duct is com- 
pletely obstructed, the jaundice is well marked, and the feces are pale 
or clay-coloured ; but in many instances biliary lithiasis is found as a 
surprise at the autopsy. According to C. French, diagnosis is impossible 
except an exploratory laparotomy be carried out. 

TREATMENT.—The hypodermic injection of morphine is indicated to 
relieve the pain, and possibly to overcome the spasmodic contraction of 
the obstructed duct. Olive oil in large doses is advised to increase the 
flow of bile, with a view to flush out the duct and thus to promote the 
passage onward of the calculus. When the common duct is firmly 
obstructed, cholagogues are contra-indicated; all agents reputed to dis- 
solve the calculi are useless. In one instance Parascandolo performed 
laparotomy, and removed three calculi from the cystic duct; recovery 
was complete in four weeks. 

Congestion of the Liver.—This is a popular term employed to desig- 
nate certain obscure conditions associated with digestive derangements, 
but in reality, so far as active hypereemia of the liver is concerned, we 
have no definite clinical knowledge. Its presence is assumed rather 
than demonstrated. 

Passive congestion of the liver (nutmeg liver) occurs in connection with 
valvular diseases of the heart, also in certain affections of the peri- 
cardium, pleuree, and lungs, and is frequently met with. The lesions 
resemble those described as occurring in the analogous affection in the 
horse. The symptoms are hypertrophy of the liver detected by a physical 
examination, pain on palpation, and ascites. Icterus may or may not 
be present, but, according to Cadéac, bile pigments are generally present 
in the urine without any evidences of jaundice. The other symptoms 
depend on the nature of the primary disease. 

TREATMENT.—This will depend on the prominent symptoms dis- 
played. Ascites must be relieved by paracentesis abdominis and the 
internal administration of potassium iodide. The accompanying cardiac 
disease is to be treated according to the indications present. 

Rupture of the Liver.—This lesion may occur in the dog as the result 
of external injuries, kicks, etc., especially when the organ is the seat of 
fatty or amyloid degeneration. Its most frequent cause is injury in- 
flicted as the result of being run over by a motor-car or other heavy 
vehicle. It may be associated with rupture of the diaphragm. Cadéac | 
records cases following the presence of sharp foreign bodies, such as 
needles, also in conditions of excessive hyperemia associated with endo- 
carditis and the presence of hemorrhagic infarcts, and in various intoxica- 
tions of the system. 


DISEASES OF THE LIVER: DOG AND CAT 589 


The symptoms are obscure, and when the rupture is extensive, death 
— occurs rapidly from internal hemorrhage. 

Acute Parenchymatous Hepatitis—In works devoted to canine 
medicine, acute inflammation of the liver appears to be a very favourite 
term, but the symptoms ascribed to the condition are either those com- 
mon to many hepatic affections, or else not suggestive of any special 
disease. According to Friedberger and Fréhner, parenchymatous hepa- 
titis may change into acute yellow atrophy after phosphorus-poisoning, 
septicemia, or various infectious diseases. These authors also remark 
that the affection is of subordinate importance clinically, owing to the 
difficulty in diagnosis, and also as it usually represents secondary changes 
in various infectious diseases or in cases of poisoning. Hutyra and Marek 
state that susceptibility to pressure over the region of the liver, evidence 
of pain during defecation, and finally jaundice, indicate acute hepatitis, 
provided the history of the case is in agreement with such a diagnosis. 
According to these authors, diagnosis can be made earliest in the dog. 
The causes suggested are toxic agents or micro-organisms, which reach 
the liver by way of the portal vein from the intestine, or by way of the 
bile-duct. Cases are recorded in which a primary hepatitis occurred in 
association with gastro-intestinal catarrh. According to Miiller, the 
symptoms presented are: evidences of gastric catarrh, pain on palpation 
of the hepatic region, and icterus. 

If the presence of the condition be suspected, the treatment indicated 
is the administration of mild saline purgatives, and attention to diet; 
the food should be light and restricted in amount. From the above 
description, however, it seems hardly likely that a definite diag- 
nosis can be made, and probably in the large majority of cases the symp- 
toms will receive attention rather than the actual condition that is 
present. 

Suppurative Hepatitis—This condition is occasionally met with in 
the dog as the result of the presence of foreign bodies in the liver, phle- 
bitis of the portal vein, pyemia, septicemia, and, according to some 
authors, from the effects of external injuries, such as blows, kicks, or 
wounds. The abscess may be single and voluminous when due to 
traumatic causes, but when metastatic the lesions are multiple and small 
in size. When depending on the presence of a foreign body, the pus is 
foetid and of a reddish or greenish colour. The symptoms are obscure. 
Rigors, febrile phenomena, icterus, increase in the area of hepatic dulness, 
and enlargement of the right hypochondriac region, associated with 
tenderness on palpation, may be observed. In a case observed by Cadéac, 
in which a needle was lodged in a hepatic abscess, rabiform symptcms 


590 SYSTEM OF VETERINARY MEDICINE 


were manifested. Rupture of a large abscess may occur into the peri- 
toneal cavity, followed by a fatal peritonitis. Medicinal treatment is 
useless. If the condition can be diagnosed, surgical measures may be 
attempted. 

Chronic Interstitial Hepatitis (Cirrhosis of the Liver).—This is a 
condition of common occurrence in the dog and cat, especially in aged 
animals. The various forms of cirrhosis as described in the equine 
section are met with in the dog, and although in some cases a diagnosis 
can be arrived at by a careful examination of the patient and a con- 
sideration of the history of the case, there are many instances in which 
the lesion is only discovered at the post-mortem examination. 

Etrotocy.—In many instances nothing definite is known with refer- 
ence to the etiological factors. Many causes are suggested, such as 
lack of exercise, excessive feeding, microbial infection from the intestine, 
etc. According to Cadéac, it is impossible to ascertain the exact patho- 
genesis of the affection. Chronic inflammation of the walls of the bile- 
ducts and extension of the inflammatory process from the interlobular 
and intralobular bile-ducts to the interstitial tissue, leading to an increase 
in this latter structure, are regarded as the etiological factors in that 
type of the disease known as biliary cirrhosis. According to Hutyra and 
Marek, engorgement with bile may lead to impairment of nutrition in 
the epithelium of the bile-ducts, and thus permits bacterial invasion, 
succeeded by the production of fibrous tissue in the surrounding hepatic 
parenchyma; or the tissue production may depend on the injurious effects 
of the biliary engorgement on the hepatic cells. Hepatic abscess and 
tuberculous lesions may be followed by either a localised or a diffuse 
cirrhosis. According to Friedberger and Froéhner, cirrhosis may be 
associated with valvular diseases of the heart, leading to chronic venous | 
congestion of the liver. Livesey has found that cirrhosis is very fre- 
quently the result of chronic valvular disease of the heart, and is generally 
associated with interstitial nephritis. This is also Gray’s experience, 
and he has observed chronic asthmatic bronchitis as a common com- 
plication. 

Morsip Anatomy.—The lesions have already been described in the 
equine section. Cirrhosis is frequently associated with fatty degenera- 
tion. Congestion of the kidneys, interstitial nephritis, and hypertrophy 
of the spleen may be present as complications, also evidences of chronic — 
gastro-intestinal catarrh. Ascites is often present. Livesey has found 
that in the cat, cirrhosis of the liver is very often associated with the 
formation of huge cystic enlargements of the organ; interstitial nephritis is 
frequently present, but valvular disease of the heart is comparatively rare. 


DISEASES OF THE LIVER: DOG AND CAT 591 


Symptoms.—In many instances advanced lesions may be present 
without any special symptoms being manifested. Jaundice is generally 
absent during the development of the disease, but may sometimes be 
observed during the later stages. The affection runs a slow, insidious 
course, and may only present vague symptoms of a digestive disorder. 
In the hypertrophic form the enlargement of the liver can be detected 
by palpation and percussion. According to Hutyra and Marek, the 
enlargement extends downwards and backwards, usually reaching the 
umbilical region, and also in a forward direction on the left side. These 
authors point out that marked reduction in the size of the organ is some- 
times indicated by a decrease in size of the area of hepatic dulness, and 
that in such cases the liver can be felt from the costal arch only, but its 
firm consistency and uneven surface can be detected. Ascites is often 
present and may be extensive; in some cases it is the most prominent 
symptom and the first to be observed. In the later stages cedematous 
swellings of the inferior abdominal wall and limbs may occur. Chronic 
gastro-intestinal catarrh (due to interference with the portal circulation) 
is evidenced by attacks of vomiting and diarrhcea. In some cases en- 
largement of the spleen can be detected by palpation. Emaciation is a 
common symptom, and Mayhew drew attention to the rapid manner 
in which a fat dog suffering from cirrhosis of the liver falls off in con- 
dition. In old dogs the external abdominal veins are enlarged, dilated, 
and tortuous. Congestion of the rectal and anal veins, with swelling 
of the anus, is often present. Hzmorrhoids may sometimes be observed. 
In the advanced stages the emaciation, with the “ pot-bellied ” appear- 
ance of the animal, is the clinical picture presented, but this also occurs 
in cases of tuberculosis, carcinoma of the liver, neoplasms of the omentum, 
and ascites due to chronic cardiac and renal affections. 

The differential diagnosis is carried out by practising paracentesis 
abdominis (in cases where ascites is present), and then ascertaining the 
condition of the liver by palpation and percussion. An examination of 
the urine for the presence of bile pigments also gives assistance. 

Although, with suitable treatment, temporary improvement may occur, 
the disease always terminates fatally. 

TREATMENT.—T his can only be symptomatic and palliative. Ascites 
must be relieved by carrying out paracentesis abdominis at intervals as 
required. Saline aperients are indicated. Occasional doses of grey 
powder may prove useful. Potassium iodide may be given, but its value 
is doubtful. Livesey has found phenolphthalein administered in the 
form of pill, to prove useful in some cases. Cardiac complications must 
be treated according to the symptoms presented. In the case of valuable 


592 SYSTEM OF VETERINARY MEDICINE 


pet dogs the operation of omentopexia may be tried. This consists in 
suturing a portion of the great omentum between the oblique muscles 
of the abdominal wall, and thus establishing a collateral circulation 
between the portal and systemic vessels. 

Nodular Necrosis of the Liver.—According to Hutyra and Marek, this 
is of quite exceptional occurrence in the dog. Cadéac describes cases of 
the affection associated with infectious enteritis, distemper, and intoxica- 
tions. The symptoms were partially masked by those of the primary 
disease. Nephritis was generally present. Icterus, anuria, or oliguria, 
fever, extreme depression, and constitutional disturbance, foetid diar- 
rhoea, and difficult respiration were observed. The disease developed 
rapidly, and death occurred in a few days. The nature of the affection 
was not suspected during life, and was only revealed at the post-mortem 
by a microscopical examination of the liver. 

The treatment advised is the administration of intestinal antiseptics, 
such as salol, benzo-naphthol, or salicylate of soda. 

Fatty Liver.— This condition is not uncommon in aged, over-fed 
dogs in fat condition and getting little exercise. It also occurs in associa- 
tion with other pathological conditions of the liver, such as tuberculosis, 
carcinoma, cirrhosis, poisoning by phosphorus, etc. Continental authors 
describe a nodular fatty hepatitis, in which yellowish or reddish-yellow 
nodules of various sizes and of a soft, friable consistence are found in the 
liver, associated with extensive fatty deposits in the mesentery and 
omentum. | 

Gowing* recorded a case in a Skye terrier, twelve years of age, in 
which the liver was three or four times larger than normal, pale yellow 
in colour, and on section showed a granular surface. Microscopical 
examination revealed that no normal liver cells were present; “‘ the entire 
structure was filled with fat globules, which not only occupied the interior 
of the cells, but existed everywhere in the tissue of the part.” Fatty 
degeneration of the heart and congestion of the spleen were also present. 
In the cat the condition often occurs as the result of the ingestion of 
phosphorus paste, which has been laid down for the destruction of rats, 
beetles, etc. 

There are no characteristic symptoms. Cadéac states that the abdo- 
men may be pendent, resembling the appearance seen in ascites, and that 
a false sensation of fluctuation may be present on palpation. 

Treatment is useless. 

Amyloid Degeneration of the Liver.—This, as in the horse, is generally 
a secondary condition, and depends on similar etiological factors. Rabe 


* Veterinarian, February, 1870. 


DISEASES OF THE LIVER: DOG AND CAT 593 


has observed the lesion in a bitch associated with carcinoma of the 
udder. 

Diagnosis is impossible, and treatment is useless. 

Neoplasms of the Liver.—These are more frequently met with in the 
dog than in other animals. In consequence of the obscure character of 
the symptoms, tumours of the liver are of more interest to the pathologist 
than to the clinician. | 

Carcinomata.—These may be primary or secondary. The primary 
form is generally adeno-carcinomatous in type. Cases are recorded in 
which the lesions originated in the pancreas and in the ampulla of Vater, 
and invaded the liver, causing obstruction to the passage of bile and 
giving rise to icterus. 

SyMproMs.—These are neither constant nor characteristic. Marked 
emaciation, anemia, foetid breath, and, in some cases, obstinate vomiting, 
are observed when the disease has made some progress, Loss of subcu- 
taneous fat, and atrophy of the muscular system, especially of the tem- 
poral and masseter muscles, occur, giving the animal a peculiar physi- 
ognomy. Icterus may occur in some cases, but is absent in others. 
Ascites 1s a common symptom. Palpation may reveal the enlarged liver 
and the presence of nodules on the organ, or the hypertrophied condition 
of the mesenteric glands. Percussion and auscultation on the posterior 
area of the right lung may show that the enlarged liver encroaches on 
the thoracic cavity. Cadéac records cases in which the hypertrophied 
organ caused an external projection on the inferior aspect of the right 
flank just posterior to the last rib. 

Tuberculosis of the liver may give rise to similar symptoms. 

Livesey has met with several instances of carcinoma of the liver 
in the cat. In one case the neoplasm invaded the duodenal wall and the 
pancreas. No symptoms were, observed until the disease was far 
advanced. 

Sarcomata.—In the large majority of instances the lesions are second- 
ary; they resemble in appearance tubercular lesions of the liver. We 
have met with cases in which, beyond gradual emaciation and an enlarged 
condition of the abdomen, no symptoms were observed. In other 
instances symptoms similar to those met with in carcinomata are present. 

Angiomata.—These are occasionally met with; they may be in the 
form of single tumours or multiple and diffused. In colour they are 
purplish or brownish, and, as in the horse, they may show on section a 
cavernous appearance. Spontaneous rupture may occur, causing death 
from internal hemorrhage. Cadéuc regards these tumours as having a 
tuberculous origin. 

VOL. II, 38 


594. SYSTEM OF VETERINARY MEDICINE 


Lipomata.—Trasbot recorded a case in a bitch of lipoma of the liver. 
Two tumours were present, one being of enormous size. The parenchyma 
of the organ was entirely destroyed and replaced by the neoplasms. 

Tuberculosis.—T uberculosis is a common lesion of the liver in the dog 
(sec Vol. I.). The lesions macroscopically may simulate those of car- 
cinoma of the liver. 

Parasites of the Liver.—See the section on Parasites. 


BIRDS. 


Tuberculosis is a common lesion of the liver met with in birds (see 
Vol. I.). Necrotic foci of the organ, in connection with many infectious 
processes, are of very frequent occurrence in birds other than the domestic 
poultry, and are often mistaken for tuberculosis. 

Inflammation of the Bile-Ducts and Gall-Bladder.—Cases of angio- 
cholitis and cholecystitis are recorded in birds. Larcher met with an 
instance in a cock in which the gall-bladder contained a mucilaginous 
liquid composed almost exclusively of mucus and only a very small 
amount of biliary constituents. 

Fatty Liver.—T his is not uncommon in highly fed birds allowed only: 
little exercise. 

Rupture of the Liver.—Johne has frequently observed this lesion in 
fatty and amylaceous livers of well-nourished fowls and geese. It is 
also met with in cases of tuberculosis of the liver. 

Amyloid Degeneration.—This is met with in fowls and pheasants, 
and, according to Cadéac, it generally depends on tuberculosis. Hutyra 
and Marek remark that the liver, on section, is found granular and brittle. 

Neoplasms of the Liver.—Secondary sarcomata have been recorded 
by Cadiot. Ratz has met with cases of lipomata in the liver in birds. 


DISEASES OF THE PERITONEUM IN THE 
HORSE 


By J. J. O'CONNOR, M.R.C.V.S., 
Professor of Surgery, Royal Veterinary College of Ireland, Dublin. 


PERITONITIS. 


General Remarks.—The term “ peritonitis” signifies inflammation of 
the peritoneum, but it is also employed to designate the train of symp- 
toms resulting from septic inoculation of the peritoneal cavity, wherein 
it may cause very little inflammatory reaction, the severity of the systemic 
disturbance being almost inversely proportional to the degree of inflam- 
matory phenomena. In many instances the affection is more of a peri- 
toneal septicemia or toxemia from septic absorption through the serous 
membrane than a peritoneal inflammation. When the peritoneum is 
attacked by pathogenic organisms, the infection has a great tendency to 
become diffused, owing to the constant contamination of different parts 
of the membrane in consequence of the mobility and frequent change of 
position of many of the abdominal viscera, which bring successive areas 
of non-infected peritoneum into contact with infected parts. Apart from 
these causes, a virulent peritonitis spreads readily by continuity and by 
the lymphatic system. When the invading organisms are of more or 
less feeble virulence, the healthy peritoneum prevents diffusion of the 
infective process by throwing out an inflammatory fibrinous exudate. 
This causes adhesion between affected parts, and forms a cordon round 
the infected region, which thus remains localised. 

When the bacteria are more virulent, the peritoneum is unable to 
arrest their progress, and merely shows an inflammatory reaction, This 
varies in intensity in different cases according to the amount of resistance 
offered by the peritoneum, and the duration of the disease. Organisms 
of very exalted virulence entering the peritoneal cavity completely over- 
come its powers of defence, and may cause death from hyperacute peri- 
tonitis, or peritoneal septicemia, or toxeemia, in a very short time (twelve 
to twenty-four hours), without leaving marked local changes in the serous 
membrane. The inflammatory reaction is the manifestation of Nature’s 

595 


596 SYSTEM OF VETERINARY MEDICINE 


method of combating the morbid process. The cases in which this 
reaction is so pronounced as to localise the area of infection are those in 
which the animal may recover from the general effects of the disease; 
but when the infection becomes widespread through inability of the 
peritoneum to cope with it by the agency of inflammatory phenomena, 
it proves fatal. 

It is now an established fact that peritonitis is always caused, directly 
or indirectly, by micro-organisms. Cases of peritonitis have been seen 
which were due to toxic absorption from septic neighbouring tissues, 
such as strangulated bowel, without bacteria reaching the peritoneum, 
the disease being due entirely to the toxins which they elaborated in the 
vicinity. This was proved by the fact that the peritoneal inflammatory 
effusion was found to be sterile. Cases of this kind are known as 
‘* chemical peritonitis.” 

The liquid effused into the abdominal cavity as the result of inflamma- 
tion of the peritoneal serous membrane has a salutary effect in diluting 
the bacterial toxins and inhibiting the growth of the organisms by the 
antibodies which it contains. This is similar in effect to Bier’s hyper- 
emic treatment of septic indolent wounds, whereby they are sometimes 
rendered sterile in a few days. Hence drainage of the exudate in a case 
of peritonitis is of doubtful benefit, except in so far as it removes a 
certain amount of the septic material from the peritoneal cavity. It is 
different with entravasated blood, which favours the growth of bacteria, 
and thus frequently acts as an indirect cause of peritonitis. Mechanical, 
physical, or chemical, non-infective irritants can, according to Bumm, 
give rise to peritonitis; but they probably act chiefly as predisposing 
causes by injuring the abdominal or intestinal walls, through which 
organisms can then pass from the outside or from the alimentary tract 
respectively into the peritoneal cavity, and excite the disease. Peri- 
tonitis from any other exciting cause than infection is so rare, if it exists 
at all, that it need not be considered in discussing the disease. The 
normal peritoneum possesses properties or peculiarities which have an 
important bearing on the phenomena following its infection. Its area 
is very great, being equal, according to Wegner, in man to that of the 
integument of the body, or 17,000 square centimetres, and it has a 
remarkable power of absorption equal to 3 to 6 per cent. of the body- 
weight. Hence one can easily understand the intensity of the con- 
stitutional disturbance when this structure suffers from general infection. 
From this vast surface serious reflexes originate (described by Giibler 
under the name of “ peritonism”’), “whose point of departure is at the 
peritoneal or subserous nerve terminals, whose centripetal transmission 


DISEASES OF THE PERITONEUM: HORSE 597 


follows the solar plexus, and whose centrifugal effects reach the heart and 
- respiratory centre.”’ 

The peritoneum offers considerable resistance to infection, the degree 
of resistance varying in different species of animals, and even in different 
individuals of the same species. There are certain conditions which 
greatly facilitate the bacteria in overcoming this power of defence—for 
example, mechanical, physical, or chemical irritation of the peritoneum, 
such as rough handling, too long exposure during an abdominal opera- 
tion, or the use of strong antiseptics. Hemorrhage into the peritoneal 
cavity has a well-known effect in favouring the onset of peritonitis, 
whilst constitutional affections like diabetes, rheumatism, nephritis, or , 
any serious disturbance of health, diminish the resisting-power of the 
subject, and render him more suceptible to the disease. 

Within the last twenty years the progress of pathology, bacterio- 
logy, and abdominal surgery has abolished the old classification of 
‘idiopathic’ peritonitis in contradistinction to “traumatic” peri- 
tonitis, and practically transferred the disease from the domain of 
medicine to that of surgery, its origin being in most cases associated with 
surgical conditions. Except where the peritonitis is a local manifesta- 
tion of a general affection like tuberculosis or some other special bacterial 
disease, there is little ground for considering it from any but a surgical 
standpoint. 

The course of peritonitis may be acute or chronic. An exudate partly 
‘fluid and partly solid characterises the acute form; adhesions or fibrous 
thickenings, with or without some inflammatory effusion, is characteristic 
of the chronic form. Acute peritonitis affects all animals; chronic 
peritonitis is rare in the horse, and more common in the ox, pig, and 


dog. 
I. Acute Peritonitis. 


Etrotogy.—Acute peritonitis is due to primary or secondary infec- 
tion of the abdominal cavity. The peritoneum is protected from inflam- 
mation so long as micro-organisms are excluded, for even when exten- 
sively wounded no appreciable inflammation occurs in the membrane 
provided that it is not contaminated by pathogenic organisms. This is 
exemplified in the castration of abdominal cryptorchids and in ovari- 
otomy of mares, performed with careful aseptic and antiseptic precau- 
tions. Jalaguier and Mauclaire have shown that an aseptic roll of gauze 
or an aseptic sponge enclosed in-the abdominal cavity of a dog proved 
harmless, and after a time became enveloped in false membranes. 

The susceptibility of the horse to peritonitis is explained by his 


598 SYSTEM OF VETERINARY MEDICINE 


receptivity generally to the organisms of suppuration. That acute in- 
flammation of the peritoneum cannot occur without the presence of 
microbes can be demonstrated by comparing the effects of inoculating 
a culture medium with ascitic fluid and with some of the inflammatory 
exudate from a case of peritonitis respectively, the medium remaining 
sterile in the former, and showing numerous growths in the latter case. 
Research for the purpose of ascertaining the kind of organisms contained 
in the peritoneal inflammatory exudate has shown that the morbid 
reaction, as well as the clinical aspect of peritonitis, depends more on the 
quantity of organisms introduced than on their specific nature. The 
disease 1s often due to a mixed infection, so that it would not be prac- 
ticable to classify it according to the organisms causing it. The most 
convenient way of discussing the etiology of peritonitis is to deal with 
the mode of entrance of the infecton into the peritoneal cavity as 


follows: 
1. By the blood-stream. 


2. Through the abdominal wall, as in traumatic peritonitis, or 
that following an abdominal operation. 

3. From the alimentary tract. 

4. From the uterus in a case of metritis, or through a per- 
foration of the organ during parturition. 

5. From an extra- or intra-abdominal purulent cyst by the 
organisms passing through its wall, or escaping into the 
abdominal cavity when the cyst or abscess ruptures. 


1. By tHE Bioop-Stream.—This port of entrance for infective organisms is 
normally closed and rarely opened, cases of primary peritonitis being only excep- 
tionally met with. The microbes reach the peritoneum in this case as the result 
of a general infection and a predilection of the organisms for this serous membrane. 
Bacteriological analysis has shown that the organisms which flourish in the peritoneal 
cavity are staphylococci, streptococci, diplococci, and the Bacillus coli communis, and 
they are responsible for most cases of peritoneal inflammation. The Bacillus coli 
is normally present in the intestinal tract of all animals. When taken from healthy 
bowel it is non-pathogenic, but when the intestine becomes the seat of disease, 
obstruction, strangulation, or inflammation, the bacillus at once becomes virulent, 
and, passing through the diseased intestinal wall, gives rise to peritonitis. There 
are, of course, conditions which render the peritoneum, like other tissues, more 
susceptible than usual to the effects of bacteria circulating in the blood-stream, 
such as mechanical, physical, or chemical interference with the membrane, or the 
presence of fluid (except normal saline), especially extravasated blood, in the serous 
cavity. All the peritoneal infections indirectly due to exposure to cold have been 
described under thename of “‘spontaneous,” “‘idiopathic,” or “‘rheumatic peritonitis.” 
Cold from rectal injections, long exposure to rain or cold winds, when sweating, the, 
ingestion of cold moist food (cold drinks, green food covered with frost or cold dew), 
from sudden immersion in cold water, or from any other cause, may permit the 
entrance into the system of infective agents, or give rise to peritonitis in subjects 
already infected. 

But in all cases the entrance of bacteria is indispensable; without them cold may 
cause congestion, but never inflammation. The expe1imental production of peri- 


DISEASES OF THE PERITONEUM: HORSE 599 


tonitis under the influence of cold has never been effected. The association of the 
two pathogenic influences—cold and micro-organisms—enables one to understand 
' the rare or doubtful cases where peritonitis has been observed to supervene after 
exposure to severe cold. 

2. THROUGH THE ABDOMINAL WAtLL.—The entrance of disease-producing germs 
through the abdominal wall determines the peritonitis following penetrating. 
accidental, or operation wounds of the abdomen. The disease may arise either 
from penetration of the abdominal wall by a septic object, such as a fork, a shaft, 
an ox’s horn, etc., the organisms being introduced by the offending body, or from 
subsequent bacterial invasion of the cavity through the opening in the abdominal 
wall, or from both sources. Sometimes the perforation involves the intestine, 
when a diffuse peritonitis usually results, owing to escape of intestinal contents ; 
but on other occasions a local peritonitis ensues, followed by adhesion of the bowel 
to the abdominal wall at the seat of the lesion, and the formation of an intestinal 
fistula, complete recovery eventually taking place. Infection of the peritoneum 
during an abdominal operation may occur from some defectin the aseptic precautions, 
or it may supervene afterwards when the operative interference has been for the 
relief of some affection of the bowel whereby its vitality has been lowered, and 
microbes from the lumen of the viscus have been enabled to pass through its wall 
into the peritoneal cavity, as, for example, in a case of strangulated hernia. Peri- 
tonitis following an operation may be at first local, with the formation of adhesions 
and the occurrence of suppuration. After several days, or even several weeks, 
the lesion becomes generalised, owing to the pyogenic organisms invading other 
parts of the abdominal cavity through the rupture of an abscess, or through the agency 
of the lymphatic system. On the other hand, the infection may be so virulent at 
the outset that generalised peritonitis makes its appearance within two days after 
the operation. Enterotomy by means of a fine trocar and cannula is never com- 
plicated with peritonitis if the usual antiseptic precautions are observed. 

PERITONITIS AFTER CASTRATION.—Infection of the peritoneum through the 
castration wound in the male frequently supervenes when the operation has been 
performed without due attention to cleanliness or antisepsis, and it has often 
occurred in an enzo6tic form. In 1830 Texier saw 200 out of 2,000 horses castrated 
at Caen. perish from peritonitis. In 1838 Lacaste lost 42 out of 62 horses operated 
upon. The complication is more common in some districts than in others, although 
the same precautionary measures have been taken in each case. Peritonitis as a 
sequel to castration usually appears on the second to the sixth day after the operation, 
rarely on the eighth to the tenth day, exceptionally after fifteen days, one month, 
two months (Gourdon), or nearly three months (Langeron). The organisms which 
cause this peritonitis are streptococci and the bacilli of malignant edema. Strepto- 
cocci must frequently contaminate the castration wound, but it is only in a small 
minority of cases that they reach the peritoneum, their passage being arrested at 
the level of the points of contact of the cord with the tunica vaginalis. They may, 
however, penetrate beyond this level, gain the peritoneal cavity, and give rise to 
a peritoneal septicemia, which has often been ascribed to infection by the 
Vibrion septique. Cuillé saw peritonitis and other lesions of streptococcic septi- 
cemia follow the castration of a cryptorchid, showing that the streptococcus 
organism, as well as the bacillus of malignant cedema, is capable of setting up a 
septicemic peritonitis when it enters the body through the wound caused by 
castration. 

In the absence of systematic bacteriological investigation it is impossible to state 
the proportion of cases of peritonitis following castration caused by each of these 
organisms. For many years it was believed that this form of the disease, mani- 
festing as it does the general symptoms produced by infection with the organism of 
malignant cedema, was invariably due to this organism. Although in many cases 
it is the infecting agent, the local symptoms characteristic of malignant oedema com- 
plicating other wounds are always wanting in the castration wound. The probable 
explanation is that after castration the malignant oedema bacillus has only to 
traverse the castration wound, or the injured and badly defended tissues, to multiply 
in the peritoneal cavity, thus causing no characteristic local reaction. Sanla has 
demonstrated this bacillus in the lesions of peritonitis following castration. The 


600 SYSTEM OF VETERINARY MEDICINE 


malignant cdema organism is very resistant to antiseptics, and this affords an 
explanation of the enzodtic outbreak of peritonitis which sometimes occurs after a 
series of castrations in the same locality. In many cases the disease is probably 
caused by the streptococcus of strangles, and the fatalities following castration, 
when either the animal is already infected with strangles, or the operation wounds 
subsequently become infected, are well known to practitioners (see ‘Strangles, 
Vol. I.). Ovariotomy in the mare may in a similar way be followed by infection of 
the"peritoneum. 

3. By THE ALIMENTARY TRAoT.—The digestive tract is a fruitful source of 
peritonealinfection. Bacteria may emerge from the intestines without any apparent 
perforation to invade the peritoneum and produce their pathogenic effects there. 
Wurtz and Hudelo have proved this experimentally. By subjecting animals to the 
action of severe cold and by poisoning them by different substances, they have 
observed the passage of the Bacillus coli communis, streptococci, and numerous 
anaérobic bacteria into the peritoneum without any solution of continuity in the 
intestine. As already indicated, many cases of so-called idiopathic peritonitis 
originate in this way, the pathogenic orgainsms having migrated through the 
intestinal walls when they have been damaged, or when their circulation or nutrition 
has been interfered within any way. Injuries of the abdomen, kicks, horn-thrusts, 
or other contusions, may cause a lesion of the bowel wall without appreciable altera- 
tion in the skin or muscles of the abdominal parietes. In this way a local fibrinous 
peritonitis may be produced. It is quite different when there has been a rupture or 
perforation of the alimentary tubs enabling the organisms contained within it to 
inundate the peritoneum, and cause peritonitis of a very virulent type. The stomach 
suffering from distension, or affected with abscesses due to strangles, may rupture 
as the result of a shock on the abdomen, such as may be caused by a fall or any 
violentimpact. The alimentary matter, with its flora, becomes scattered in variable 
quantity throughout the serous cavity, and produces a fatal peritonitis. The 
duodenum may be perforated by ascarides, or it may give way when obstructed by 
masses of these parasites, or a solution of continuity may be caused by ulceration or 
malignant disease, or it may be penetrated by hard foodstuffs, like straw, lucerne, 
etc., especially if there be a lesion of the mucous membrane from ulceration or other 
cause. In each of these cases the way is opened for infection of the peritoneum, 
and a form of peritonitis supervenes, whose nature depends on the amount and 
virulence of the germs which have gained entrance to the peritoneal cavity. Pointed 
foreign bodies in the food, such as portions of wire or nails, may easily perforate some 
part of the alimentary canal, and lead to generalised peritonitis. New growths and 
ulceration giving rise to peritonitis are most common in the vicinity of the ileo- 
cecal valve. The point of the cecum may be perforated by foreign bodies in its 
interior, or it may rupture when weakened by inflammation, or abscesses, or ulcera- 
tion in its walls, or when distended by its contents, or subjected to violent impact, or 
involved in a penetrating abdominal wound. 

The large colon is the most common seat of rupture or perforation which is pre- 
disposed to or actually caused by fatty degeneration, tumours, or abscesses affecting 
its walls, by hardened fecal contents, calculi, twist, strangulation, falls, or external 
injuries. Oalculi or hardened feces may cause solution of continuity of the small 
colon. 

The p2ritoneal infection is always profuse and widespread when it originates 
in the anterior part of the intestinal tract, but when it follows perforation of the 
rectum or small colon, a more limited formh of the disease may ensue. 

These cases of secondary peritonitis are very rapidly evolved and very virulent 
in type, on account of the immense number and variety of organisms gaining access 
to the abdominal cavity through the opening in the viscus (V2brion septique, staphylo- 
cocct, streptococci, Bacillus coli, and para coli). The rectum is another source of 
peritonitis when perforated in that portion which has a peritoneal covering. It ' 
may be ruptured by the penis of the stallion during copulation, by incautious 
exploration, by the tube of the clyster syringe, by manipulation by laymen, or 
maliciously. 

4, From THE Uterus.—According to Ligniéres, the Staphylococcus albus and 
aureus are normally and constantly present in the uterus. Other organisms, like the 


DISEASES OF THE PERITONEUM: HORSE 601 


streptococcus and colon bacillus, may also be present accidentally, or arrive in the 
organ at the time of parturition. Some or all of these organisms may gain access to 
- the peritoneum through a rupture in the uterus or anterior part of the vagina, or, 
during an attack of metritis, through the Fallopian tubes or lymphatic vessels, and 
cause a more or less virulent form of puerperal peritonitis. 

The bladder when over-distended is liable to rupture as the result of jumping, 
falling. or contusions, the accident being followed as a rule by generalised peritonitis. 

5. From A PURULENT ABDOMINAL Oyst or ABscESs.—Strangles, or other abscesses 
in the mesentery or abdominal organs, may rupture into the abdominal cavity, and 
cause a rapidly fatal peritonitis. Before the abscess is mature, or during its for- 
mation, there is a local peritonitis, with adhesion of the part containing the abscess 
to the neighbouring structures. The pus from the centre may infiltrate the sur- 
rounding tissues into the peritoneum, and thus cause peritonitis without rupture of 
the wall of the abscess. . 

‘Abscesses of the abdominal wall following traumatic injury and infection may 
open into the peritoneal cavity. St. Cyr recorded a case in which the pus from an 
abscess in the sheath reached the peritoneum. The abscess which occasionally 
forms in the scrotal or inguinal region after castration may in a similar way 
determine a generalised peritonitis. 


New growths of the peritoneum and suppurative lesions of the ovaries, kidneys, 
liver, or spleen, may also cause septic infection of the peritoneal cavity. Purulent 
affections of the thorax may determine peritonitis by the infection spreading through 
the lymphatics of the diaphragm. The propagation of organisms through the 
diaphragm, however, is more readily effected from the peritoneum to the pleura than 
vice versd. Infection may also occur from microbic infiltration through the 
diaphragm. 

Morsip ANATOMy.—The lesions involve the peritoneum and abdominal 
organs. They are hardly appreciable when death occurs in twelve to 
twenty-four hours, but they are well marked when it is deferred for three 
or four days. 

The Peritoneum.—tThe parietal and visceral peritoneum is red and 
covered with a serous, sero-purulent, purulent, or putrid exudate, and 
with false membranes. The redness never occurs alone, except the peri- 
tonitis has not passed the stage of congestion. It corresponds to the 
beginning of the irritation, before fluid exudate or false membranes are 
observed. The surface of the serous membrane is studded with ecchy- 
moses, and it is marked by red lines and arborisations, which are usually 
most pronounced at the level of the spaces between the intestinal con- 
volutions. The peritoneum is the seat of an interstitial exudate. It is 
blurred, opaque, thickened, and rough on its surface. 

The coils of small intestine become agglutinated together, and 
adherent to the great omentum, thé large intestine, and the abdomina 
walls. 

The false membranes are formed about twenty-four to thirty-six 
hours after the onset of the disease. They appear first’as villosities or 
small bands at the points of contact of the intestinal coils. They glue 
together the different parts of the intestine or float in the inflammatory 
fluid. They are delicate at first, but afterwards become organised, and 
form a permanent fibrous union between the parts of the intestine which 


602 SYSTEM OF VETERINARY MEDICINE 


come in contact, or between the bowel and the diaphragm, liver, spleen, 
or abdominal wall. These bands of new tissue may fix and immobilise 
a portion of intestine in an abnormal situation, where it may become 
strangulated or kinked, so as to form an obstruction of the bowel. The 
colour of these membranes is at first yellowish; it afterwards becomes 
of a greyish-red, and finally white, which is their permanent colour when 
their development is complete. 

The exudate may be serous, sero-purulent, purulent, inodorous, or 
putrid. It varies notably in quantity, being almost absent in certain 
cases of hyperacute peritonitis (dry peritonitis), but often very profuse 
(30 to 40 pints) in less acute forms of the malady (exudative peritonitis) , 
When the exudate is serous it is always in considerable amount, and 
resembles somewhat ascitic fluid. The sero-purulent exudate is of a dirty 
yellow or reddish-yellow colour. It may attain 25 pints in quantity, 
and holds in suspension flakes of fibrin. It occupies the dependent parts 
of the abdominal cavity and the spaces between the coils of intestine. 

The purulent effusion is generally the sequel of the rupture of an abscess 
into the abdominal cavity. Its origin may be found in the remnant of 
an old pus cavity whose advanced stage of organisation is evidence that 
it existed for a considerable time before the peritonitis set in. A common 
seat of this abscess is the mesentery, where the lesion may equal in size 
a man’s head. Its wall is often hard and fibrous; it may even grate to 
the knife when cut, and may be honeycombed by spaces containing a 
white creamy pus more or less mixed with blood. The abscess is usually 
due to strangles. It is frequently suspended in the sublumbar region, 
and is adherent to the small intestine, to the large colon, to the kidney, 
spleen, liver, pancreas, or diaphragm, or binds together portions of the 
bowels. 

The putrid effusion is usually indicative of perforation of the bowel, 
It is greyish or reddish, foetid, and may contain gas, alimentary débris, 
feecal matter, urine, worms, or foreign bodies, depending on the nature 
of the case. 

Abdominal Organs.—The surfaces of the abdominal organs show the 
lesions described as affecting the peritoneum. The bowels are frequently 
tympanitic. The small intestine is often very irregular in calibre, 
showing successive constrictions and dilatations in its course. The new 
membranes uniting the intestines between themselves and to the ab- 
dominal wall or other abdominal organs may become partially absorbed, 
or may bring about inflammation, softening, and perforation of the intes- 
tinal walls. The liver and spleen are paler than normal, their capsules 
are thickened and opaque, and their serous covering is inflamed. 


DISEASES OF THE PERITONEUM: HORSE 603 


In the stallion the testicles and the tunica vaginalis may be involved 
_In the morbid process in a similar manner to the abdominal contents. 

The lesions of septicemia are seen when the peritonitis has been due 
to perforation of the intestine, and the evidences of a more or less recent 
castration are observed when the disease has followed this operation. 

Symproms.—Peritonitis, whatever its cause, is characterised by a 
group of constitutional and physical or local symptoms peculiar to the 
affection. 

Constitutional Symptoms.—The disease is usually ushered in by 
partial or general shivering. Inspection of the patient at once reveals 
the gravity of his condition. The expression of countenance is anxious, 
the head is lowered and often resting on the manger, the lips are tightly 
closed, there is a fixed far-away look in the eyes, which are glassy or 
brilliant in appearance. The attitude of the patient is indicative of 
intense suffering. He stands persistently in the same position. When 
made to move, he does so very reluctantly and with difficulty, the move- 
ment apparently causing pain. The back is arched, the hind-limbs 
somewhat straddled, and the dorso-lumbar region is held stiffly like a 
board. 

The constitutional disturbance is very severe. The fever is intense 
and continuous. The temperature may be 105° or 107° F., the pulse 
80 to 130 per minute, small, hard, and wiry at first, afterwards becoming 
rapidly thready and almost imperceptible. The mucous membranes are 
pale or of a dirty yellowish, dark red colour, and when the dyspneea is 
pronounced they are cyanotic. The skin is dry and hot, and the animal 
seems in a state of profound depression. 

The toxins elaborated by the organisms multiplying in the peritoneal 
cavity are absorbed, passing by osmosis into the rich network of lym- 
phatics and veins of the serous membrane, producing fever by their 
thermogenic power, and reacting on the central nervous system with 
symptoms of depression, respiratory and cardio-vascular troubles. 

The pain is intense, and subject to paroxysms. It results from irrita- 
tion of the abdominal nerves (splanchnic and terminations of the phrenic), 
and is exaggerated by intestinal movement and by the least shock on the 
abdomen, such as may be caused by a manual examination of its walls or by 
the act of coughing. If the patient is overcome by fatigue, he lies down 
carefully on the side, with the under hind-limb extended backwards, so 
as to avoid pressure by it on the abdomen. He groans on the act of 
lying or rising, and occasionally even when standing, but especially if 
made to move. 

The abdominal pain is of the nature of severe continuous colic, which 


604 SYSTEM OF VETERINARY MEDICINE 


is not manifested by violent external symptoms. The animal occasionally 
paws the ground, looks round at his sides, half opens his mouth, or grinds 
his teeth. He never throws himself about, as in ordinary colic, rarely 
assumes the dorsal position, and never flexes and extends the limbs 
suddenly, except there is a twist of the bowel present. The spasmodic 
‘movements which may be seen in the peritonitis following castration are 
the result of compression of the nerves of the spermatic cord, and are 
independent of the peritonitis. Constipation is usually a constant symp- 
tom during the first few days of the disease, in consequence of the paralysis 
of the intestine, for every muscle subjacent to the inflamed serous mem- 
brane is paralysed, and this want of power in the intestine is also followed 
in most cases by a certain degree of tympany. Sometimes, however, the 
paralysis does not occur, and a persistent diarrhoea may then take the 
place of the constipation. 

The bladder becomes paralysed in the same way as the intestines, 
with symptoms of dysuria. The animal frequently whisks the tail and 
ejects only a small quantity of highly-coloured urine. These abnormalities 
in the urine are due to the feeble power of absorption of the intestine 
and the diminished secretory power of the kidneys, brought about by 
the action of the toxins on the nervous and circulatory systems. 

The respiratory movements cause pain, hence the respirations are 
superficial, incomplete, and consequently more frequent than normal, 
being 70 per minute in some cases, and chiefly costalin type. The animal 
endeavours to immobilise the diaphragm in order to relieve the pressure 
which it causes on the abdominal organs at each respiratory effort. 
Inspiration is very short and insufficient. Symptoms of dyspnoea may 
supervene, owing to immobility of the diaphragm, to diminution of the 
thoracic cavity consequent on the peritoneal effusion and the tympany, 
which push the diaphragm forwards, and to the weakened action of the 
heart. Every movement is difficult and painful, and when the patient 
is made to walk there is marked straddling of the hind-legs. Sweat 
sometimes bedews the body, there is complete loss of appetite, and the 
abdomen increases In size due to tympanites, which distends the flanks from 
the second or third day of the attack. Vomiting (Roll) or eructation is 
seldom observed, and hiccough from inflammation of the diaphragm is 
a rare symptom (Anacker). 

Physical Symptoms.—After peritonitis has set in the appearance of. 
the abdomen alters. It becomes “ tucked up,” hard, and resistant, as an 
instinctive means of protection to the inflamed surface within its cavity. 
This symptom, however, is not permanent, as it soon becomes effaced by 
the tympany. Pressure on the abdominal wall causes great pain, which 


DISEASES OF THE PERITONEUM: HORSE 605 


has no chief centre of localisation. Palpation reveals the tension and 
marked hyperesthesia of the abdominal wall, and the patient resents it 
by turning round his head or by moving away. The pain on palpation 
is superficial and continuous. It may at first be confined to the point of 
origin of the peritonitis, and afterwards become generalised. 

It is of little significance from a diagnostic point of view in irritable 
or nervous horses. Hxamination of the rectum finds it full of hard, dry 
pellets of feeces covered by mucus. 

Percussion of the abdomen causes a sonorous tympanitic sound, due 
to distension of the bowels with gas. Except a considerable quantity of 
fluid is formed in the peritoneal cavity, its presence may not be diagnosed. 

CouRSE AND TERMINATION.—The rapidity with which the symptoms 
develop depends on the extent and severity of the peritonitis—that 1s, 
on the degree of septic intoxication, which varies according to the number 
and virulence of the microbes which have infected the peritoneum. 

From this point of view two principal forms of peritonitis may be 
considered—viz., pyogenic peritonitis and septic peritonitis—each of which 
may be subdivided into several varieties. 

Pyogenic Peritonitis.—Pyogenic peritonitis is that form of the disease 
caused by pus-forming organisms, whether they reach the peritoneum by 
the blood-stream or any other route. Its onset is preceded by a history 
of exposure to chill, by an accidental or operation wound, by the rupture 
of an abscess, or by some local or general disease. Its symptoms are 
typical of an inflammatory affection. It is chiefly due to streptococci 
and staphylococci, which, secrete toxins and cause leucocytic invasion 
and a more or less profuse fibrinous exudate. 

The local reaction preponderates, and is characteristic of this infec- 
tion, but all the forms of purulent peritonitis are not productive of the 
same local phenomena. The more virulent the organisms, the less 
marked the local reaction, and vice versa. Between the hyperacute and 
subacute forms of peritonitis there are many intermediary forms. The 
peritoneum combats the microbic invasion by the agency of phagocytosis 
and antitoxins. The abundant solid exudate tends to localise and restrict 
the infective process. Death may supervene from the fourth to the 
eighth day. At its approach the tympany becomes excessive, the 
respirations become laboured, the pain diminishes and disappears, com- 
pression of the abdomen is not resented by the patient, and if constipa- 
tion has been present it is now replaced by diarrhea. This is the usual 
termination of acute peritonitis. It may occur in a few hours after the 
commencement of the disease from reflex action on the respiratory and 
circulatory centres (the “‘ peritonism” of Gibler). At the autopsy in 


606 SYSTEM OF VETERINARY MEDICINE 


this latter case there is only found a generalised congestion of the peri- 
toneum. The disease may become chronic. When the inflammation is 
localised the acute symptoms gradually subside, and the condition ter- 
minates in ascites and the formation of adhesions. Resolution is rare, 
and need not be counted upon. The absorption of the exudate is usually 
incomplete, and adhesions are formed which may cause stricture or 
strangulation of the bowel. 

Septic or Putrid Peritonitis—This form of the disease includes the 
peritonitis due to gastro-intestinal rupture or perforation, and that 
resulting from a wound communicating with the abdominal cavity— 
e.g., that following castration—the causal organisms being the colon 
bacilli, very virulent streptococci, and the bacilli of malignant cedema. 

The symptoms here are almost exclusively general, the local symp- 
toms being only of secondary importance. The toxemia characterised 
by the depression and collapse of the patient supervenes almost im- 
mediately. The subject is affected with rigors, extreme weakness, and 
prostration, the eyes are haggard and staring, the skin is often cold, and 
the sensibility of the abdomen is often nil. The abdominal walls may 
be forcibly compressed from the first without provoking any resistance, 
the patient showing an air of indifference. The fever is moderate and 
sometimes absent, the animal is in a state of complete collapse, the body 
may be covered with cold sweats, and the pulse is quick and weak. 
When the disease follows castration, the animal may stand persistently 
in one spot, and show no evidences of abdominal pain. Swelling may be 
absent from the region of the operation wounds, but there is generally a 
discharge of a thin, sanious, foetid character. The respirations are 
irregular and very accelerated. The abdomen becomes rapidly distended 
by tympany, and when the peritonitis is the result of perforation of the 
alimentary canal, death occurs within a few hours without any appre- 
clable lesion in the serous cavity. There are sometimes the local symp- 
toms of malignant cedema at the point of origin of the peritonitis—i.e., 
the wound in the abdominal wall. 

The course of putrid peritonitis is very rapid. The animal may suc- 
cumb, especially in the case of perforation of the intestine, in less than 
twelve hours. He may live twenty-four or forty-eight hours, or even 
four or five days, as in the case of infection following castration, where 
it is less pronounced and less complex. All cases of peritonitis resulting » 
from perforation are not of a putrid nature; sometimes they are purulent. 
A very small perforation, or one which is quickly filled up with a fibrinous 
exudate, is followed by a general intoxication and by very marked local 
phenomena. 


DISEASES OF THE PERITONEUM: HORSE 607 


Puerperal Peritonitis.—See Metritis and Metro-Peritonitis, p. 638. 

DIFFERENTIAL D1AGNnosis.—The symptoms of purulent peritonitis are 
not very diagnostic in all cases. The subdued symptoms of colic at the 
commencement of the attack are common to many forms of intestinal 
obstruction. The constant standing in a “ huddled-up ”’ position is very . 
characteristic, and, combined with the fever.and profound dejection and 
indifference of the patient to his surroundings, may be the only symp- 
toms indicative of the disease when it is a sequel of castration or any 
operation involving the surgical opening of the abdominal cavity (hernia), 
and they are quite sufficient, under such circumstances, for a positive 
diagnosis. 

In other cases the history of the case, the persistent standing, the 
pallor of the conjunctiva, and the fever generally, may enable us to dis- 
tinguish it from enteritis. 

The respiratory and circulatory phenomena are not likely to cause 
confusion with pneumonia or pleurisy, as an examination of the thoracic 
and abdominal cavities will decide. Traumatic or operative peritonitis 
is suspected shortly after the accident or operation which has permitted 
the peritoneal infection, and its course and development can be followed 
as if it were an experimental inoculation. 

Most cases of peritonitis resulting from the rupture of an abscess or 
perforation of the alimentary tract are not recognised, their course being 
too rapid to be observed, or they are masked by the general symptoms 
of the primary affection which gave rise to the peritonitis. 

Prognosis.—This is very grave in all forms of acute peritonitis. The 
mortality is high, and treatment seldom proves successful. 

TREATMENT.—Preventive treatment consists in observing the usual 
rules of surgical cleanliness and antisepsis in operations upon the ab- 
dominal cavity and in castration, and the careful antiseptic treatment 
of perforating abdominal wounds through which infection has not 
already gained entrance. 

When the disease exists, treatment comprises medical and surgical 
measures. Medical treatment has for its main object either increased 
action of the bowels or arrest of their peristalsis. 

The rationale for inhibiting intestinal movements is to prevent dis- 
semination of the infection throughout the serous membrane, and in the 
case of perforation of the bowel to arrest the further passage of intes- 
tinal contents through the opening into the peritoneal cavity. The 
most effective drug for this purpose is opium or morphine. In a case of 
generalised peritonitis, or when the disease is due to perforation of the 
intestine, etc., there is little ground for adopting this method of treat- 


608 SYSTEM OF VETERINARY MEDICINE 


ment except for the purpose of relieving suffering, as the termination 1s 
always fatal. The frequent exhibition of medicine by the mouth, except 
in the form of electuary, is not advisable, owing to the weak condition 
of the patient. The most convenient and efficient way of relieving pain 
—to some extent, at least—is by the hypodermic injection of morphine 
combined with hyoscine hydrobromide. Although the use of these drugs 
may afford some relief, and consequently give one the impression that 
the patient is improving, they are of very doubtful benefit. They really 
lower vitality, and the apparent improvement which sometimes follows 
their use is deceptive. According to Treves, a hypodermic injection of 
strychnine in the human patient has a stimulating and reviving action, 
thus affording a greater sense of relief than morphine. A sedative effect 
may also be produced by a rectal injection of a solution of chloral hydrate 
or belladonna. ) 

Medication causing increased action of the bowels is contra-indicated 
when the peritonitis is localised, as the intestinal movement would tend 
to diffuse the infection, and it can have little effect as an eliminative in 
a case of peritonitis where the toxins of the disease have already invaded 
the system. 

Purgatives, however, are indicated in cases of intestinal obstruction 
acting as the cause of the peritonitis, owing to bacteria or their toxins, 
or both, passing through the weakened and paralysed bowel wall into the 
peritoneal cavity. Their good effect is explained by their action in 
removing the reservoir of the virus. Calomel is the drug most in vogue 
for this purpose, being an intestinal antiseptic as well as a hydragogue 
and cholagogue. It should be given in small doses, frequently repeated. 

Bleeding from the jugular vein may be adopted in a sthenic subject to 
relieve excessive inflammatory reaction in the peritoneum, but in the 
majority of cases the depression of the patient contra-indicates such a 
measure. 

Locally hot compresses, frequently renewed, may be applied to the 
abdomen, but their efficacy is doubtful. On the Continent cold in the 
form of ice-bags or compresses kept cold by repeated irrigation with cold 
water is recommended. 

The application of counter-irritants to the abdomen may be tried, 
such as mustard paste, etc.; but their value is very doubtful, and they 
only tend to annoy the patient. 

Surgical Treatment—When tympany is severe, puncture of the 
cecum or colon will give some relief from abdominal pain and from 
dyspnoea. 

If an abdominal purulent cyst in contact with the abdominal wall be 


DISEASES OF THE PERITONEUM: HORSE 609 


diagnosed, it should be opened early to prevent its rupturing into the 
abdominal cavity. Laparotomy for the treatment of ruptured or per- 
forated bowel or other primary sources of the disease, with irrigation and 
drainage of the abdomen, have no chance of success in the horse. 

In the peritonitis following castration, treatment of any kind generally 
proves useless. 

II. Chronic Peritonitis. 

GENERAL RemMarKs.—Chronic peritonitis results from acute localised 
peritonitis characterised by adhesions which have prevented the spread 
of the infection, and kept within narrow bounds the reservoir of the 
virus. Occurring generally at the periphery of the liver, spleen, kidney, 
or a loop. of bowel, the lesion in these cases is usually slight, giving rise 
as a tule to little constitutional disturbance. The condition may also 
be brought about by a localised but permanent lesion affecting the 
peritoneum, such as a neoplasm or a tuberculous centre, from which 
peritonitis gradually extends throughout the serous cavity, the process 
being sufficiently slow to enable the patient to offer more or less resistance 
to its general effects. This form of peritonitis assumes the nature of 
ascites. Chronic peritonitis may therefore be classified as follows: 


1. Chronic local peritonitis. 
2. Chronic diffuse peritonitis. 


Chronic Local Peritonitis—Etiotocy.—A bscesses and tumours of the 
stomach, intestines, liver, spleen, mesenteric lymphatic glands; aneurisms 
of the posterior aorta and mesenteric arteries; ulceration of the intestine ; 
enteritis, metritis, ovaritis, recent or old hernie; castration of males and 
females and of cryptorchids; and surgical puncture of the large bowel, 
may be followed by localised adhesive peritonitis. Severe injuries of the 
abdominal wall, such as may be caused in collisions or by objects pene- 
trating it, may cause a local peritonitis with adhesion of the intestine to 
the abdominal wall. Foreign bodies entering the peritoneal cavity may 
become encysted, and cause no inconvenience to the subject. Circum- 
scribed peritonitis may follow the treatment of hernia by suture or by 
the application of caustics. 

This form of peritonitis may have a good effect in preventing the 
invasion of the rest of the abdominal cavity by septic organisms, and in 
offering resistance to prolapse of the bowel through a narrow opening. 
But occasionally, after remaining localised for weeks or months, it may 
become generalised. 

Morzsip ANATOMy.—Local peritonitis in the horse usually assumes 
the chronic form, seldom the acute form, The lesions comprise abnormal 

VOL. II. 39 


610 SYSTEM OF VETERINARY MEDICINE 


adhesions or marked thickening of the serous membrane, which close up 
openings and limit and isolate the inflammatory centres. The affected 
serous membrane may show ecchymoses or abnormal vascularity, and 
may be covered with granulations, or be the seat of fibrous plaques, bands, 
and filaments. Local peritonitis affects the serous membrane of the liver, 
also in many cases that of the spleen, diaphragm, ovaries, stomach, 
umbilical region, and epiploon. In these cases the lesion may consist 
entirely of a chronic phlegmonous inflammation of the omentum or of a 
chronic inflammation of the mesentery, with fibrous tissue - enclosing 
bloodvessels, nerves, lymphatic vessels, and glands, constricting a portion 
of the intestine, and accompanied by a series of cysts with fibrinous and 
serous contents. The posterior face of the diaphragm is the predilection 
seat of organised false membranes in the form of plaques and filaments. 
Serous cysts may also be found in this situation. 

Symproms.—Usually there is no history to account for these lesions. 
When the condition is the result of a direct injury, some symptoms of its 
onset may be noticed, such as contraction of the abdominal wall and 
circumscribed pain, but no marked signs of general disturbance are 
observed. These symptoms soon attenuate and disappear, thickening 
and adhesions are formed, and the inflamed area becomes encysted in 
fibrous tissue, which acts as a barrier against further invasion of the 
peritoneum, whilst on the other hand it sometimes causes death by 
leading to strangulation of the intestine. 

Diacnosis.—The diagnosis is often very difficult or impossible. 
Rectal exploration may enable one to recognise fibrous bands resulting 
from the local peritonitis, but in the mare these are said to be much 
more readily detected by passing the hand directly into the peritoneal 
cavity through an opening made in the anterior part of the vagina. 

TREATMENT.—In rare cases laparotomy per vaginam or in the flank 
may permit the clinician to insert his hand into the abdomen, and break 
down adhesions causing constriction of a loop of bowel. Needless to 
remark, such an operation is not likely to be attempted in general 
practice. | 

Chronic Diffuse Peritonitis—HtT1oLocy.—Chronic peritonitis is always 
secondary, and is very rarely generalised. Lesions of chronic peritonitis 
are frequently seen on post-mortem examination of aged horses. Equines 
may be affected with diffuse symptomatic peritonitis resulting from 
melanosis or malignant tumours. Other causes only give rise to a local 
form of the disease. Acute peritonitis in the horse very seldom gets an 
opportunity of becoming chronic. Cadéac records a remarkable case of 
chronic peritonitis in which the stomach was intimately adherent to the 


DISEASES OF THE PERITONEUM: HORSE 611 


spleen and liver, and the latter to the diaphragm, the liver being enclosed 
in a fibrous capsule, the cavity of the stomach lessened in extent, and 
the lower abdominal wall infiltrated with serum and fibrin. 

Symproms.—The symptoms are chiefly those of digestive trouble 
possessing no characteristic features of the disease in question. We may 
observe loss of appetite, constipation followed by a profuse intermittent 
diarrhcea, and subdued colic, which becomes more marked alter the 
animal has partaken of a full feed. Constitutional disturbance is not 
very pronounced. There is a slight rise in temperature, and the pulse is 
quick and weak. Examination of the abdominal walls reveals some 
abnormal sensibility. It is difficult to distinguish the affection from 
simple ascites when there is a large quantity of effusion and no rise in 
temperature. 

TREATMENT.—-Treatment is generally of no avail, and will vary 
according to the cause and symptoms of the malady. Slight repeated 
purgation is indicated to overcome the constriction of the intestines 
caused by the false membranes. Frequent small doses of sulphate of 
soda or sulphate of magnesia may be administered. Diuretics should be 
given to promote the elimination of absorbed products from the system, 
and to limit the effusion into the peritoneal cavity. Potassium iodide in 
full doses may be tried. It is also advisable to stimulate the functions 
of the liver and to prevent stasis of the blood in the mesenteric vessels. 

A combination of digitalis, salicylate of soda, bicarbonate of soda, 
and gentian, is recommended by Cadéac. Nutritious, easily digested food 
is always necessary. 

ASCITES. 

Synonym.—Abdominal dropsy. 

GENERAL REMARKS AND Eriotocy.—Ascites is the name given to 
dropsy of the peritoneal cavity, and it is a symptom common to different 
organic affections. The transuded fluid is serous, non-inflammatory, 
and sterile. It is common in the dog, and rare in the horse, ox, sheep, 
goat, and pig, occupying an intermediate position between these animals. 
The condition may result from— 

1. Debilitating affections, such as leucocythemia. 

2. Mechanical obstruction acting directly or indirectly on the portal 
circulatory system, such as tumours of the liver, spleen, or pancreas; 
atrophic cirrhosis of the liver or kidneys; disease of the heart; chronic 
lung affections; and compression of the posterior vena cava or of the 
portal system by tumours or enlarged lymphatic glands. 

3. Affections of the peritoneum involving the fine branches of the 
portal system (tumours, tuberculosis). 


612 SYSTEM OF VETERINARY MEDICINE 


Chronic affections of the circulatory system interfering with the return 
of the blood may produce ascites, such as chronic endocarditis causing 
valvular incompetency. Tumours of the liver, sarcoma, and carcinoma, 
also cause ascites by impoverishing the blood, and by pressing on the 
branches of the portal vein. Ovarian cysts may have the same effect by 
compressing the posterior vena cava or the iliac veins. 

Morpip ANAToMy.—The presence of the fluid in the abdominal cavity 
and alterations in the aspect of the peritoneum constitute the lesions of 
ascites. The quantity of fluid may be 25 to 50 or even 100 to 150 pints. 
It is clear, lemon-coloured, and albuminous, and has a specific gravity 
of about 1012. It is neutral or slightly alkaline in reaction, and may 
contain some leucocytes and red blood-cells. It is rich in water, and poor 
in mineral matter and albumin. . 

The peritoneum is pale and attenuated, and has a washed appearance. 
It may be covered with multiple tumours of varying size, usually sarco- 
matous in nature. The abdominal wall is diminished in thickness, 
atrophied, or cedematous. The diaphragm is decolorised, and the intes- 
tines may be constricted. Cardiac or vascular lesions which gave rise to 
the dropsy may be encountered. 

Symproms.—Ascites is slow and insidious in its origin. The gradual 
manner in which the effusion takes place into the abdomen, the great 
capacity of the latter, and the absence of constitutional symptoms until 
the condition is far advanced, render its diagnosis difficult or impossible 
in the early stages of the affection. When the quantity of accumulated fluid 
is large, its presence 1s revealed by physical and functional phenomena. 

Physical Symptoms.—The most striking physical symptoms are the 
increase in size of the abdomen and the alteration in its contour. It 
appears to be drawn downwards, and distended in its inferior portion. 
The hypochondriac regions are carried outwards, the flanks are lowered, 
and appear flatter than normally, owing to the tension exerted upon them. 
The skin on the inferior region of the abdomen is tense and smooth, and 
the hind-limbs are cedematous. 

Palpation of the abdominal wall elicits the most characteristic symp- 
toms of the affection—namely, fluctuation. Raising the abdomen with 
the knees or with the two hands, or placing one hand flatwise on the 
abdominal wall and giving it a series of short thrusts or shocks with the 
other hand, or, better, by the hands of an assistant on the opposite side 
of the abdomen, gives a sensation of fluctuation or undulation in the 
abdominal fluid. The hand inserted into the rectum feels a similar 
fluctuation when the lateral aspect of the abdomen is vigorously and 
rapidly compressed by an assistant. 


DISEASES OF THE PERITONEUM: HORSE 613 


Percussion of the abdominal wall reveals complete dulness in the 
lower part of the abdomen limited superiorly by a horizontal line, above 
which there is resonance. Auscultation while fluctuation is produced by 
an assistant detects a sound of waves of liquid breaking against the 
abdominal walls. 

Functional Symptoms.—There are two varieties of functional dis- 
turbance, one being due to the ascites and the other to the affection 
with which the ascites is associated. The former only will be dealt with 
here. The effects of the effusion in the peritoneal cavity are due to the 
pressure 1t causes on the abdominal organs and, through the diaphragm, 
on the lungs. The results are that digestion and the movement of the 
ingesta are rendered difficult, the liver and spleen become anemic, the 
inspiratory capacity of the lungs is diminished, and the posterior vena 
cava and portal vein are pressed upon, retarding the circulation, pro- 
ducing symptoms of cedema in dependent parts, and of pulmonary and 
cardiac dyspnoea. The pulse is weak and thready, the heart-beats are 
tumultuous, the mucous membranes are pale, the respirations are quick 
and shallow, and the patient remains standing to avoid the asphyxia or 
syncope likely to result in the recumbent position. 

Course, Duration, TERMINATION.—Ascites, being only a symptom 
of a disease, depends for its prognosis upon the latter, which is usually 
an incurable organic affection. The ascitic fluid may increase rapidly or 
slowly in quantity, or apparently remain stationary, but a permanent 
cure of the condition is out of the question. 

Diacnosis.—Inspection, palpation, percussion, and auscultation, 
reveal the presence of abdominal fluid, while abdominal puncture shows 
its nature, and, taking into account the absence of fever, confusion with 
peritonitis 1s prevented. Rectal exploration distinguishes ascites from 
pregnancy, and may discover the tumours which caused the condition. 
The ease with which the rectum can be displaced from right to left when 
the hand is introduced is regarded as pathognomonic of ascites. It is 
often impossible to ascertain the disease which gave rise to the condi- 
tion. 

Abdominal tumours are sometimes so large as to simulate abdominal 
dropsy. Tumours of the liver are generally beyond the reach of explora- 
tion. Diseases of the heart may be diagnosed, and by a process of 
elimination the cause of the effusion may be arrived at. Extensive 
ventral herniz, associated with effusion into the abdominal walls, may 
simulate ascites, but the use of a fine trocar and cannula will decide the 
question. 

TREATMENT.—The only object in treating ascites is to alleviate com- 


614 SYSTEM OF VETERINARY MEDICINE 


plications to which it has given rise. This is accomplished by removing 
more or less of the fluid by aseptic puncture of the abdomen with a fine 
trocar and cannula at the linea alba midway between the xiphoid car- 
tilage and the pubis. Aseptic and antiseptic precautions are necessary 
to prevent peritonitis. All the liquid should not be withdrawn at once, 
lest the animal might collapse from a sudden fall in the blood-pressure. 
This treatment is not indicated except where a large accumulation is 
causing marked functional disturbance, as the fluid withdrawn is soon 
replaced, thereby debilitating the patient by causing a fresh drain on the 
system. Diuretics and cardiac tonics are also indicated, such as digitalis, 
potassium nitrate, and pilocarpine. Potassium iodide may be prescribed 
to reduce enlarged lymphatic glands, and cholagogues, such as calomel, 
bicarbonate of soda, salicylate of soda, and salol, are indicated to promote 
the functions of the liver. 


TUMOURS OF THE PERITONEUM. 


Tumours of the peritoneum may be primary or secondary, and benign 
or malignant. They are of more interest to the pathologist than to the 
clinician, as their diagnosis is often attended with considerable difficulty, 
and successful treatment cannot be carried out. 


I. Benign Tumours. 


Benign tumours usually develop in the omentum. They comprise, in order of 
frequency, lipomata, fibromata, myxomata, and melanomata. 

Lipomata.—Lipomata are the most common tumours of the omentum and 
mesentery. They are usually situated on the fringe of the omentum. They may be 
sessile or pedunculated, single or multiple, isolated or diffuse. 

Most of the isolated tumours are pedunculated, resembling a testicle without an 
epididymus. 

The pedicle is round, about as thick as a lead pencil (from 5 to 30 centimetres), 
long, hard, fibrous, and resistant. When the tumour surrounds the intestine its 
pedicle may strangulate it like acord. Solitary lipomata are thus a common cause of 
intestinal occlusion. They sometimes cause twist and invagination of the bowel. 

During their development these tumours possess a serous covering, beneath 
which there is a fibrous capsule enclosing a mass of fat, which may be soft, or firm 
from the pressure of fibrous tissue, and in some cases calcareous material. When the 
pedicle is ruptured, the tumour becomes free in the abdominal cavity. Usually the 
lipomata are small in size, but they may be very large, attaining a weight in some 
instances of 12 to 20 kilogrammes. They may develop in the region of the small 
intestine, the large colon, the cecum, the floating colon, or the rectum. 

Diffuse lipomata may be of enormous dimensions, enveloping the intestinal 
coils, forming lobulated masses, in which it may be difficult to recognise the intestine. 
Some of the neoplasms are composed of firm compact tissue, while others are formed of 
a loose areolar tissue, containing in its meshes a serous yellow fluid, which, when the 
tumour is placed on a table, gravitates into its dependent parts, forming a number 
of small transparent cysts. When the tumour is changed to a diametrically opposite 
position, these cysts disappear, their liquid contents passing to another situation 
and causing other little vesicles, which appear like small dilatations of the enclosing 
membrane, and give to the tumour a mulberry-like appearance. 


DISEASES OF THE PERITONEUM: HORSE 615 


Those tumours fixed to the small intestines, ceecum, or colon, compress the bowel, 
causing strictures of it, followed by dilatations, which become filled with alimentary 
matter, and finally cause death from intestinal occlusion. 

Fibromata.—The fibromata are usually very small and pedunculated, and may 
be overlooked, or are confounded with lipomata. They commonly become 
calcified before rupture of the pedicle. 

Myxomata.—Myxomata have the appearance of developing fibromata, but they 
acquire a greater size. They are simple, pedunculated, and lobulated, each lobule 
being about the size of a grape or date. 

Trasbot found a tumour of this kind in the colic mesentery. 

Angiomata.—Small angiomata are exceptionally met with on the peritoneum. 
They arise sometimes from a varicose dilatation of a large branch given off by one 
of the colic arteries, and sometimes from a varicose condition of the anterior 
mesenteric artery. 

They are formed of cysts, with walls of varying thickness, and vary in size from 
that of a pin’s head to that of a nut, communicating between themselves, and con- 
taining a reddish liquid formed exclusively of the elements of blood. Old blood- 
clots may be found in them uniformly laminated. These tumours, pedunculated or 
sessile, sometimes attain a considerable volume, up to 5 kilogrammes (Launlanie), 
and they may extend into the subperitoneal connective tissue. 

Plaques of Ossification.—These are spoken of by Wheatley and Draum as 
occurring in the intestinal wall beneath the peritoneum. They are very rare, and 
can be felt by the fingers as hard plates in the thickness of the bowel wall, varying in 
size and fracturing when forcibly compressed. They are fixed to neighbouring parts 
by branching filaments. In the vicinity of these bony plates the muscular tissue 
is atrophied. Macroscopically and microscopically they show all the characteristics 
of normal bone in various stages of development. 

Symproms.—Benign tumours of the peritoneum are seldom revealed by any 
symptom. They are discerned at the autopsy of animals dead from other causes. 
They may cause interference with digestion, with corresponding symptoms. Peduncu- 
lated tumours may encircle a portion of bowel and cause strangulation of it, but 
there is nothing to indicate that the latter is due to this cause until a post-mortem 
examination is made. 

'TREATMENT.—When strangulation due to a tumour is diagnosed, it is usually 
too late to intervene. In any case laparotomy for the removal of an abdominal 
tumour in the horse is practically certain to end in failure. 


~ JI, Malignant Tumours. 


Primary epitheliomata of the peritoneum cannot occur owing to their mesoblastic 
origin. 

Fiemme and endotheliomata are the most common malignant tumours found 
developing on the peritoneal serous membrane, but old tumours in the vicinity readily 
involve the peritoneum, spreading by means of the blood or lymph stream, or by 
ascitic fluid, which diffuses the neoplasmic elements which it contains. 

Cancerous tumours of the abdominal cavity are sometimes so adherent to 
abdominal organs that it is difficult to say whether they properly belong to these 
organs or to the serous membrane covering them. 

Epitheliomata.—Malignant epithelial tumours usually result from a generalisation 
of some of the cells of the testicle, liver, mammary gland (Beau), bladder, prostate, 
or lymphatic glands. They assume the form of pink, greyish, or whitish nodules. 
according to their size and age. They vary in size from a pin’s head to a duck’s 
egg, and occupy the surface of the abdominal wall, the mesentery, or the serous 
covering of the intestine. The peritoneum is often inflamed, and the serous cavity 
may contain a large quantity of fluid. Malignant tumours of mesodermic origin 
comprise primary tumours, like endotheliomata and lymphadenomata, rarely 
sarcomata, which are usually secondary. 

Endotheliomata.—These tumours arise from the endothelium of the serous 
membrane or of the lymphatic vessels. They form multiple, whitish, flattened 
nodules, or confluent plaques, causing a kind of neoplasmic eruption on the folds 


616 SYSTEM OF VETERINARY MEDICINE 


of the peritoneum. Some authorities describe them as cylindrical endothcliomata 
(Delamotte, Weber, Montané, and Viaud). The tumours have the volume of a 
bean, or sometimes of a hen’s egg. The peritoneal cavity contains a small quantity 
of yellowish serous fluid. 

Sarcomata.—Sarcomata are solitary, or multiple and disseminated. They are 
sometimes scattered throughout the pleura and peritoneum under the form of 
soft red enlargements, varying in size from a pea to a nut, and give rise to a sarco- 
matous pleurisy and peritonitis. 

When isolated they may attain considerable dimensions. They may weigh 
5 kilos (Mouquet), 22 kilos, 75 kilos (Cadéac), or even 100 kilos. Fixed to the 
omentum these neoplasms exert traction on the intestine, and contract adhesions 
with all the abdominal organs. On section soft spots and hemorrhagic centres are 
seen. 

Other tumours whose nature is not well determined are also found, ovoid, globular, 
or irregular in shape, and often attaining an enormous weight and dimensions 
(90 to 100 kilos). 

Symptroms.—The symptoms are similar to those caused by tumours in the 
stomach and intestines. There is loss of appetite, also pallor of the mucous mem- 
branes, dulness, emaciation, difficulty in movement, and attacks of colic. The 
colic may be continuous or intermittent, and slight or violent. Strangulation of 
the bowel or rupture of the intestines may occur. The feces vary in character: 
they may be coated with mucus, or a profuse greenish-yellow diarrhoea may be 
present. Pressure of the abdomen causes evident pain. External or rectal palpation 
may detect the presence of tumours in the abdominal cavity. The tumours may 
cause a bulging of the abdominal walls in the region of the flank, and the breathing 
may he interfered with owing to pressure upon the diaphragm when the neoplasms 
are large. The abdomen becomes enlarged owing to the presence of tympany in 
the bowels, and sometimes to an accumulation of ascitic fluid in the serous cavity. 
The patient becomes cachectic in the case of generalised malignant tumours, and 
epistaxis, with a foetid odour from the breath, may be noticed in some instances. 

Dracnosis.— Diagnosis is very difficult, except the tumours can be felt through 
the abdominal wall or per rectum, but frequently peritoneal tumours are more or 
less numerous, and can be detected on palpation through the wall of the rectum. 
The sublumbar lymphatic glands may be involved and become enlarged. If the 
tumours press on the bladder there is a constant desire to urinate, and the animal 
makes frequent attempts at micturition. When they are situated in the region 
of the stomach or duodenum they may cause vomiting. Ascites is the most con- 
stant complication. 

Prognosis.—The prognosis varies according as the tumour is malignant or 
benign, but in either case it is grave, for when diagnosis is possible, the tumour or 
tumours have attained such dimensions that treatment is useless or impossible. 

TREATMENT.—The only rational treatment is the performance of laparotomy and 
the extirpation of the tumour, an operation which in the horse, even in most 
favourable cases, is not likely to succeed. 


PARASITES OF THE PERITONEUM. 


See the section on Parasites. 


DISEASES OF THE PERITONEUM IN 
RUMINANTS 


By J. J. OCONNOR, M.R.C.V.S., 
Professor of Surgery, Royal Veterinary College of Ireland, Dublin. 


Acute Peritonitis. 


In ruminants two varieties of acute peritonitis are recognised —viz., 
diffuse fibrinous peritonitis and local purulent peritonitis. 

Diffuse Fibrinous Peritonitis—Eriotocy.—Peritonitis is not common 
in bovines, although the peritoneum is frequently subjected to traumatic 
injury and to that caused by parasites, the explanation of the apparent 
immunity being that the phagocytic power of the membrane protects it 
from the pathogenic effects of micro-organisms. Bacteria of feeble 
virulence or in small quantity are destroyed by the germicidal properties 
of the peritoneum, which only becomes vulnerable when the constitution 
of the patient is debilitated, or suffering from the effects of toxemia, or 
when there is much extravasated blood in the abdomen, or when the 
peritoneum is affected with grave lesions, the result of an accident or 
prolonged surgical intervention. As regards the so-called idiopathic 
form of the disease, similar remarks to those already made with reference 
to the affection in equines will apply. 

Traumatic peritonitis and that following operation on the peritoneal 
cavity are comparatively rare on account of—(1) The thickness of the 
skin in the ox, which renders it difficult to penetrate, and thus protects 
against peritoneal infection; (2) the susceptibility of the peritoneum in 
the ox to pyogenic and septic organisms being infinitely less than in the 
horse, as is demonstrated by the impunity with which abdominal opera- 
tions, such as gastrotomy and enterotomy, can be performed; also pene- 
trating abdominal wounds, except accompanied by the escape of alimen- 
tary matter or a large quantity of blood into the peritoneal cavity, rarely 
prove fatal. It is only absolute negligence of the ordinary rules of 
cleanliness that leads to an attack of acute peritonitis in abdominal 
operations on the bovine, provided dangerous complications do not already 


exist. 
617 


618 SYSTEM OF VETERINARY MEDICINE 


The digestive apparatus is a source of purulent, generalised, or local 
peritonitis, but seldom of a septicemic form. <A perforation of the 
alimentary tube usually becomes filled by a plug of fibrin, but when the 
infection is sufficiently virulent to produce suppuration this process 
almost invariably tends to remain localised, the pus becoming encysted. 
Septic peritonitis, in the true sense, is rarely found in ruminants, which 
are very resistant to the organisms of septicemia. Peritonitis in them 
generally commences by the production of masses of fibrin, which con- 
stantly tend to isolate and localise the inflammatory centres. These 
centres may be invaded by suppuration, but the fibrinous defensive pro- 
cess tends to encyst the pus which is produced. The inflammation has 
little tendency to become diffused or to invade the whole of the peri- 
toneum. 

The immediate, complete, hyperacute septic infections of equines are 
not observed in ruminants, and one could hardly be justified in classify- 
ing as such the infective peritonitis following gastro-enteritis in the ox and 
sheep caused by the ingestion of damaged roots or grains. The combined 
infection and intoxication in these cases overcome the powers of defence, 
and allow the micro-organisms to be spread broadcast throughout the 
whole system as well as the peritoneum, the condition being a genera] 
infection, and not a simple inflammation of the peritoneum complicating 
gastro-enteritis. 

Rupture of any part of the digestive tube (rumen, reticulum, true 
stomach) under the influence of traumatism, perforation of these organs 
and of the intestine as the result of deep ulceration or the passage of a 
foreign body, is followed by peritonitis, which may be either generalised 
or localised. The foreign body is surrounded by fibrin, and provokes a 
protective inflammation characterised by an intimate adhesion of the 
organ traversed to that about to be penetrated. This adhesion between 
the affected viscus and the abdominal wall sometimes permits of the 
passage of a foreign body from the alimentary tract through the skin 
without any appreciable complication. Rupture of the bladder is a 
most important cause of peritonitis in the ox. Under ordinary cir- 
cumstances, urine is aseptic, and exercises no deleterious effect on 
the peritoneum, as has been demonstrated by experiments on 
several animals. This explains how it is that in some instances the 
ox survives for two or three weeks after rupture of the bladder has 
occurred. Sooner or later, however, the urine becomes septic, the infec- 
tion being associated with urethral calculi, or occurring independently of 
them through the urethra; but so long as this infection is absent the 
peritoneum shows no reaction, 


DISEASES OF THE PERITONEUM: RUMINANTS 619 


The meatus urinarius of the cow’s urethra may be torn by the bull’s 
penis, and peritonitis may ensue directly, or supervene later from 
retention of the urine and consequent rupture of the bladder. 

Abscesses of the liver, abdominal wall, mesenteric lymphatic glands, 
suppurative hydatid cysts, and pyelonephritis, are causes of local and 
more rarely of generalised peritonitis. 


Puerperal peritonitis is not so common in ruminants as in other species of 
animals. It supervenes on metritis, retention of the fatal membranes or other 
putrid material, or may be the result of a puerperalsepticemia. The organisms of the 
genital passages capable of causing puerperal fever and consequent peritonitis are 
the Staphylococcus pyogenes aureus, albus, and citreus, the Streptococcus pyogenes. 
and the Bacillus coli communis. These organisms are normally inhabitants of the 
vulva of healthy animals, but are subjected to phagocytosis on entering the vagina 
or uterus. The injection into the cow’s vagina of very virulent cultures of staphylo- 
cocci, streptococci, and coli bacilli, is not followed by general disturbance, but under 
the influence of certain conditions, such as retention of the foetal membranes, the 
presence of the foetus for a long time in the uterus after rupture of the membranes, 
and wounds of the uterus or vagina, the micro-organisms of the vulva infect the 
uterus, invade the peritoneum by the lymphatics, enter the blood-stream, and may 
overpower the resistance of the patient. The lesions resulting from these infections 
are not the work of asingle variety of microbe or of aspecific organism, but of common 
bacteria, amongst which the staphylococcus and sometimes the colon bacillus assume 
the chief réle. 

Symproms.—The train of symptoms which marks the onset of acute 
peritonitis in the bovine is much less characteristic than in the horse. 
The constitutional symptoms—fever, absence of rumination, loss of 
appetite, and dulness—do not differ appreciably from those observed in 
the majority of inflammatory affections of the digestive apparatus. The 
functional disturbance is not pathognomonic. Pain in the peritoneal 
cavity is indicated by subacute colic of short duration, or which passes 
unnoticed when the septic intoxication is severe. It is usually mani- 
fested by paddling of the hind-limbs, but occasionally by more violent 
movements, during which the patient lies down and rises repeatedly. 
As the toxemia advances these outward signs of pain become less marked. 
The animal makes every effort to immobilise the abdomen, and stands 
with the back arched in order to diminish the tension on the inferior 
abdominal wall, and with the legs well under the centre of gravity for 
the purpose of relaxing the abdomen. The number of respiratory move- 
ments is increased in order to diminish their amplitude, and to substitute 
costal for diaphragmatic respiration. The patient, however, never 
presents symptoms of obvious or alarming dyspncea. The abdominal 
wall is contracted and rigid, and its tension is increased on the slightest 
touch. The flanks are distended as a result of this contraction, and the 
tympany caused by the paralysis of the gastro-intestinal tract. 

The pain revealed by palpation is not always very characteristic. 


The tympanitic sound obtained on percussion of the upper part of the 


620 SYSTEM OF VETERINARY MEDICINE 


flanks is evidence of persistent meteorism. The effusion which occurs in 
the inferior part of the abdominal cavity is only appreciable in. a few 
forms of peritonitis. Groaning is heard when tympany and colic are 
present, and is the most reliable and most constant sign of abdominal! 
pain. It may be continuous or intermittent, and is exaggerated when 
the animal is made to move or when lying down. It is heard at the 
commencement of each expiration. It would appear as if expiration had 
just commenced, then became arrested by closure of the glottis, and 
recommenced by this peculiar noise after an interval of a few seconds. 
When it ceases momentarily it can be made to reappear on simply 
flicking the animal or on palpating the abdominal wall with the 
hand, 

Auscultation reveals the suppression of intestinal peristalsis and of 
the movements of the rumen. Palpation gives similar results to those 
described in connection with equines. 

Two symptoms are said to be characteristic—viz., lachrymation and 
nasal discharge. Ocular phenomena may also result, such as con- 
junctivitis and keratitis. 

Fibrinous Peritonitis—The symptoms are similar to those met with 
in the horse, but are less acute and less characteristic. In the milch-cow 
the secretion of milk is arrested. The temperature reaches 105° to 107° F., 
the horns are alternately hot and cold, the pulse quick, weak, and wiry; 
the heart-beats are tumultuous; the respiration is laboured; and the 
animal groans at every movement. The subject walks with difficulty, 
and is reluctant to change its position. It remains lying with an anxious 
expression, or stands motionless with the back arched, the head low, 
and the limbs slightly flexed and gathered under the body. Colicky 
pains may appear, but they are subdued and not very noticeable. They 
may cause the animal to stamp the hind-feet, and rarely make it bellow. 
The coat is staring. Trembling of the muscles, especially those of the 
abdominal wall, is observed. Obstinate tympany is present, and con- 
stipation followed Jater by diarrhea. 

Rectal exploration is carried out with difficulty. The rectum is 
tightly constricted, and there is considerable trouble in introducing the 
hand and arm into it. This constitutes an important and, according to 
Fabretti, a pathognomonic symptom of peritonitis. The rectal mucous 
membrane is always covered with a certain amount of straw-coloured 
mucus. 

Course AND TERMINATION.—Sometimes the inflammation reaches its 
height in one or two days; at other times its evolution is much slower, 
and may require six or seven days for its completion. Death may super- 


DISEASES OF THE PERITONEUM: RUMINANTS 621 


vene in forty-eight hours, or from the fourth to the sixth day, or it may 
be delayed for several weeks. The premonitory signs of approaching 
death are the extremely weak, small, almost imperceptible pulse; the 
great weakness of the animal; the difficulty or impossibility of lying 
down and rising, the patient requiring a great effort to do so; the increase 
in the tympany ; and the constant groaning. 

Resolution of the exudate may take place. The infecting organisms 
disappear from the exudate, which, being now aseptic, is no longer a 
cause of peritoneal inflammation. It becomes absorbed sooner or later, 
and then all evidences of digestive trouble disappear. 

Recovery is rare, and when it occurs it is imperfect. The chronic 
form frequently succeeds the acute form; then ascites becomes the 
dominant symptom. 

Puerperal Peritonitis.—See Metritis and Metro-Peritonitis (p. 638). 

Dracnosis.—Careful examination of the abdominal walls and the in- 
sertion of the hand into the rectum may suffice to arrive at a diagnosis in 
the fibrinous form of peritonitis, when its development is complete. 
Diagnosis is impossible at the outset, when vague general symptoms 
only are observed, except the history of the case indicates that it is 
probably the peritoneum that is affected, and even then reservation is 
necessary. 

The operation of ovariotomy in the cow is sometimes followed by 
digestive disturbance, due to shock, and the symptoms simulate those 
of peritonitis. 

The diagnosis can only be positive when the following symptoms are 
evident: Tympany of the abdomen, abdominal pain accompanied by 
groaning, and, above all, the lachrymation, ophthalmic trouble, and 
nasal discharge. When these last-mentioned symptoms are absent, 
there is nothing in the other phenomena characteristic of peritonitis, as 
they are present in most forms of indigestion. 

TREATMENT.—The principles of treatment are similar to those ad- 
vised in the case of equines. In all cases due to perforation of the bowel 
the only chance of success in treatment is the performance of laparotomy, 
suture of the perforation, and the removal of escaped alimentary contents 
from the abdominal cavity. Indeed, in every instance in which the 
disease is well established the only hope of saving the animal’s life is in 
surgical interference to remove the cause of the malady and abolish the 
reservoir of the virus. This hope, however, is seldom or never realised, 
for not only is operation for this purpose often impracticable, but it is 
also usually illusory in its effects, the system being already so overcome 
by toxic absorption that recovery is out of the question. 


622 SYSTEM OF VETERINARY MEDICINE 


Local Purulent Peritonitis——Acute purulent localised peritonitis con- 
stitutes a clinical type of the disease well defined in ruminants, and only 
exceptionally found in other species of animals. Two conditions govern 
the onset of this form—the resistance of the peritoneum in ruminants to 
the organisms of suppuration and septicemia, and the localisation otf 
the region affected. Localised peritonitis is most frequently found in 
the post-diaphragmatic and pelvic regions—that is, in the vicinity of the 
reticulum or uterus. Foreign bodies which have escaped from the 
reticulum become encysted in an abscess on the abdominal floor in the 
xiphoid region. This abscess contains a creamy, greenish, or reddish- 
grey pus, more or less foetid, and holding in suspension flakes of lymph. 
It points towards the skin, and ruptures outside the body; but when 
the foreign body is small, the collection of pus may remain encysted 
indefinitely, and the walls of the abscess then become sclerosed and 
greatly thickened, being in many cases several centimetres thick. In 
these cases the abscess may contain several pints of pus. 

Symproms.—The initial stage of the disease is often overlooked, and 
symptoms of peritonitis are only observed when the septic liquid perco- 
lates through the false membranes, and gives rise to an abscess. The 
pain caused by pressure is acute. It is always localised in the region 
affected, but the area over which it is evinced exceeds that occupied by 
the lesion. The animal stands with the hind-limbs well under the body 
and the back arched, rarely lies down, and when he does, assumes the 
position very cautiously. Respiration is normal, and percussion reveals 
nothing except the pain, which is evinced in the right hypochondrium 
by the patient resenting interference. Rectal exploration provokes the 
resistance of the subject when the disease is localised in the pelvis. The 
rumen is constantly distended with gas, and its walls are paralysed. 

Diaenosis.—The disease may be confounded with tuberculosis, but 
the use of tuberculin will enable a distinction to be made. 

TREATMENT.—Medical treatment is of no avail, and surgical measures 
rarely succeed. 

| Chronic Peritonitis. 


Chronic peritonitis in bovines, owing to the tendency which it has to 
become encysted, is very seldom generalised. Three forms, however, of 
the disease are recognised: (1) Circumscribed form; (2) cystic form; 
(3) diffuse form. 7 

Circumscribed Form.—Lesions are frequently found on the surface of 
the liver, spleen, and rumen, perihepatic peritonitis being the most 
common, resulting either from abscess of the liver, biliary calculi, hydatid 
cysts, or from the presence of liver flukes in the bile-ducts. Tumours 


DISEASES OF THE PERITONEUM: RUMINANTS 623 


and other lesions of the spleen, and puncture of the rumen, may deter- 
mine a local peritonitis in the region of these organs. Tuberculosis 
sometimes causes a circumscribed form of peritonitis, with thick false 
membranes, in the substance of which tubercles may be found. Foreign 
bodies proceeding from the reticulum or rumen are a fairly common 
cause of localised inflammation of the peritoneum. 

Symptoms.—The disease is slow and insidious in its onset, and is not 
diagnosed as a rule until after the death of the subject, except in cases 
where the cause is known—as, for example, puncture of the rumen, when 
a purulent focus limited by false membranes may be discovered at the 
site of the operation. 

Cystic Form.—This form of the disease is characterised by the presence 
of a multitude of serous cysts attached to the mesentery or the surface 
of the abdominal organs. They have been described as cystic lymph- 
angiomata, resulting from degeneration of the mesenteric lymphatic 
glands; but their origin is obscure, and their clinical history has not been 
studied. 

Diffuse Form.—Diffuse chronic peritonitis results from extension of a 
local peritonitis or from a focus of suppuration in which the pus is incom- 
pletely encysted. Various subacute inflammatory conditions are the 
chief source of this variety of peritonitis, which 1s favoured by debility, 
advanced age, and numerous parturitions on the part of the subject. 
Tuberculosis, distomatosis, and suppurative hydatid cysts of the liver, 
play the chief réle in the production of chronic peritonitis; but sometimes 
malignant tumours, especially sarcomata, give rise to the condition. 

The lesions and clinical history resemble those occurring in diffuse 
peritonitis of the horse. 


Ascites. 


This affection, as regards etiology, pathology, and symptoms, does 
not present anything special in ruminants as compared with the horse. 

Ascites must be distinguished from rupture of the urinary bladder, 
gestation, and hydrops amnii. Rupture of the bladder in the ox is pre- 
ceded by urethral obstruction, and followed by fever and collapse. The 
liquid removed by paracentesis has the odour of urine, the bladder is 
empty, and micturition is absent. 

Hydrometra, pyometra, dropsy of the foetal membranes, and preg- 
nancy, are recognised by rectal examination. Moreover, in these cases 
the lower part of the abdomen is not much altered. 

When ascites is well developed, the animal should be destroyed, as 
treatment is of no avail. 


624 SYSTEM OF VETERINARY MEDICINE 


Tumours of the Peritoneum. 


Malignant tumours which may primarily or secondarily affect the 
peritoneum of ruminants are endotheliomata, sarcomata, lympho- 
sarcomata, and other tumours of doubtful structure. 

Fibromata.—Fibromata of the peritoneum are very rare, and little is 
known concerning them. 

Ossification of the Mesentery.—This is a very rare lesion. It may 
result from chronic inflammation following an injury or an operation. 
Gunlt has observed a coral-like osteoma embracing a portion of the intes- 
tine. The ossified area may be several centimetres in length, and up to 
21 centimetres in thickness, and sometimes it invades the abdominal 
wall. 

Symproms.—Animals affected with malignant tumours lose their 
appetite, become weak and unable to work. They fall away in condi- 
tion, and frequently grunt. Ascites and paraplegia are common com- 
plications, which intensify the symptoms and hasten death. Palpation 
through the right flank may reveal a tumour as a hard body inside the 
abdominal cavity, and, when large, it may cause a bulging of the ab- 
dominal wall in this region. It may also be felt on rectal examination. 
Benign tumours are frequently not suspected during life, and are only 
found as a surprise at autopsies. 

TREATMENT.—Treatment is not practicable in any form of peritoneal 
tumours. 


Parasites of the Peritoneum. 


See the section on Parasites. 


DISEASES OF THE PERITONEUM IN THE 
PIG, DOG, CAT, AND IN BIRDS. 


By J. J. O};CONNOR, M.R.C.V.S., 
Professor of Surgery, Royal Veterinary College of Ireland, Dublin. 


PIG. 
Peritonitis. © 

Et1otogy.—The peritoneum of the pig is not very susceptible to the 
effects of micro-organisms. It is only when it is invaded by a large number 
of virulent bacteria that peritonitis supervenes. Foreign bodies in the 
peritoneal cavity frequently become encysted. 

The operations of castration of the male and spaying of the female 
are frequently performed by the travelling gelder with an entire absence 
of cleanliness, and yet are seldom complicated with inflammation of the 
peritoneal cavity. Sometimes, however, the virulent infection which 
supervenes when the abdomen is opened accidentally or surgically sets 
up a fatal peritonitis. 

Rupture of the uterus and acute and chronic metritis may lead to 
septic inflammation of the peritoneum, and fat sows which have a diffi- 
culty in parturition may succumb from the disease. . 

Symproms.—The symptoms are not diagnostic, except the peritonitis 
supervenes on an abdominal operation. The animal lies persistently, 
grunts when forced to move, walks with difficulty, with the back arched, 
the snout close to the ground, the ears drooped, and, when left alone, the 
recumbent position is quickly resumed. Palpation of the abdomen 
causes pain, obstinate constipation is present, the appetite is lost, and 
thirst is intense. 

The disease is rapid in its course, the animal in some cases dying 
within forty-eight hours in cases where the peritonitis follows an ab- 
dominal operation; but ordinarily its duration is prolonged, the patient 
becoming progressively weaker, and showing on some occasions marked 
increase in the respirations, due to the pleura being involved. 

Morsip ANAToMy.—There is profuse fibrinous exudation, ‘which 


unites the different parts of the intestines, covers the diaphragm, the 
VOL. II. 625 40) 


626 SYSTEM OF VETERINARY MEDICINE 


abdominal walls, and even the pleura when the chest cavity has become 
affected owing to extension of the infection through the lymphatic 
system. 

TREATMENT.—--Prevention consists in avoiding the causes by ob- 
serving surgical cleanliness in abdominal operations. When the disease 
is established, treatment of any kind is hopeless. 


Emphysematous Cysts of the Mesentery. 


According to Jager, this lesion is due to a bacillus of the colon 
group—viz., the Bacillus coli lymphaticum aerogenes. The disease is of 
little interest to the clinician. 

This condition is characterised by the presence of numerous cysts 
filled with gas on the surface of the small intestine, mesentery, and 
lymphatic glands, ranging in size from a pin’s head to a small nut. They 
appear in clusters, chiefly at the mesenteric attachment on the small 
bowel. ) 


DOG. 


Peritonitis. 


Acute Peritonitis—In carnivora peritonitis occurs with very little 
local reaction or evidence of defence on the part of the peritoneum, 
the false membranes are few, and intoxication takes place rapidly. 

ErioLocy.—General affections, such as pyzmia, septicemia, and 
tuberculosis, frequently cause peritoneal lesions. Malignant tumours 
may involve the peritoneum, and cause peritonitis, alimentary disorders 
(toxic gastro-enteritis, verminous enteritis, foreign bodies, invaginations, 
etc.), may lead to perforation of the digestive canal, and a rapidly fatal 
putrid peritonitis. In metritis, infection may spread to the peritoneal 
cavity, and give rise to puerperal peritonitis. 

A perforating wound of the abdominal wall may be the origin of 
peritoneal infection, or it may result from violent impact of the abdomen 
against a blunt body, causing intestinal rupture, and escape of intestinal 
contents into the peritoneal cavity. Rupture of the bladder following 
blocking of the urethraby a calculus is a cause of hyperacute peritonitis, 
with much effusion. Rupture of the intestine, abdominal operations, or 
operations performed without proper antiseptic precautions, are followed 
by peritonitis. 

Long exposure to the air or traumatic injury of the peritoneum 
weakens its resisting power, and renders it more susceptible to the attacks 


DISEASES OF THE PERITONEUM: DOG 627 


of bacteria. The use of strong antiseptics on the peritoneum, coagulat- 
ing the albumin (carbolic acid, corrosive sublimate, etc.), and destroying 
the endothelium, favours the onset of peritonitis by suppressing the natural 
resisting-power of the peritoneal serous membrane. In a similar way 
the effect of shocks or blows on the abdomen in producing peritonitis 
may be explained. They inhibit the endothelial defensive agents of the 
peritoneum, which then becomes invaded by organisms circulating in the 
blood, or they injure the intestinal walls so seriously that the organisms 
from the intestines are able to pass through the wall of the bowel and 
enter the peritoneal cavity. 

Morzip AnaTtomy.—The lesions indicate a septic purulent infection. 
There is no sign of the formation of false membranes. The fibrinous 
exudate found on the surface of the abdominal viscera is very slight. 
The peritoneal effusion is whitish, opaque, and purulent, and appears in 
the form of a thin creamy layer over the peritoneum. It is sometimes 
greyish, reddish, or sanguinolent, foetid, and putrid. No adhesions are 
found between the intestines. A foreign body may be found projecting 
through the intestinal wall into the peritoneal cavity. Sometimes 
marked cedema of the hind-limbs is observed. According to Hobday, a 
localised peritonitis may be met with confined to the pelvic region, or 
within a few inches of an operation or accidental wound. 

Symproms.—Pain evinced by whining or screaming may be a marked 
symptom. The abdomen is tense and tucked up in the first stage of the 
disease, and is painful on palpation. The patient generally lies motion- 
less, and, when foreed to walk, he does so with difficulty, the back is 
arched, the head carried low, and the hind-quarters held stiffly. Loss 
of appetite, nausea, and vomiting, are present. The abdomen becomes 
gradually tympanitic from paralysis and meteorism of the intestines. 
When an accumulation of pus exists in the peritoneal cavity, there may 
be cedema of the umbilical region. The temperature often exceeds 
104° F., and the pulse is quick and weak, or almost imperceptible. The 
respirations are short, the patient’s expression is anxious, and the eyes 
are sunken in the orbits. 

According to Hobday, acute suppurative peritonitis may cause death 
within forty-eight hours, being preceded by coldness of the surface and 
extremities, and coma. In less acute cases the patient may live for 
three or four days. Instances are also met with in which death has not 
occurred for several weeks after the operation or injury which has pro- 
duced the peritonitis. Occasionally it results from asphyxia or cardiac 
paralysis. Resolution never occurs, and the affection rarely terminates 
in the chronic form. 


628 SYSTEM OF VETERINARY MEDICINE 


_ TREATMENT.—The administration of opiates is generally advised to 
inhibit intestinal iis to relieve the suffering, and to check the 
vomiting. | 

The patient’s strength may be sustained ty giving it small quantities 
of milk at frequent intervals. The thirst may be allayed by barley 
water or linseed tea, etc. Warm water enemata may prop beneficial 
in overcoming the constipation. 

The application of counter-irritants to the abdomen is of no Salvi. 
and simply adds to the patient’s sufferings. If a perforation of some of 
the hollow abdominal viscera is suspected, laparotomy should be per- 
formed, in order to adopt surgical measures for the relief of the condition 
and to cleanse the peritoneal cavity. 

Drainage of the abdominal cavity by an incision about 1 inch in length 
in the umbilical region is recommended by some authors. 

The large majority of cases of septic peritonitis prove fatal, in spite 
of every form of treatment. 

Chronic Peritonitis—Localized Form.—Chronic peritonitis is com- 
paratively rare in the dog, and as a rule is only found affecting the 
surface of the spleen or liver, where it is due to tumours involving 
these organs. It is seldom that it supervenes as the result of an external 
injury to the abdominal wall. It is of no significance from a clinical 
point of view. 

Diffuse Form.—This is generally associated with multiple neoplasms 
of the abdominal organs, and is usually confounded with dropsy of the 
abdominal cavity. 


Ascites. 


EtioLocy.—Ascites is common in carnivora. Mechanical obstruc- 
tion to the circulation, cardiac and hepatic affections, diseases of the 
peritoneum, and tuberculosis, are the chief causes of ascites in carnivora, 
and they may all be associated in the one animal. 

Anything which primarily or secondarily leads to venous congestion 
of the abdominal organs may cause ascites. Abdominal tumours, 
cirrhosis of the liver or kidneys, and new growths pies on the portal 
vein, also bring about the condition. 

Ascites is therefore associated with circulatory troubles, and the 
symptoms accompanying it vary with the nature of the lesion giving 
rise to it. ‘Lhe peritoneum itself has an influence in the production of 
ascites, as is seen in cases of peritonitis, and it is often very difficult to 
distinguish between a chronic peritonitis and a mere abdominal dropsy. 
Tumours of the liver, spleen, and mesenteric lymphatic glands, cause 


DISEASES OF THE PERITONEUM: DOG 629 


ascites by producing cachexia, giving rise to more or less irritation of 
the peritoneum, and bringing about increased intravascular pressure in 
the portal system. Tuberculosis produces an ascitic peritonitis by im- 
peding the portal circulation, altering the liver, heart, and pericardium, 
and causing more or less stasis of blood in the abdominal organs. Yet 
in many cases of generalised tuberculosis there is no ascites. 

Symptoms.—The first symptom to attract attention is the gradual 
increase in volume of the abdomen, which also descends and becomes 
more hollow in the flanks. The posterior ribs are projected outwards, 
and farther apart than usual, the belly may almost touch the ground, 
the vertebral column is bent downwards, and the flanks approach each 
other. Fluctuation of the accumulated fluid is readily detected by 
placing one hand flatwise and stationary on one side of the abdomen, 
and striking the diametrically opposite side with the other hand, a sensa- 
tion of a wave of liquid is then felt impinging on the former. Sometimes. 
the undulation thus produced can be seen starting at the point struck, 
and terminating at the opposite point. The greater the quantity of 
fluid present, the more readily is the fluctuation observed. Percussion 
reveals dulness inferiorly, and a tympanitic sound superiorly. Changing 
the position of the patient alters the seat of the dulness. 

The compression caused by the liquid interferes with the functions 
of most of the internal organs. The skin is dry, respiration is difficult 
or dyspneeic, the heart-beats are tumultuous, the pulse is small, the 
mucous membranes are pale, the appetite is in abeyance, the secretion 
of urine is scanty, and diarrhcea is sometimes observed. 

Death occurs in a variable period, and the duration of the case is 
largely influenced by the nature of the primary disease. 

Dracenosis.—Ascites is to be distinguished from the following con- 
ditions: | 

Diffuse Chronic Peritonitis.—If on exploratory puncture the fluid is. 
found clear and free from fibrin, the case is one of ascites. 

Obesity is recognised by palpation and percussion, and exploratory 
puncture shows that there is no fluid in the abdominal cavity. 

Tympany occupies the superior region of the abdomen, and with it 
there is resonance on percussion. 

Extensive tumours of the omentum may simulate ascites, but the 
evidences obtained by a physical examination and, if doubt exists, by 
an exploratory puncture with a trocar and cannula, will enable a differ- 
ential diagnosis to be made. ) 

- Increase in size of the abdomen caused by gestation is revealed by 
palpation. | 


630 SYSTEM OF VETERINARY MEDICINE 


The great emaciation of the patient may cause one to suspect car- 
cinoma or tuberculosis. The latter may be diagnosed by the aid of 
tuberculin or by a bacteriological examination of portions of the ascitic 
fluid. 

Hydrometra causes increase in volume of the abdomen, but the 
latter is not so pendulous as in ascites, and the fluctuation in it is not so 
marked. Moreover, the aspect of the abdomen in this case is not mani- 
fested by changing the position of the patient, as it is in ascites. The 
liquid obtained by puncture is different from ascitic fluid. It is thicker, 
and not so clear. The chief reliance in diagnosis must be on the non- 
pendulous though yet greatly increased volume of the abdomen. The 
increase in size of the abdomen in hydrometra extends higher than in 
ascites. 

Diagnosis by means of an exploratory puncture with a trocar and 
cannula is not always reliable, as in some instances, owing to a thick 
omentum, the opening of the cannula becomes obstructed, and although 
fluid is present, it cannot be withdrawn. 

Proaenosis.—The prognosis is very grave, the condition being usually 
due to an incurable organic affection. Nevertheless, there are rare cases 
of ascites in which the effusion disappears spontaneously, sometimes as 
suddenly as it appeared; at other times it is gradually absorbed after 
being in existence for a long time. When ascites is due to long-standing 
cirrhosis of the liver, causing compression of the portal system, it may ~ 
disappear in spite of the persistence of this condition, owing to the 
development of a collateral circulation. Alternative routes for the 
portal blood are numerous in the dog. The most important of these are 
the subcutaneous abdominal veins, which anastomose in the xiphoid 
region with the epigastric veins. The latter communicate with the 
portal veins through the intermediary of the peri-umbilical veins, and 
open into the iliac veins through the inguinal region. There are also 
other venous anastomoses which assist in maintaining a collateral cir- 
culation. 

TREATMENT.—The indications for treatment are to bring about 
elimination of the accumulated fluid, and the alleviation of the organic 
affection on which the ascites depends. Diuretic agents, such as citrate 
of caffeine, preparations of digitalis, benzoate of soda, acetate of potash, 
squills, diuretin, etc., are generally advised in order to assist absorption | 
and elimination of the transudate. The primary disease must be treated 
according to the leading symptoms that are present. Iodide of potassium 
proves useful in many instances. 

When the quantity of fluid present is considerable, the operation of 


DISEASES OF THE PERITONEUM: DOG 63] 


“tapping” (paracentesis abdominis) by means of a small trocar and 
cannula must be carried out, in order to remove the liquid and relieve 
the dyspnoea. The technique is simple, and the operation safe, provided 
surgical cleanliness is observed. The operation can be performed with the 
patient either in the standing posture, or on its side, or placed on its back. 
When in doubtful cases an’ exploratory puncture is made, the latter of 
these positions is the safest, as the intestines are not then in contact with 
the inferior abdominal wall. When the instrument is inserted and the 
trocar withdrawn, the patient can then be laid on the side. The punc- 
ture is made in the linea alba, about 1 inch behind the umbilicus, the 
skin being previously disinfected by painting with a solution of iodine. 
The fluid should be withdrawn slowly, so as to avoid the danger of 
collapse owing to a sudden fall in blood-pressure and cerebral anemia. 
If there are no evidences of cardiac weakness, the liquid may be allowed 
to flow until it ceases spontaneously. The cannula is then carefully 
withdrawn, the seat of puncture again painted with iodine, and a layer 
of aseptic cotton-wool and a broad bandage applied to the abdomen. 
As a rule the fluid recurs in a variable interval, and the operation must 
be repeated as required. When the condition depends on an organic 
affection, tapping 1s only a palliative measure. In order to prevent 
fresh effusion of liquid, intraperitoneal injections of tincture of iodine 
or Lugol’s solution are advised by some French authors, but the risk of 
the procedure causing a rapidly fatal peritonitis is pointed out by other 
observers. 

Sendrail and Cuillé advise the intraperitoneal injection of a 20 per 
cent. sterilised solution of chloral hydrate (about 1 gramme to each 
kilogramme body-weight). A portion of the ascitic fluid is first removed, 
and the solution is then injected. Several injections are necessary at 
increasing intervals. 

The operation known as “‘ omentopexia ”’ is also advised by the above 
authorities. This consists in the fixation of a portion of the great omen- 
tum between the oblique muscles of the abdominal wall by means of 
sutures, and thus establishing a collateral outflow from the portal system 
into the general circulation. For full details of the operation and of the 
technique the reader is referred to Cadéac’s work, “ Pathologie Interne,” 
vol. iii, 

When a case of ascites is proved to be due to tuberculosis, either by 
the tuberculin test or by a bacteriological examination of the fluid, the 
animal should be destroyed. 


632 SYSTEM OF VETERINARY MEDICINE 


Tumours of the Peritoneum. 


_ Primary tumours are very rare in the dog. Cases of lipomata, endo- 
theliomata, and cysts, have been recorded. Malignant tumours of the 
omentum and mesentery are also met with, including carcinomata and 
sarcomata. The symptoms are generally obscure, but in cases of 
malignant growths of large size the abdominal cavity is distended by a 
solid mass, and the animal suffers from gradual emaciation and debility. 
Chronic peritonitis or ascites may be associated with the condition. 

Little can be done in the way of treatment, as in the large majority 
of instances the neoplasms have reached an inoperable stage before their 
presence is suspected. Moreover, in the case of malignant Brow 
treatment is useless. 


CAT. 
Chylous Ascites.* 


Synonyms.—Milky, opalescent, lactescent, fatty, or chyliform ascites. 

DeFIntt1Ion.—The term “ chylous ascites ” is given to that condition 
in which the peritoneal cavity contains a quantity of fluid having a 
milky or chylous appearance. 

Species AFFECTED.—So far as is known—or, at least, recorded—up 
to the present time it only appears in the cat, man, and dog, its SENG 
frequency in these species being in the order given. 

History.—Although this form of abdominal dropsy has, since 1873, 
been recorded several times in man, its occurrence in the cat and dog 
was first reported by Walley in 1890. In 1893, Gray recorded a case in 
the cat. McFadyean made an examination of these cases reported by 
Walley and Gray. In 1895, Dollar recorded a case in the cat, and con- 
sidered it unique, having probably overlooked the fact that others before 
him had seen and recorded such. In 1896, P. Salmon, of Paris, gave a 
good critical review of the cases registered in man since 1873. Fried- 
berger and Froéhner, in their “‘ Textbook of Special Pathology,” mentioned 
that only two cases (both in the cat) had been observed—one of them 
by Gray, and the other by Marcone, of Pisa. In 1904, Wohlmuth, of 
Vienna; in1908, the Primes, of Norwood; in 1909, Suffran, of Toulouse; in 7 
1911, the Smythes, of Falmouth; and in 1912, Poénaru and Georgesco, of 
Bukarest, severally observed and reported isolated cases in the cat. In 
1912, V. Ball, of Lyons, reported two cases, one in the cat, and the other 
in the dog. | 

* For this article we are indebted to Henry Gray, M.R.C.V.S. 


DISEASES OF THE PERITONEUM: CAT 633 


The disease is, notwithstanding the paucity of literature on the 
subject, far from rare, as several practitioners in various parts have 
witnessed instances of 1t both in the cat and in the dog, and certain of 
them, especially in Ireland, have proclaimed that it is the commoner 
form of ascites in the cat. To this view, however, the writer is not 
inclined to subscribe. 

Etiotogy.—The cause of this form of abdominal dropsy has not 
been elucidated. Some authorities, however, have incriminated rupture 
of the lacteal vessels or obstruction to the passage of chyle; others believe 
the milky condition of the fluid is the result of fatty transformation of a 
peritoneal effusion. 

Poénaru and Georgesco suggest that coccidia, which are frequently 
found in the chyle system in the normal cat, may play a mechanical part, 
causing dilatation and even rupture of the lymph-ducts, whereby the. 
chylous. fluid is poured into the peritoneal cavity. Against this view 
must be placed the observations, of McFadyean, who could detect no 
rupture or abnormality in the lacteals. Suffran’s observations agree with 
the latter finding. 

Compression of the thoracic duct by new growths, enlarged glands, or 
inflammatory thickenings, has been invoked; but experimental evidence 
has shown this hypothesis to have no foundation in fact. 

As to the view that the lactescent fluid is due to fatty transformation 
of inflammatory exudates, this is hardly feasible, since the peritoneal 
cavity is quickly refilled with milky fluid after the abdomen has been 
tapped previously, and one can hardly believe that an inflammatory 
exudate could so rapidly undergo transformation as to induce the milky 
appearance of the fluid mentioned. Again, in several instances there do 
not appear to be any inflammatory conditions giving rise to a clear 
exudate, which could, if it were possible, become converted into a milky 
fluid. In one of Walley’s cases (dog), however, McFadyean found on 
post-mortem examination that the fluid had lost its milky character. It 
had been removed thrice before death, and on each successive occasion 
the milky appearance was materially reduced. 

OccastonaL AssocraTeD DisEases.—The disease is sometimes asso- 
ciated with tuberculosis, sarcomatosis, carcinomatosis, peritonitis, 
pleurisy, nephritis, cirrhosis or fatty degeneration of the liver, or hel- 
minthiasis. Probably, some at least of these associated conditions are 
in reality tuberculosis unrecognised. 

AcE or PrEDILECTION.—In the human subject it is generally seen in 
children as young as six months, and rarely over thirteen years. In 
animals it is usually encountered in adults or the aged, rarely in the young. 


634 _ SYSTEM OF VETERINARY MEDICINE 


Symproms.—If seen early in the course of the malady, the animal 
may be dull, have fits of vomiting, loss of appetite, interspersed with 
periods of brightness, and a ravenous appetite. Thirst is usually great; 
the coat may be open, dull, and dry, and the hairs pull out easily or are 
rapidly shed, even en masse. As the distension of the abdomen pro- 
gresses, the muscles of the croup, lom, back, neck, and head, waste to 
such a degree that the bony processes stand out prominently, and the 
animal in some instances assumes the lateral recumbent position, groans 
or grunts, and, when disturbed, the respiratory rhythm becomes dis- 
ordered and distressed, the breathing is short and hurried, or the animal 
opens its mouth as if gasping for air. The temperature during the 
earlier stage ascends to 103° or 105° F., and at other times it is irregular, 
fluctuating one or two degrees. The heart’s action is tumultuous, 
intermittent, or irregular; but the arterial pulsations are weak and 
almost imperceptible. The mucous membranes are pallid or anemic. 
In an advanced stage the abdomen is very much distended and hard, the 
whole of the muscular tissue is extremely attenuated, the limbs may be 
swollen from cedema, the animal has a difficulty in assuming the recum- 
bent position or in walking, the breathing becomes gasping, and death 
takes place from syncope, from gradual cardiac failure, or suffocation, 
or, rather, lack of hematosis. On the inferior surface of the abdomen 
the cutaneous veins become distended and tortuous. If the animal 
is relieved by paracentesis abdominis before its condition becomes 
extreme, an improvement is generally observed ; but the emaciation 
is often so pronounced that the body is only skin and bone. In many 
instances, however, after tapping, exhaustion rapidly sets in, and the 
animal dies in a few hours or in a day or two. In those animals that 
temporarily recover, the abdomen quickly becomes refilled with the 
milky fluid; but there are instances, as in one of Walley’s cases, in 
which after each successive tapping the fluid gradually loses its milky 
appearance until entirely replaced by a citron or sero-hemorrhagic 
fluid. In certain instances the fluid may disperse under medicinal 
treatment, to reappear after several months. Sometimes the dis- 
tension of the abdomen becomes rapidly progressive; at other times it 
is slow in its course. Symptoms peculiar to any associated disease, 
such as pneumonia, tuberculosis, etc., may be engrafted on to the 
tableau given. ; 

Diacnosis.—This can only be arrived at on performing paracentesis 
abdominis, but the condition usually comes as a surprise at a post- 
mortem examination. 

Proanostis.—The condition is always fatal, or, at least, the animal is so 


DISEASES OF THE PERITONEUM: CAT 635 


excessively emaciated that destruction is demanded by the owner. It is 
extremely fatal in man, and recoveries are very rare. 

Courss.—Although the ascitic condition of the abdomen may appear 
in the course of a week or a fortnight, it may in other instances take 
several weeks or even months for extreme distension to arise, necessl- 
tating the owner to seek professional advice, in order to have the distress 
of the patient relieved. Under appropriate treatment the accumulation 
may in a few cases be held in check, even though it does not disappear 
altogether for a time. In the apparently recovered cases the fluid is not 
long in accumulating after treatment is suspended. In those cases 
relieved by tapping the accumulation soon reappears after each tapping, 
and the animal gradually grows weaker until death takes place from 
exhaustion or syncope. 

Morpip ANnatomMy.—In the majority of cases there is very little 
observed beyond a congested appearance of the peritoneal, omental, and 
mesenteric bloodvessels, and a quantity of milky, citron, or blood-tinged 
fluid in the peritoneal cavity. There is, however, in every case a total 
absence of fat, and a marked anemic and atrophic appearance of the 
muscular tissue In every part of the body. In several instances 
fatty degeneration or hypertrophic cirrhosis of the liver has been 
present. In Dollar and Wohlmuth’s cases small elongated whitish spots 
resembling minute worms, many of which were no larger than grains of 
sand, were observed covering the serous coat of the bowel. In Dollar’s 
case there were also minute red granulations, most marked on the free 
border of the duodenum and jejunum. There were also some deposits 
of lymph on various parts of the abdominal viscera. In Poénaru and 
Georgesco’s case the thoracic and abdominal viscera showed scattered 
spots of fatty degeneration and calcareous infiltrations ; there were 
perihepatitic nodulations, the liver itself being enlarged, and the gall- 
bladder dilated and containing a multitude of coccidia in its lumen. 
Diffuse chronic peritonitis, dilated lacteals and enlarged lymphatics 
containing coccidia, were also observed. There may also be found in 
isolated cases intestinal sarcoma, cancerous or tubercular peritonitis, 
generalised miliary tuberculosis, helminthiasis, and other conditions. 
These are, in the writer’s opinion, only foreign, and quite coincidental to 
the chylous appearance of the effusion. 

Characters of the Lactescent Fluid.i—Nearly every authority, including Walley, 
McFadyean, Suffran, and Ball, consider the milky material is indistinguishable 
from chyle. Itis rather thick, alkaline in reaction, density about 1015 at ordinary 
temperature, contains very fine, fatty globules, a few white, and sometimes red, 


cor puscles, and occasionally fibrinous coagula. Analysis reveals fat (7-6), glucose, 
albumin, chlorides, sulphates and phosphates of potassium, sodium, magnesium, 


636 SYSTEM OF VETERINARY MEDICINE 


and calcium. The albuminoids are represented by fibrin, globulin, and albumin, 
without casein (Wohlmuth). McFadyean found neither cream, sediment, nor 
epithelium on subjecting the fluid to the action of the centrifugal machine. Poénaru 
and. Georgesco found a quantity of granular polynuclear leucocytes having the 
aspect of. pus corpuscles, some mononuclear leucocytes, and some desquamative 
cells and red corpuscles. Some larger fatty globules produced by the fusion of the 
small fat granules were also observed. Bacteriological examination gave negative 
results. In Dollar’s case the fluid coagulated within half an hour of withdrawal. 

In general the fluid has the appearance of milk; when mixed with ether and 
afterwards decanted and poured on paper, it leaves a greasy stain after evaporation. 
Under the microscope the fatty particles, under the action of ether, run into one 
another, forming more or less voluminous unequal refractile globules. This reaction 
is characteristic of chylous ascites. Left in a vessel it may retain its homogeneity 
for a long time, even for twenty-four hours or longer. It does not separate at first, 
but ends in separating into two layers. The lower layer is clear, although opaque, 
and contains some red and white corpuscles. The upper layer is more opaque, 
white, and creamy. This latter may, however, be absent. There is often no coagu- 
lation, thus showing the absence of fibrin, in some cases at least. It may retain its 
sweetness, even when exposed to the air, for several days, even for a fortnight. 
Probably the white and red corpuscles, the epithelia] cells, and the fibrin found in 
many cases, are due to secundary inflammatory or other lesions, and therefore are 
only foreign to the chylous fluid proper—in fact, they are contaminating materials. 

As to the quantity. of fluid, it varies from one to several pints, according to the 
size of the animal, and the degree to which the distension or accumulation is allowed to 
run before tapping, etc. In the cat as much as 3 gallon has been withdrawn. 


TREATMENT.—As the causation or nature of this malady has not 
been established, the treatment at the most can only be empirical, and. 
even then the usual result is a fatal one, 

The writer has, however, prolonged life and relieved distress by ie 
internal administration of iodide of potassium and by the painting of the 
outer wall of the abdomen with tincture of iodine. Opening the abdomen 
and inserting a portion of the omentum between the peritoneal and 


muscular walls may be attempted. 
Nourishing food, such as milk, fish, and raw meat, should be offered. 


BIBLIOGRAPHY. 


- Watiey: Journal of Comparative Pathology and Therapeutics, vol. iii., 1890, 
p. 262. 

Gray: Jbid., vol. vi., 1893, p. 375. 

DoLuaR: Veterinarian, 1805, Pp: 403; and in Cadiot’s Clinical Medicine and 
Surgery, 1900, p. 380. 

P. Satmon: Archives Générales de Méiicine, 1896, pp. 464-468; and in Veterinary 
Record, vol. x., 1897-1898, pp. 90 and 102. 

Wountmurs: Tieriirztliches Zentralblatt, 1904, p. 305; and in Revue Générale de 
Médecine Vétérinaire, tome v., 1905, p. 150. 

PRIME: Veterinary Journal, 1908, p. 614. 

SUFFRAN: Revue Vétérinaire, 1909, p. 473; and in Journal of Comparative 
Pathology and Therapeutics, vol. xxili., 1910, p. 66. 

SMYTHE AND SMYTHE: Veterinary Journal, vol. xvii-, 1911. 

PoENARU UND GEORGESCO : Extract from Archiva Veterinara, in Veterinary 
Journal, vol. xix., 1912, ; 


DISEASES OF THE PERITONEUM: BIRDS 637 


BIRDS. 


Acute Peritonitis.—This is a rare condition. It has been observed as 
the result of rupture of the oviduct, and may sometimes be a prominent 
lesion in cases of fowl cholera and in aspergillosis. The symptoms 
observed are pain. on palpation of the abdominal region, and during 
defzcation, loss of appetite, marked prostration, succeeded by death, 
which may occur more or less rapidly. Judging by the rough-and-ready 
manner-in which the operation of caponising is carried out by amateurs, 
and the successful results obtained, we must conclude that the peritoneum 
of the bird is very resistant to septic infection. — 

Chronic Peritonitis.—A form of chronic peritonitis associated with 
the presence of a large number of cysts was described by Nocard and 
Railliet. ) ee 

Tumours of the Peritoneum.—Cases of epitheliomata and sarcomata, 
either solitary or multiple, are recorded. Dermoid cysts are said to be 
common in the peritoneum of the duck and goose, and sometimes occur 
in fowl. They resemble lipomata externally, and are composed of a 
layer of fat containing a quantity of feathers firmly compressed. 

Ascites is met with in birds, especially in the fowl and canary. Para- 
centesis abdominis can be carried out by means of a hollow needle, such 
as that used with a serum syringe. Painting the abdominal region with 
tincture of iodine, and administering iodine of potassium in the drinking- 
water may be adopted. 


METRITIS AND METROPERITONITIS 


By AINSWORTH WILSON, F.R.C.V.S., 
Professor of Surgery and Obstetrics, Royal (Dick) Veterinary College, Edinburgh. 


ACUTE METRITIS AND METROPERITONITIS. 


SYNONYMS.—Septic metritis; Acute endometritis; Puerperal septi- 
cemia. | 

This is an inflammation of the uterus due to bacteria, commencing as 
a rule in the mucous coat (endometritis), and frequently spreading to the 
muscular coat (metritis), and serous covering (metroperitonitis), and other 
parts. It may affect all domesticated animals after parturition or abor- 
tion, and be followed or accompanied in severe cases by sapreemia, septi- 
cemia, or pyemia, and death. 

CLASSIFICATION AND Forms or Metritis.—Attempts to classify the 
various forms of metritis from a clinical point of view have proved un- 
satisfactory, notwithstanding their pathological interest. Endometritis 
is the essential and primary lesion in the great majority of cases. The 
inflammatory process may even remain confined to the endometrium, 
although some writers on gynecology deny its separate existence (Reed).* 
Various forms of acute endometritis have been described. In reality, 
however, they are mild forms of metritis, the differential diagnosis of 
which is not only difficult or impossible, but also of little practical im- 
portance. 

Furthermore, acute puerperal metritis is always associated with more 
or less septic poisoning—+.e., one or other of the forms known as “ sap- 
remia,” “septicemia,” or “pyemia.”’ Peritonitis is also frequently 
present (metroperitonitis). 

Metritis may assume the acute or the chronic form. The former 
especially has nearly always a puerperal origin. It may be associated 
with marked septiczemia from the outset, or the inflammatory symptoms 
may predominate. These terms are useful to the clinician in indicating 
the gravity of the condition, which depends mainly on the virulence of 
the infection and the animal’s resistive power. Yet, clinically speaking, 


* « Textbook of Gynecology.” 
638 


METRITIS AND METROPERITONITIS 639 


the distinction is not clear. It is merely a matter of degree. Again, the 
local lesion may not be confined to the uterus. Not uncommonly there 
exists a concurrent or secondary inflammation of the cervix, Fallopian 
tubes, ovaries, or vagina. This occurs in retention of the after-birth, in 
which condition the whole mucosa from the vulva to the uterus is in- 
volved in the septic process. The tubes, especially in mares, may also 
be affected (salpingitis). 

There is thus a close relation existing between different parts of the 
genital tract in disease. This relation or sympathy also exists under 
normal conditions. It is a physiological fact which can easily be demon- 
strated by experiment. 

For the reasons just stated, we attach a broad comprehensive mean- 
ing to the term “ metritis.” | 

GENERAL ReEMARKS.—Acute metritis is always septic, and it is gener- 
ally referable to parturition at term or before. In other words, it is a 
puerperal disease. 

Puerperal Infection (Sepsis) is essentially a toxemia or septicemia 
due to wound infection, and accompanied as a rule by some form of 
metritis. It differs from other wound infections only in the port of 
entrance of the bacteria. These latter are of various species and degrees of 
virulence, frequently acting together, and producing a mixed infection. 
The significance of wounds in the genital canal has long been recognised. 
Not only are septic products easily and directly introduced into the 
general circulation through wounds, but they furnish an avenue of infec- 
tion to the puerperal uterus through the open os. Absorption also 
readily occurs through the open uterine veins and lymphatics. Wounds 
in the form of slight abrasions, or contusions and lacerations, are also of 
very frequent occurrence, more especially in cases of dystokia and in 
primipare. The septic nature of such wounds, the tardy involution 
of the uterus, exhaustion of the dam, and the frequent retention of 
decomposing membranes and blood-clots—all these offer favourable 
opportunities for infection during the puerperium | 

It is generally accepted that severe cases have their origin in the 
uterus itself, although mild cases may readily arise through the medium 
of wounds nearer the vulva. 

Bacteria as a rule establish a primary lesion in the genital canal. 
They spread by continuity of the mucous membrane and through the 
lymphatic vessels to the endometrium and other coats of the uterus, the 
Fallopian tubes, peritoneum, and ovaries. They also pass to other 
organs and tissues of the body through the blood and lymph streams, 
thus giving rise to general infection. Again, the urinary tract is not 


640 SYSTEM OF VETERINARY MEDICINE 


infrequently invaded through the short urethra, followed by purulent 
conditions of the bladder and kidneys (see Bacillary Pyelonephritis, 
Vol. I.). Infection of the genital tract is characterised by local inflam- 
matory reaction and septic poisoning: The inflammatory process, it is 
well to remember, is both restrictive and reparative, limiting and local- 
ising the infection, and acting as a barrier to generalisation. If the local 
reaction is slight, bacteria and their products readily invade the blood, 
with quickly fatal results. The absence of inflammatory phenomena is 
doubtless due to the virulence and rapid action of the invading organisms, 
which destroy the resistive power of the tissues. Resistance to the spread 
of bacteria appears to depend mainly on the leucocytic zone in the uterine 
wall, for if this is incomplete or overcome, general infection invariably 
follows. Pomayer,* in his classic work, emphasises the: me ae of 
leucocytosis in limiting infection. | 

These remarks explain 1 In some measure the very seit phenomena 
to which the same organism may give rise in different individuals of the 
same species. | 

Non-Puerperal Metritis —This form is rare in large animals, and it is 
usually chronic. Insmallanimals, however, particularly the bitch and eat, 
metritis is not necessarily dependent on parturition—in fact, the majority 
of cases in the bitch occur in maidens or in animals which have not been 
bred from for a long time. Specific infection is an occasional cause 
in the lower animals—e.g., tuberculosis and contagious granular vaginitis 
—but if we except contagious abortion, specific infections are relatively 
very uncommon in veterinary patients. Non-puerperal metritis may be 
secondary to suppurative foci in other organs and tissues. As a rule, 
however, it is due to traumatisms, such as injuries to the vagina during 
copulation and operative interference. Thus the surgical treatment of 
sterility may result in metritis.. We have met with several cases in mares 
and cows caused by forcible dilatation and laceration of the cervix, in 
which the infection was conveyed by dirty hands or instruments, or both. 
A chronic suppurative metritis was set up. A similar result may follow 
the induction of artificial abortion and is due to wound infection and 
retention of a portion of the after-birth. 

In human practice, acute inflammation of the gravid and non-gravid 
uterus is a rare disease, and Spiegelbergt doubts if it ever arises spon- 
taneously during pregnancy. | 

ETIOLOGY OF ACUTE (PUERPERAL) ease —Inflammatory lesions 
of the whole generative system are due solely to micro-organisms and 


* “Das Zuriickhalten der Nachgebart beim Kind.”’ 
t ‘Textbook of Midwifery,” second edition, vol. i., p. 408. 


METRITIS AND METROPERITONITIS | 641 


their toxins, apart from those somewhat rare accidents in which in™ 
flammation is induced by the use of strong antiseptics or very hot douches. 
The causes may be summed up in one word—“ infection ’’—of which 
there are two chief sources: (1) Parturition, or abortion, or puerperal ; 
(2) operative interference, copulation, and other traumatisms, or non- 
puerperal. | 

In woman, the gonococcus is responsible for a large percentage of 
cases, but animals are fortunately spared this fruitful source of infec- 
tion. 

Although certain bacteria are invariably found in the septic uterus 
at parturition, there is no specific organism for any form of metritis or 
septic poisoning. The bacteria may be divided into two main groups: 
(1) Putrefactive, (2) pyogenic (ordinary staphylococci and streptococci). 
Of these, the organisms of suppuration are mainly responsible, acting 
through the medium of wounds and the raw surface produced by the 
detachment of the placenta. The commonest and most virulent organism 
is undoubtedly the Streptococcus pyogenes, either in pure culture or in 
association with staphylococci, and the Bacillus coli communis. In 
woman, as in animals, cases of pure streptococcal infection are occa- 
sionally met with, giving rise to a fatal septicemia. Pyamia, on the 
contrary, is usually a mixed infection due to various suppurative bac- 
teria. 

Putrefactive organisms Bh eae invade the puerperal uterus when 
the latter contains portions of after-birth, a dead foetus, a blood-clot, 
or other débris. The absorption of the decomposition products of these 
organisms sets up the well-known condition—sapremia. Lastly, the 
B. coli communis is sometimes found associated with inflammatory 
conditions of the genital and urinary Brean It is probably always a 
secondary infection. 

We might add that the recognition of the causal organism or group 
of organisms has an important bearing on specific treatment by antitoxic 
sera and vaccines. 

CoNTRIBUTORY OR PREDISPOSING CausES—Conditions which delay 
Involution and diminish Resistance to Bacterial Invasion.—1. Retention of 
the After-Birth is by far the most important condition, inasmuch as the 
membranes swarm with organisms in twenty-four hours, and they soon 
decompose. Retention is relatively uncommon in mares and bitches, 
but it is infinitely more serious in these animals. They are more sus- 
ceptible to sepsis than the cow. Besides, the placental site in the mare 
covers the whole uterus, and the area available for absorption is thus very 
arge. Abortion favours retention, and therefore sepsis. 

VOL, I. 41 


642 SYSTEM OF VETERINARY MEDICINE 


2. A Dead Fetus in utero, to which air gains access, decomposes, and 
invariably causes metritis. 

3. Dystokia, Prolapse of the Uterus, and Wounds.—Dystokia acts by 
exhausting the dam, weakening the phagocytic and contractile power of 
the genital canal, and causing traumatic lesions. In mares and bitches 
especially, even small penetrating wounds in the anterior vagina and 
uterus are followed by septic metroperitonitis and death. The impor- 
tance of traumatisms in all animals has already been emphasised. 

4, Debility and Disease (local or systemic)—e.g., travelling, exposure 
to cold and wet, insanitary surroundings, dilated conditions of the uterus, 
as in hydramnios, twins. or multiparity, and tuberculosis. 

5. Age-—Wounds at parturition are seen more largely in primipare, 
and retention of the after-birth in animals which have already borne 
young. 

SUMMARY OF THE ETIOLOGICAL Factors.—Although acute metritis 
may follow normal parturition and expulsion of the after-birth, the vast 
majority of cases follow wound infection in dystokia, retention of the 
foetal membranes, and abortion. 

Metuops oF InFecTion (AcuTE Mertritts).—Little remains to be said 
except to emphasise the fact that the disease can be easily conveyed from 
one parturient animal to another. The causal organisms are nearly 
always introduced from without, either through wounds in the posterior 
genital tract or by means of the soiled hands, instruments, and ropes of 
the attendant. We have seen septic infection conveyed from diseased to 
healthy animals by the vaginal and uterine cannula. Contaminated 
boxes have also proved infective in our practice, probably through soiled 
floors and bedding in lymg down. De Bruin* has had a somewhat similar 
experience. The occurrence of auto-infection in animals is open to con- 
siderable doubt; nevertheless, some gynecologists are of opinion that 
bacteria may be already present in or near the uterus at the commence- 
ment of parturition, and that these may give rise to auto-infection. 

Morspip ANnatomy.—Iwo pathological forms may be described: 
(1) The local form, chiefly affecting the uterus; (2) the septicamic or 
generalised form, which resembles any acute wound infection. These 
forms usually coexist, but, as we have seen, to an unequal extent. The 
morbid changes found in septicemia need not be detailed here. In some 
cases the uterus may be almost empty, and partial involution may even 
have taken place. 

Local Lesions.—The uterus is enlarged, softened, and congested; its 
coats are thickened and infiltrated with exudate to varying degrees. It 


* “ Bovine’ Obstetrics,” p, 341. 


METRITIS AND METROPERITONITIS 643 


is more or less dilated, owing to paralysis of the muscular coat, and 
consequent inability to contract, whilst the uterine cavity contains 
a variable amount of fluid, resembling in character the discharge 
which issued from the vulva before death. The mucous membrane 
is dark red, swollen, very vascular, and often hemorrhagic. Dark grey 
or greenish necrotic patches are sometimes present, and portions of 
the mucosa may be covered with a croupous exudate. The cotyle- 
dons in the cow are frequently necrotic, yellow, and macerated-looking, 
easily detached, or lying free in the fluid. Portions of very fostid 
after-birth may still be adherent. The cervical and vulvo-vaginal mucous 
membrane has in many cases a similar appearance. The uterine veins 
are thrombosed and inflamed, and the thrombi are often softened and 
semipurulent. On section, a yellowish-red or brownish exudate may be 
pressed out of the muscular coat. The latter is rarely the seat of abscesses. 
Under the microscope, the muscle fibres are infiltrated with leucocytes, 
which tend to bar the passage of organisms. Staphylococci and strepto- 
cocci are also present in large numbers, both in the wall of the uterus and 
in the fluid contents. The serous coat, when involved, is covered with 
lymph, and shows petechial extravasations. From this point extension 
to the pelvic peritoneum is common, and the tubes and ovaries may be 
involved in the inflammatory change. A frequent lesion is patchy or 
diffused peritonitis. In the latter case blood-stained fluid is found in the 
abdominal cavity. Extension to the pelvic connective tissue may also 
take place. Wounds inflicted during parturition are often superficial, 
sometimes very trivial, and situated on any portion of the mucous mem- 
brane from the uterus to the vulva. Discolorations and abrasions of the 
mucosa result in superficial ulcers surrounded by a zone of intense con- 
gestion. They may resemble the necrotic areas seen sometimes on the 
endometrium. 

These lesions, although common, are by no means constant. Atypical 
cases are sometimes seen. Nevertheless, when inflammatory reaction 
has taken place, we have always found the uterus large and flabby, and 
the cervical canal patent. In very virulent infections all the local 
phenomena may be very slight, and the uterine cavity may contain only 
a small amount of brownish fluid, possessing little or no odour. 

Symptoms oF Acute Merritis (Marz AND Cow).—The symptoms 
vary within wide limits according to the severity of the inflammation 
and the amount of toxins absorbed into the blood. They appear usually 
between the second and fifth day after the act of parturition. Both the 
onset and the character of the phenomena vary according as the disease 
is localised or generalised. Thus, it frequently develops on the second 


644 SYSTEM OF VETERINARY MEDICINE 


or third day if there is marked septic poisoning, with a high temperature 
and great depression. On the other hand, self-limited cases with severe 
local inflammation may be delayed till the fourth or fifth day in cows. 

General disturbance is shown by fever, sometimes introduced by rigors, 
especially when toxins are being rapidly absorbed. The temperature 
rises to 104° or 106° F. or higher, varying a little, but always remaining 
high in the earlier stages. The respirations are rapid and shallower than 
normal, the mucous membranes dirty red or reddish-yellow, the pulse 
rapid and weak. Cardiac weakness is directly proportional to the degree 
of septic poisoning. The appetite and secretion of milk fail, and the 
udder and teats become cold and flaccid. Pain in defecation causes 
retention of feces, or there is actual constipation, followed in many 
instances by diarrhoea, which is usually foetid, and sometimes contains 
a little blood and mucus. 

Occasionally muscular twitchings are noticed, and thirst may be 
marked. The animal shows pronounced stiffness, especially in the hind- 
quarters, and a staggering gait is often present. She is very dull and 
weak, becomes rapidly prostrated, and quickly loses condition. The coat 
stares, the extremities are cold, or cold and hot alternately, the back is 
arched, the legs drawn together, the hind-fetlocks frequently knuckled, 
the head is carried low, and the expression is more or less anxious. In 
sapremia the cow occasionally staggers in a stupid fashion round the 
box, and may bore her head in a corner. 

The general appearance is now most miserable, and the patient lies 
or stands persistently, assuming a more or less fixed position, owing to 
the pain in the region of the uterus and the general weakness. 

The temperature, although important, is not a certain clinical index. 
In septicemia it is often 106° or 107° F. at the outset, falling rapidly in 
the Jater stages, and becoming subnormal. The pulse, too, is very rapid 
and very weak—always a bad sign. In sapremia, on the other hand, 
the temperature may be almost normal. 

Coma usually sets in some time before death. The pulse has already 
become imperceptible, and the animal is quite unable to rise. In rapidly 
fatal cases the patient may be semicomatose, and the temperature is low 
or even subnormal from the outset. 

Pyemia follows the detachment of emboli from the thrombosed uterine 
veins. These emboli, swarming with pyogenic organisms, are then 
arrested in the lungs, joints, and other parts, setting up secondary foci 
of infection. Compared with septicemia, the onset is generally delayed 
until the fifth or sixth day, the symptoms are usually so urgent, and the 
course is more protracted. 


METRITIS AND METROPERITONITIS 645 


It is of practical importance to remember that the lung infection may 
give rise to acute pneumonia, the symptoms of which complicate those 
already existing, and add to the gravity of the case. 

Pyemia, like septicemia, may follow sapremia—in fact, these 
three forms of septic poisoning may occur in any combination or 
sequence. | 

The local symptoms may be slight, particularly in some septiceemic 
cases in which there is little or no evidence of local change. Not infre- 
quently the vulvar labia are swollen, the vulvo-vaginal mucous mem- 
brane is dark red, infiltrated, very sensitive, and hot. It is often dis- 
coloured, and gangrenous patches may be seen along the floor of the 
canal, especially in contact with the after-birth when the latter is retained. 
A muco-purulent discharge is constantly present, usually very fcetid, 
dirty grey, reddish, or chocolate coloured from admixture with altered 
blood. It frequently contains shreds of after-birth or necrotic cotyle- 
dons (cow), which increase the foetid odour. 

The uterus, on rectal examination, is enlarged, and soon becomes 
paretic. It contains a small or large quantity of the fluid which is seen 
issuing from the vulva. The huge sac is freely movable, its walls are 
thickened, and palpation gives rise to severe straening. Straining is also 
excited by urination, the acrid discharge, and the pain caused by the 
introduction of the hand into the vagina. At such times, and also in 
lying down, the contents of the uterus are expelled in small quantities. 
Uneasy movements of the tail and hind-legs are also noticed. The 
abdominal muscles are tense, and the abdomen is tender on pressure, 
especially in the right flank of the cow. The cervical canal, like the 
uterus, is dilated and swollen. It admits several fingers or the whole 
hand in the earlier stages, and it is never entirely closed. Nevertheless, 
it contracts considerably after the third day in a full-term parturition, 
and the contents of the uterus tend to become imprisoned. 

SPECIAL SyMPTOMS oF ACUTE METRITIS IN THE Marz.—Loss of in- 
terest in the foal, sudden and early cessation of milk secretion, occasional 
colicky pains (more marked when the peritoneum is involved), perspira- 
tion patchy or diffuse, but not constant. The mare usually stands per- 
sistently, but may lie, especially if sepsis is pronounced. Laminitis is 
very common in the milder forms of the disease (endometritis). It also 
appears early, but the coincidence of laminitis and acute septiceemia is 
seldom observed. Infection occurs earlier than in the cow, for reasons 
already noted; so much so, that premonitory symptoms are frequently 
observed during the first twenty-four hours, and the disease is established 
on the second day. The abdomen is tense and distended. 


646 SYSTEM OF VETERINARY MEDICINE 


SpecIAL SyMPToMS IN THE Cow.—These are groaning, moaning, 
grinding of the teeth, rapid sinking of eyes in the orbits, tympanites, 
more arching of the back. The straining is sometimes continuous, and 
the swelling of the vulva may spread over the perineal region. Occa- 
sionally the vulva is smaller than normal, shrunken, and retracted. In 
such cases, although the uterus may be full of fluid, only a small quantity 
of brownish chocolate-coloured discharge issues from the vulva. The 
general symptoms are those of septicemia. The cow lies a great deal, 
rises very stiffly and reluctantly, and soon lies persistently, and becomes 
unable to rise. On vaginal examination, the uterus often contains the 
whole or a portion of the after-birth, the cotyledons are more or less 
necrotic, whilst some of them may be found lying free in the cavity. 

FAvouRABLE Signs In Acute Merritis.—The animal’s appearance 
alters, sometimes in a few hours. She js brighter, shows less prostration, 
the pulse is stronger, and the appetite begins to return. The discharge 
becomes lighter in colour, mixed with mucus, and less fetid. The 
straining, acute pain, and local swelling abate, whilst the uterus examined 
per rectum is found distinctly smaller, softer, and less thick than before. 
Involution is always a favourable sign. 

Coursr, ProcREss, AND TERMINATION oF AcuTE Merritis.—The 
course is rapid, the acute symptoms seldom last longer than a week, and 
either end fatally or pass into the chronic stage, to be presently described. 
Death before the tenth day is a common termination in all animals. It 
occasionally happens that in acute septic cases death occurs within 
twenty-four to forty-eight hours. The mortality is probably well over 
60 per cent. Rapid and complete resolution seldom occurs; nevertheless, 
it is well known that cows suffering from sapremia sometimes make 
remarkably quick recoveries. If septiceemia should not prove fatal, the 
animal remains in an emaciated, weak condition for some time, and a 
prolonged convalescence is the rule. 

ProGnosis or AcuTE Metritis.—It follows that the prognosis of all 
puerperal infections should be very guarded. The gravest cases are those 
which commence very shortly after parturition with pronounced sepsis 
or extension to the peritoneum. If toxins alone are circulating in the 
blood, it is clearly a matter of dose. It must be remembered that. the 
onset may be very insidious. We have just said that grave symptoms 
sometimes follow an apparently mild infection. We would add that the 
significance of a mild attack in the absence of a rectal and vaginal ex- 
amination may easily be overlooked at a stage when very energetic 
measures, to be effectual, must be adopted. In the cow, the form known 
as “‘ sapremia’’ is more amenable to treatment, owing to the fact that 


METRITIS AND METROPERITONITIS 647 


premonitory symptoms are usually present, and absorption is compara- 
tively slow. The prognosis of acute metritis in the mare and bitch is less 
favourable. In any animal the “favourable signs” already described 
should be looked for. 

Diaanosis oF AcuTE MEtritis (MARE anp Cow).—Karly diagnosis is 
essential to a favourable result. It is not difficult, except in insidious 
cases, which must be treated on suspicion. The physical signs are all- 
important, especially the examination per rectum and per vaginam. (The 
latter is very painful when the septic inflammation affects the cervix, 
vagina, and vulva.) The frequent disparity between the general infec- 
tion and the local lesions should be borne in mind, and also the difficulty 
or impossibility of determining their extent. 

IMPORTANCE, COMPLICATIONS, AND SEQUEL& or AcuTE METRITIS.— 
The immediate and remote effects are often very serious. Many valuable 
animals are lost every year, whilst others, in which the disease becomes 
chronic, become temporarily or permanently sterile. The breeder of 
pedigree animals may suffer severely from the loss of both dam and 
offspring. The disease is much too frequently met with, especially 
amongst the larger domestic species. 

The following is a tabular statement of the complications and sequele: 

1. Septiceemia, pysemia, and infection of the joints (polyarthritis). 

. Septic peritonitis. 

. Metastatic pneumonia and laminitis. 

. Septic mammitis. 

. Cystitis and bacterial pyelonephritis (cows). 
. Malignant cedema (cows). 

7. Chronic inflammatory lesions of the uterus, ovaries, and other 
genitalia. 

8. Sterility. 

9. Tetanus (rare). 

Mild Form of Metritis.—This is termed acute endometrites by many 
authors when the infection is thought to be localised in the mucous 
membrane and submucous tissue of the uterus. Here the clinical picture 
is considerably modified. The local symptoms may be very similar to 
those already described. There is, however, less constitutional disturb- 
ance, the appetite and secretion of milk do not completely fail, the pulse 
and respirations are stronger and less frequent, and the animal’s strength 
and spirits are not lost so rapidly or to the same degree. 

The prognosis is much more favourable, owing to the localisation of 
the disease, and the small amount of toxins absorbed. Thus, cases which 
recelve prompt attention give a good percentage of recoveries. At the 


So OU Ee  bO 


648 SYSTEM OF VETERINARY MEDICINE 


same time, no fine distinction can be drawn. A mild case may suddenly 
become severe, with marked general infection. | 

TREATMENT OF AcuTE Metritis (MARE AND Cow).—To be of any avail, 
therapeutic measures must be applied energetically in the first stages. 
They are undertaken with three distinct objects: (1) The prevention of 
further absorption; (2) the support of the patient; (3) the elimination of 
toxins already absorbed. Much depends upon whether the infection has 
spread beyond the uterus. The first indication is the removal of the cause 
by mechanically cleansing the uterus and vagina. The animal—mare or 
cow—should be isolated in a suitable box, and placed in charge of a good 
attendant, who should be forbidden to approach other parturient animals. 
Strict precautions should be taken to prevent the latter contracting the 
disease. These measures include the disinfection of the hands, instru- 
ments, premises, utensils, clothing, and attendants. The body and 
extremities should be kept warm, and the young animal should be 
removed early and receive proper attention. 

Local or Surgical Treatment —The following technique can be recom- 
mended: Cleanse the perineal region, and douche the vagina with a mild 
antiseptic; disinfect and anoint the hand and arm, and insert cautiously 
with fingers in the form of a cone. The passage of the hand is always 
very painful when the whole mucosa is inflamed, as the procedure 
excites violent straining. When this abates, proceed to clear the uterus 
of all traces of after-birth and other material. (If parturition has 
occurred some days previously, manual dilatation of the os will 
usually be required before the whole hand can be inserted.) Flush 
out the uterine cavity with large quantities of warm boiled water 
treated with sodii bicarb. 3 drachms, or sodil chlor. 2 drachms, to the 
quart. If sterilised water is unobtainable, use soft clean water with 
a little antiseptic. Fill the uterus with fluid, prevent straining, and 
continue the preliminary douching until the fluid issues quite 
clear from the vulva, as it is important to remove all septic material 
before disinfection is attempted. Empty the uterus, siphoning off any 
remaining fluid, and irrigate with 5 per cent. of a B.P. solution of liydrogen 
peroxide (10 vols. oxygen). Repeat the process after a few hours, sub- 
stituting lyso) (1 per cent.), carbolic acid (1 per cent.), or chinosol (1 to 
1,000). Any good non-irritating antiseptic may be used, but on the 
whole we prefer lysol for cows and chinosol for mares. We have also | 
made considerable use of Lugol’s solution of iodine with belladonna, and 
found satisfactory results. Insert a sedative antiseptic pessary over- 
night consisting of iodoform diluted with boracic acid or chinosol, 
salol, etc. Continue the injections twice daily, unless they cause 


METRITIS AND METROPERITONITIS 649 


excessive straining and exhaustion. The uterus should be emptied of 
fluid as far as possible on each occasion. 

It should be borne in mind that the effect of intra-uterine injections 
is chiefly mechanical. One cannot hope to destroy the organisms in the 
uterine wall, nor must the antiseptic fluid be used sufficiently strong to 
interfere with leucocytosis and set up severe and continuous straining. 

Wounds within reach should be painted with pure carbolic acid, 
or carbolic acid and iodine. 

Apparatus.—Flexible metal, gum-elastic, and rubber tubes are mainly 
employed. Rubber tubes are best, fitted to a Winton’s enema syringe, 
or, better still, used with a large funnel or clamped to the side of an over- 
head pail or tank, and fitted with a perforated sinker. The American 
horse stomach-tube, first recommended to us by Professor W. L. Williams, 
answers the purpose very well indeed. In certain cases, before contrac- 
tion of the os takes place, it is possible to introduce the tube into the 
uterus without inserting the hand. Its extra length (10 feet) is advan- 
tageous both for filling and emptying the uterus. After use, pure rubber 
and metal tubes can be boiled; other tubes are soaked in an antiseptic 
solution for some hours. A simple gravitation apparatus causes least 
straining, and hence least exhaustion. 

General Treatment comprises good nursing, and the administration of 
stimulants, nutrients, and internal antiseptics. Practitioners, both 
human and veterinary, are not agreed as to the advisability of giving 
purgatives. Most writers deprecate active catharsis. Nevertheless, we 
would recommend a full dose of Jinseed oil and calomel at the outset in 
the mare and cow. Salts and aloes are too drastic and too depressing. 
The same objection applies to the hypodermic injection of physostigmine. 
or arecoline, even when combined with caffeine or strychnine. Neverthe- 
less, W. L. Williams* advises the use of hypodermic purgatives in smal] 
repeated doses. Diarrhoea, if present, should be controlled rather than 
checked; yet it must not be allowed to weaken the patient still further. 
Alcoholic stimulants should be given at frequent intervals, especially 
whisky, rum, or gin. In grave cases we give 4 ounces of gin every two 
hours, and a hypodermic injection of caffeine and strychnine at each visit. 
Nutrients include gruels, teas, milk, eggs, etc., given freely and frequently. 
The appetite should be coaxed in every way. Internal anttseptics have 
probably little specific action on the invading organisms or their toxins. 
Their main action is to lower temperature, yet we have found quinine 
invaluable. The best results are obtained by giving 3-ounce doses of 
quinine twice or even thrice daily for some days, either alone or along 


* “Veterinary Obstetrics,”’ pp. 806, 883. 


650 SYSTEM OF VETERINARY MEDICINE 


with spirits of nitrous ether, gentian, chlorate of potash, camphor, cubebs, 
and similar drugs. Salicylate of soda may be substituted for quinine in 
mild cases, and the hyposulphite is also administered. Sedatives should 
be used cautiously. Hot fomentations and an anodyne may be pre- 
scribed in the mare if there is marked colic and distension of the abdo- 
men. For this purpose chloral hydrate is generally preferable to opium, 
although small doses of atropine and morphine may be given subcutane- 
ously. Potassium iodide alternated with small doses of calomel and 
sulphate of magnesium is useful in peritonitis. 

Intravenous medication has many advocates in human practice, but 
the results so far have not been very encouraging, nor have they been 
more successful in animals. Large quantities of physiological salt solu- 
tion injected intravenously or subcutaneously twice daily appear to 
exercise a favourable influence in certain cases. Chinosol and formal- 
dehyde, iodine, and other drugs, have also been tried, but it is difficult 
to understand what beneficial action they may have. Dudley* mentions 
promising results in women with collargol by the daily intravenous injec- 
tion of 15 grains in a 2 per cent. emulsion. | 

Specific Treatment.—Serum therapy and vaccine therapy, especially 
the former, seem to be specially indicated in virulent infections running 
a rapid course. Neither have yet been thoroughly worked out, and at 
the present time they have a limited application as therapeutic agents. 
If streptococci are suspected, a polyvalent (antistreptococcic) serum may 
be given subcutaneously every eight or twelve hours, and continued for 
several days if improvement follows. 

Vaccine therapy, to be successful, necessitates the preparation of a 
special vaccine from the animal under treatment, and the vaccine must 
be prepared and employed in the earlier stages of the disease. For this 
purpose the services of a trained bacteriologist are required. Vaccines 
have not as yet been employed as therapeutic agents to any extent in 
this affection in animals. The difficulties attending the preparation 
of a satisfactory vaccine are very great. They might, however, prove 
serviceable in pyemia with local abscess formation. 

TREATMENT OF Py@mia AND Mitp Inrections (AcuTE ENDOMETRI- 
TIs).—The therapeutical measures are similar to those described above, 
with alterations and modifications to suit the case. Complications must 
be dealt with as they arise. 


**° Principles and Practice of Gynecology.” 


METRITIS AND METROPERITONITIS 651 


ACUTE (PUERPERAL) METRITIS IN SMALL ANIMALS. 


This resembles the disease in the mare and cow, with minor differ- 
ences. The etiology, symptoms, and treatment are practically the same. 
A simple metritis or endometritis is rarely seen. In the great majority 
of cases the whole of the coats of the uterus are involved, including the 
peritoneum. The disease is complicated with a septic peritonitis, and 
also with more or less septic poisoning. As in large animals, metritis 
occasionally follows normal parturition. Cases run a rapid course, and 
they are generally fatal, especially in bitches, when retention and decom- 
position of one or more puppies occur. Intra-uterine death is commonly 
followed by decomposition and septicemia. We have alluded to the 
susceptibility of the bitch to septic infection at parturition through the 
medium of wounds. Hobday,* dealing with this matter, says: “* The 
slightest abrasion of the uterine or vaginal mucous surface, particularly 
in the case of the bitch, is always a source of very great danger.” 

In sheep the actual cause is often forced extraction of the foetus 
whilst in an improper position, with consequent injury to the maternal 
passage. The ewe shows weakness and prostration almost from the 
outset, and in a few hours the symptoms of septic metritis observed in 
the cow make their appearance. Distension of the rumen is always 
present. The disease is very fatal, and it is readily and too often conveyed 
to other parturient animals, the shepherd’s hands and the lambing-pens 
acting as sources and carriers of infection. Ewes which lack protection 
in bad weather prove less resistant to the action of the causal organisms. 

SYMPTOMS IN THE Brtcu.—The patient shows more or less prostration, 
dulness, complete loss of appetite, suppression of milk, with coldness and 
collapse of the mamme. Unless there is marked septiceemia, the tempera- 
ture is high, falling rapidly in the later stages. The abdominal muscles 
are tense and painful on palpation, whilst there is distinct resonance on 
percussion. When relaxation takes place, the thickened uterus may be 
felt, and the animal evinces considerable pain both on external and 
internal examination (per vaginam). Vomition and thirst commonly 
appear, and usually indicate an acute toxemia.t The condition is now 
very grave, and early collapse is to be feared. Death occurs in the 
majority of cases in two to four days, but when sepsis is pronounced the 
animal may not survive twenty-four hours. The discharge from the 
vulva is pretty constant, and frequently accompanied by straining. It 

* “Surgical Diseases of the Dog and Cat,”’ second edition, 1906, p. 316. 


+ Much the same symptoms are observed in acute puerperal peritonitis in women 
(vide Eden, “ Manual of Midwifery,” 1911, p. 532). 


652 SYSTEM OF VETERINARY MEDICINE 


is acrid, fcetid, and dark in colour, due to the presence of altered blood. 
Sometimes it has a blackish or greenish hue. Occasionally there is 
ulceration or necrosis of the uterine mucous membrane, followed in 
some cases by perforation. Not infrequently there is damage to the uterine 
wall by forceps or sharp instruments used to effect delivery, or from the 
bones of the foetus. This is probably the origin of the perforation. 

TREATMENT IN THE Bitcu.—Early hysterectomy is usually indicated. 
Intra-uterine medication is less easily carried out, especially in the smaller 
varieties, whilst the results are seldom very satisfactory. A double- 
channelled cannula is generally preferred in order to avoid overdistension. 
It is carefully introduced, and an attempt is made to direct it into each 
horn of the uterus inturn. A moderate amount of antiseptic fluid is then 
injected—e.g., chinoscl, peroxide of hydrogen, or lysol. The uterus may be 
first washed out with warm saline solution. It is then emptied by siphon- 
ing, exercise, and raising the fore-parts whilst manipulating the abdomen, 
The irrigations should be continued as long as they do not cause distress, 
or the parts have not become swollen, making the passage of the cannula 
difficult and painful. When the latter occurs, attempts to continue the 
irrigations are probably productive of more harm than good. The general 
treatment is similar to that in the larger animals. Support the strength 
with stimulants, beef tea, strong coffee, caffeine, and administer anti- 
septics such as quinine. A polyvalent serum may be tried. If collapse 
is threatened, injections of normal saline solution under the skin may 
prove serviceable. 

In almost all cases in which there is retention of membranes or 
foetuses we are of opinion that hysterectomy offers the only prospect of 
recovery. To be of service, it should be undertaken without delay, and 
before a condition of toxemia has been set up. Once a marked toxemia 
has been established, the chances of success are very poor. The operation 
is liable to be followed by early collapse, for which reason the animal 
must be kept under close observation, and active stimulants or saline 
injections administered if the necessity arises. 


CHRONIC METRITIS IN THE MARE AND COW. 


Synonyms.—Chronic purulent endometritis; Pyometra; Pyometritis; 
Uterine abscess; Hydrometra. 

RemaArKs.—The disease is very prevalent in both species, and in both 
it bears an important relation to sterility.* There is usually a purulent, 


* See paper by the author on ‘Sterility in the Mare and Cow, 


Veterinary 
Record, vol. xxv. 


METRITIS AND METROPERITONITIS 653 


thickened condition of the endometrium, The submucous tissue and 
frequently the muscular coat are involved in the inflammatory change. 
If the os remains closed, a muco-purulent fluid collects in and distends 
the uterus (pyometra). Sometimes the pus collects to an inordinate 
extent, causing very marked distension (uterine abscess). Less often the 
fluid is serous in character, clear and odourless, and mixed with a quantity 
of mucus (hydrometra). 

Chronic metritis may follow the acute. form; more often it is mild or 
chronic from the outset. This may be due to onal resistance to or 
lessened virulence of the infecting organisms. In the non-parturient or 
early aborting animals the physiological condition of the uterine wall 
tends to localise the morbid process, whilst in the parturient animal the 
conditions are more favourable to the spread of infection and the absorp- 
tion and distribution of toxins. 

Et1otocy.—The acute and chronic forms arise from similar causes. 
The following additional contributory causes may be noted: 

1. Weakness of the genital organs induced by overfeeding, confine- 
ment, and intensive breeding. 

2. Morbid conditions of other genitalia (cervix, ovaries). 

The actual cause is traceable to a previous parturition or abortion, 
although non-puerperal cases occasionally occur—e.g., hydrometra (see 
Non-Puerperal Metritis). The connection with parturition is not always 
clear. A definite history may be absent, and the disease may not ap- 
pear, or it fails to be detected, for a considerable time after the act. In 
other cases there is some straining and discharge for some days after 
delivery. The discharge ceases or becomes intermittent, only to reappear 
at the first cestrum. 

Karly death and maceration of the foetus, or retention of a portion of 
after-birth at a later stage are prolific causes. If abortion occurs early 
in pregnancy, the foetus is usually expelled with its envelopes, but it 
may remain and become macerated. 

SyMPToMs oF CHRonic Merritis (MARE AND Cow).—If acute metritis 
exists, the grave symptoms pass off, but a muco-purulent discharge re- 
mains, the animal is unthrifty, and displays a capricious appetite. There 
is moderate distension and thickening of the uterus, with slight pain and 
straining on rectal palpation. Thus the acute and chronic forms differ 
from one another in the intensity of the local reaction. 

If the secretion of milk returns, the amount is small, and, owing to 
the elimination of toxins, it may prove harmful to the young animal. 
The latter should be removed. If the mild or chronic form is primary, 
the same symptoms obtain, with more or less loss of condition, unthrifti- 


654 SYSTEM OF VETERINARY MEDICINE 


ness, and weakness. Muco-pus adheres to the tail and hind-quarters, 
and often draws attention to the condition, whilst diagnosis is completed 
by rectal and vaginal examination. The discharge varies much in 
character and amount. It is rarely constant, appearing as a rule at 
irregular intervals, which seem to correspond with cestral periods. At 
such times, under the influence of the weak uterine contractions, or, more 
probably, the pressure of the distended uterus, the cervical canal opens 
up, straining is noticed, the mare may show colicky pains, and the whole 
or a portion of the uterine contents is expelled. The amount of fluid 
may be small. On the contrary, the floor of the box may be flooded with 
several gallons of fluid. 

The fluid is usually muco-purulent, thin, greyish, or slightly yellowish 
in colour, or sanious. Sometimes it is odourless, but it may be fetid. 
Foetor is always associated with retention of the remains of a foetus or its 
membranes. On vaginal examination the os is commonly closed, and the 
distended uterus may be pressed back into the vagina. In mares one 
frequently finds the os thickened, sometimes ulcerated, displaced, or 
hidden. 

Per rectum the uterus, when full of fluid, is tense, and feels like a huge, 
fluctuating, shapeless bag. More often it is moderately swollen, per- 
mitting the cornua and ovaries to be distinguished. The cornua are 
enlarged, firm, and longer than normal, whilst the ovaries are always 
carried downwards and forwards, and they are difficult to locate. One 
horn is frequently longer than the other. In less severe cases (chronic 
purulent endometritis) the disease may be confined to one side—usually 
the horn which was previously pregnant. The wall of the uterus is 
thickened, indurated, and usually unable to contract. 

Both mares and cows, in our experience, show absence of cestrum for 
a considerable time, after which cestrum reappears; but the periods and 
duration, especially in cows, are very irregular. Nymphomania may be 
present in mares, and occasionally in cows. Heifers affected with hydro- 
metra, on the other hand, show no cstrum for a long time after copula- 
tion. The abdomen is enlarged, and they are therefore thought to be 
pregnant. Other symptoms and physical signs of pregnancy are, how- 
ever, absent. 

DvuRATION is very indefinite. The disease runs a protracted course, 
and it is often overlooked. Some cows milk moderately well for a 
certain time, but their milk should not be used for human consump- 
tion. 

Proenosis depends upon the extent and duration of the condition, 
the complications, and the condition of the animal. Slight cases not 


METRITIS AND METROPERITONITIS 655 


infrequently recover spontaneously, and conceive. Severe attacks may 
end fatally, or cause temporary or permanent sterility. The latter result 
is more common. 

CoMPLICATIONS AND SEQUELZ.—1. Sterility (most frequent and im- 
portant). 

2. Early abortion (when conception occurs before resolution is com- 
plete). ' 

3. Secondary lesions in other organs—e.g., salpingitis and occlusion 
of the oviducts, disease of the cervix and ovaries (cysts, persistent cor- 
pora lutea, etc.), catarrh of the vagina. 

4. Chronic sapreemia or hectic fever. 

~Draenosis AND DIFFERENTIAL DiacNnosis.—In some instances the 
uterine condition is not suspected, the animal merely exhibiting a some- 
what unthrifty appearance until the os opens and the accumulated dis- 
charges present in the womb are expelled. Diagnosis is assisted by— 
(1) The discharge, (2) rectal and vaginal examination, (3) the history. 
A chronic discharge, when present, simplifies diagnosis. Chronic metritis 
involving one horn of the uterus may be confused with early pregnancy. 
The best guide is careful rectal examination. In both conditions the 
affected cornu is swollen and lengthened. In metritis, however, it is 
indurated throughout, whereas the pregnant horn, together with the 
cervix, is distinctly softened, and there is more or less fluctuation over 
the foetal site. 

TREATMENT OF CHronic Metritis (MARE AND Cow).—The following 
surgical measures are indicated: 

1. Dilate the cervix, mainly by hand, and keep it open. The tech- 
nique belongs to obstetrics, but warm vaginal douches assist the process. 
An open canal is essential to secure free access to and drainage from the 
uterus. 

2. Carry out uterine irrigation and medication to remove morbid 
products and to set up healthy action. 

3. Massage the organ per rectum from before backwards, and manipu- 
late the ovaries of the cow to stimulate contraction and to dilate the 
cervix. 

A catheter or rubber tube is inserted (see Acute Metritis), and the 
uterus is thoroughly cleansed with a 1 per cent. solution of bicarbonate 
of soda. In this way mucus and other material are removed, and topical 
treatment is made to act directly on the mucous membrane. We recom- 
mend Lugol’s solution of iodine, alternated with sulphate of copper (? per 
cent.). Chinosol, lysol, and peroxide of hydrogen are also useful; the latter 
if much fetor exists. The irrigations should be carried out daily or 


656 SYSTEM OF VETERINARY MEDICINE 


every second day, then once or twice a week, until the discharge ceases 
and the volume of the uterus is nearly normal. Pessaries may be left in 
situ, thus hastening resolution and lessening the necessity for very frequent 
irrigation. We recommend pessaries containing glycerine and ichthyol 
alone or combined with iodised phenyl. Massage of the uterus should 
always be carried out. In cows, also, if the ovaries are within reach, 
massage and the pressing out of soft yellow bodies have a beneficial 
effect, although some of our cases have not responded to this method of 
treatment advocated by Professor W. L. Williams.* After thorough 
manipulation of the uterus and ovaries, cestrum appears in the majority 
of cases within ten days, but it may be delayed. 

Constitutional treatment should receive attention. Plenty of exercise 
in the open and the avoidance of sexual excitement are indicated in 
every case. Sulphate of magnesium and quinine alternated with iron 
and nux vomica have given good results in our hands. To reduce the 
size of the uterus, we have also made considerable use of hydrastine 
in 2-grain doses twice daily. Ergot is less satisfactory, although it is 
recommended in human practice. Hart and Barbour} also recommend 
the administration of magnesium sulphate and quinine. In the mare a 
course of iodide and bromide of potassium is often beneficial, especially if 
there is any tendency to nymphomania. In the cow, W. L. Williams 
advocates large doses of bicarbonate of soda for extended periods. We 
have given 4 to 6 ounces daily in a series of cases with very indifferent 
results. The local treatment is materially assisted by good food and tonics. 

Complications requiring handling are often present in old-standing 
cases. Thus topical treatment is indicated for the vagina and cervix, 
compression or ovariotomy for the ovary. It sometimes happens that 
one horn of the uterus is found dilated, thickened, firmer, and longer 
than normal, whilst the ovary on the same side is cystic or fibro-cystic. 
It matters little whether the ovarian lesion is primary or secondary. Its 
presence appears to keep up the irritation in the affected cornu, and its 
removal, in our experience, favours resolution very considerably. Hence 
unilateral spraying is adopted, particularly in the mare, in which animal 
local operative handling of the ovary cannot well be carried out. 


CHRONIC METRITIS AND PYOMETRA IN THE BITCH AND CAT. 


This is a common disease in both species. A non-puerperal form is 
frequently met with. The majority of cases are independent of gesta- 
tion and parturition, and occur in maiden bitches. Occasionally it can 


* “ Veterinary Obstetrics,” p. 225. 
+ “ Manual of Gynecology,”’ sixth edition, pp. 231, 355. 


METRITIS AND METROPERITONITIS 657 


be traced to a previous parturition. The disease also occurs in virgin 
cats, but these animals rarely retain their virginity, and usually the 
symptoms are observed shortly after a normal or apparently normal 
parturition. Middle-aged and old bitches are chiefly affected, although 
young females are not exempt. All breeds are equally susceptible. 

ET1otocy.—The actual cause is often obscure, unless the metritis 
follows an abortion or birth at term, as in the mare and cow. There is 
little doubt that micro-organisms may gain access to the uterus through 
the open os during cestral periods. At such times the organ is susceptible 
to infection, whilst exposure lessens the resistance offered by the endo- 
metrium. Henry Gray* attributes the condition to suppression of 
cestrum induced by a chill. 

Morsip AnatoMy.—The appearance of the uterus removed during 
operation or after death is very variable. If the os is closed, the organ is 
more or less distended. The coats are frequently much thickened, and 
the mucous membrane is irregularly corrugated and congested over cer- 
tain areas. The horns may be greatly swollen, their contour is lost, and 
the walls may be thinner than normal, and the mucous membrane smooth 
and quite pale. Ulceration of the mucous lining may be present, and 
Grayf describes a necrotic form with perforation of the uterine wall and 
escape of the contents into the peritoneal cavity. Wooldridget has met 
with a cystic metritis in the bitch in which the mucosa was covered with 
innumerable small cysts with serous and sometimes hemorrhagic con- 
tents. It is probably the case that the cystic condition is an early phase 
of the disease, which is therefore never encountered on post-mortem, and 
is seldom seen on operative removal of the purulent uterus. 

Symptoms.—In the early stages the symptoms are indefinite, and 
frequently unobserved. In some instances the general health is soon 
affected, but in others general symptoms may not make their appear- 
ance for a considerable period (months). The appetite becomes poor or 
capricious, condition and strength are gradually lost, and the animal is 
listless and dull. A vaginal discharge frequently first attracts attention 
to the condition. Vomition and increased thirst are not uncommon. 
If discharges have accumulated in the uterus, some uneasiness and 
disturbance, with probably a rise in temperature, precede their ex- 
pulsion. At other times fever is not usually present. Sooner or later 
the bitch or cat lies a great deal, emaciation becomes marked, and death 
results from septic poisoning, peritonitis, or exhaustion. 

* Veterinary Journal, January, 1909, p. 12. 
+ Ibid., p. 13. 
t Ibid., vol.’ xviii., 1911, p. 291. 
VOL. IT, 42 


658 SYSTEM OF VETERINARY MEDICINE 


The discharge is usually intermittent, but if the os remains open it 
may be more or less continuous, small in amount, and noticed after 
defecation and urination. Its colour and character vary, but as a rule 
it is muco-purulent and yellowish, reddish-yellow, or chocolate brown. 
Sometimes it is very footid. If the os remains closed for a time, the 
uterine horns become distended with pus (pyometra), and progressive 
enlargement of the abdomen takes place infero-laterally. : 

The accumulation of pus continues until the pressure is sufficient to 
dilate the cervix, permitting its escape. This is more likely to occur at 
cestral periods. The quantity of fluid also varies, but as much as } to 
1 pint may be voided in this way, followed by a continuous or inter- 
mittent flow from the vulva. Evacuation of the uterus is followed by 
temporary relief and marked reduction in the size of the abdomen. 
Occlusion of the os with accumulation of pus may occur at any time. 
Exceptionally, great thickening of the cervix takes place, when the dis- 
charges are permanently imprisoned. 

Palpation of the abdomen is important in completing the diagnosis. 
There is little pain, but in pyometra there is often distinct fluctuation, 
and it may be possible to feel the distended cornua. When little or no 
fluid is present in the uterus, the thickened organ may be felt. In 
doubtful cases an exploratory laparotomy may be considered. 

DIFFERENTIAL Diaanosis.—Ascites and pregnancy, like pyometra, 
are associated with enlargement of the abdomen, but the differentiation 
of these conditions seldom offers any difficulty. The affection may be 
mistaken for gastritis. Exploratory puncture in pyometra is inadvisable, 
and frequently fatal, and militates against the success of operative treat- 
ment, even if immediately undertaken. We would here direct attention 
to a clinical article by Charmoy* in the Recueid de Médecine Vétérinaire, 
July 30, 1913. 

Course.—This is very protracted as a rule. The disease may con- 
tinue for many months, with exacerbations at intervals. 

PROGNOSIS is grave. Young bitches treated early may recover with- 
out operative interference, but relapses are not uncommon. 

TREATMENT.—Irrigation of the uterus is frequently attended with 
unsatisfactory results, yet it may be tried in bitches of the larger breeds 
with the aid of a fine rubber cannula provided with a stilette (vide Acute 
Metritis). Both cornua are repeatedly washed out with warm saline 
solution, followed by Lugol’s solution of iodine, chinosol, or other anti- 
septic. The operation is not easily carried out, and it is sometimes impos- 
sible, especially in virgin bitches, owing to the thickened stenosed con- 


* “ Métrite Chronique et Pyométrie chez la Chienne et chez la Chatte.”’ 


METRITIS AND METROPERITONITIS 659 


dition of the cervix. In small bitches, and certainly in cats, it need 
scarcely be attempted. The passage of the tube through the os may be 
assisted by hot vaginal douches. After injection, the patient is raised 
on her hind-legs, and the abdomen is squeezed to expel the fluid. 

Topical applications are assisted by the internal administration of 
tonics and ecbolics, such as iron, strychnine, ergot, and hydrastine. 
Pituitrine may be tried, and a course of quinine with good nourishing 
food is indicated. 

It is generally agreed, however, that the only really curative treat- 
ment is ovaro-hysterectomy. Generally speaking, once the diagnosis is 
established, the sooner the operation is performed the better. It should 
not be delayed until the animal has become weak or a condition of 
toxemia has supervened. 

The bitch is a more favourable subject for operation than the cat. 


DISEASES OF THE URINARY ORGANS IN 
THE HORSE 


By E. WALLIS HOARE, F.R.C.V.S., anp G. L. INGRAM, M.R.C.V.S. 


DISEASES OF THE KIDNEYS. 
GENERAL REMARKS. 


RENAL diseases are said by some authors to be of comparatively rare 
occurrence in the horse, while others would apply this remark to all 
domestic animals. Williams states:* ‘“ Owing to the fact that the lower 
animals are free from mental emotions, the cares and troubles of the 
world, and that they do not indulge in alcoholic drinks, the kidneys are 
in a great measure exempt from those diseases which so often destroy 
human life. Diseases, however, do occur with which the veterinarian 
has to cope.” 

¥. Smitht remarks: “ There is scarcely any organ of the horse’s 
body so free from disease as the kidney.” 

We cannot agree with either of these statements. We know per- 
fectly well, as the result of post-mortem experience, that chronic renal 
diseases are of frequent occurrence in aged dogs. A similar experience 
teaches us that affections of the kidney are more common in the horse 
than is generally imagined. Moreover, Hutyra and Marek remark: 
“* Acute inflammation of the kidneys is a very frequent disease of animals, 
because it develops mostly from infectious diseases, which occur 
very often in domestic animals.” In reality, the explanation of the 
apparent rarity of such diseases is that they are seldom diagnosed in 
ordinary practice. No doubt amongst the laity it is imagined that 
renal affections are of common occurrence in the horse, and many and 
varied symptoms are ascribed to “something wrong with the water.” 
We must admit, also, that a diagnosis of “ kidney disease ”’ is on occasions 
given by practitioners, although it is not based on the only reliable 
evidence furnished in such cases—viz., a chemical and microscopical 

* « Principles and Practice of Veterinary Medicine.” 


t ‘Veterinary Physiology.” 
660 


DISEASES OF THE KIDNEYS: HORSE 661 


examination of the urine. In judging of the incidence of renal disease 
in the horse, there are some important matters to be considered: (1) The 
symptoms presented are very obscure, and are likely to be attributed 
to other causes; moreover, there are some cases in which lesions are 
found in the kidneys post mortem, although no appreciable symptoms 
existed during life. Again, only one kidney may be involved in some 
instances, and the other can perform the double function; also the 
presence of subjective symptoms cannot be ascertained in animals. 
(2) Examination of the urine is not adopted as a matter of routine . 
practice in the diagnosis of equine diseases; hence it is highly probable 
that many cases of renal disease are overlooked. Again, post-mortem 
examinations are not systematically carried out to anything like the 
extent that is desirable, while, in order to detect some renal lesions, a 
microscopical examination of the kidneys is essential. We must also 
point out that renal disease may be secondary to another affection, and 
the symptoms and lesions of the primary malady are likely to be recog- 
nised, while those of the kidneys may be ignored. 

It is admitted by all modern authors that the clinician has not directed 
that amount of attention to renal diseases which the subject deserves. 
Hutyra and Marek* state: “The clinical data concerning nephritis in 
veterinary medicine are as yet incomplete, probably partly because 
systematic urinary analysis does not yet occupy its proper place in 
veterinary practice. In contrast to the many forms of disease which 
have been ascertained by post-mortem examination, and still more by 
histological investigation, inthe various inflammatory processes in the 
kidneys, clinical examination is able to differentiate only few clinical 
pictures with the methods at its disposal.”’ 

This in reality sums up the situation, and it supports our view that 
renal diseases are not of rare occurrence in the horse. No doubt the 
opposite view may serve as a salve for professional apathy and ignorance; 
but rather than accept it, we should, as scientific practitioners, embrace 
every opportunity to improve our clinical knowledge of the subject 
by carrying out examinations of the urine, observing carefully the symp- 
toms present, and performing autopsies whenever opportunity offers. 
Similar remarks apply to cardiac diseases in the horse. As we shall point 
out when discussing that subject, the diagnosis is also beset with diffi- 
culty, and in consequence some authors state that such affections are 
rarely met with. But systematic post-mortem examinations tell a 
different tale. There is too often a tendency in veterinary practice to 
assume the rarity of certain diseases when we are either unable to detect 


* “Special Pathology and Therapeutics of the Diseases of the Domestic Animals.”’ 


662 SYSTEM OF VETERINARY MEDICINE 


their presence, or neglect the opportunities for clinical research that 
are presented to us. 

In the Report of the Army Veterinary Service 1911-12 three cases 
of nephritis are recorded, and the total admissions for diseases of the 
urinary system were only nine, but these include four cases of polyuria. 
In the Report for 1912-13 we find two cases of nephritis, total admissions 
for diseases of the urinary system fifteen, and these include nine cases of 
polyuria. It will thus be seen that diseases of the urinary organs are 
rare in army horses as compared with private practice. 

In order to comprehend the effects of renal disease, it is essential to 
be acquainted with the histology and physiology of the kidneys. Again, 
as the examination of the urine constitutes the only reliable means of 
diagnosis, the practitioner must be familiar with the normal appearances 
and constituents of this excretion, with its morbid conditions, and with 
the tests whereby these alterations can be detected. 

We propose to draw attention briefly to the important points in 
connection with the function of the kidneys, the characters of the urine 
in health and disease, and the diagnostic tests employed; then we shall 
consider certain pathological conditions associated with renal affections, 
and certain symptoms which, although not diagnostic, are still suggestive 
of the presence of diseases of the kidneys, and indicate the necessity for 
an examination of the urine. 

The function of the kidneys, as pointed out by F. Smith, is to regulate 
the composition of the blood by removing from it waste and poisonous 
products, and maintaining its proper degree of alkalinity. These organs 
may, in a sense, be regarded as the filters of the body. This author, in 
his work on “ Veterinary Physiology,” gives an excellent description of 
the structure and functions of the kidneys, also of the composition and 
characters of the normal urine of the horse, and to this work we are 
indebted for the following information, a knowledge of which is essential 
in order to appreciate the alterations and results produced by disease. 
Space will not permit us to draw attention to the histology of the organs, 
but their delicate structuré, their vascular arrangement, and their com- 
plex function, lead us to infer that they must frequently suffer from 
derangement, due to irrational treatment and to the effects of other 
diseases. As regards the vascular arrangement, which plays such an 
important part in connection with the function of the kidney and in | 
diseased conditions, attention should be directed to the fact that the 
renal artery is short, and is given off directly from the posterior aorta; 
also, that the blood-pressure in the former is practically the same as in 
the latter vessel, while the pressure in the renal vein is low; also, the 


DISEASES OF THE KIDNEYS: HORSE 663 


artery entering the Malpighian tuft is larger than the vein leaving it, 
so that a high blood-pressure is maintained in the glomerulus. Another 
point of interest is the large amount of blood that passes through the 
kidney. The vascular mechanism is also of importance. No secretory 
nerves to the kidney exist, the influence of the nervous system being 
confined to its action on the bloodvessels. The vascular arrangements 
are controlled by a rich supply of vaso-constrictor nerves, while the 
presence of dilator nerves is also recognised. When the general blood- 
pressure is constant, if dilatation of the renal vessels be brought about, 
an increased secretion of urine results. On the other hand, if these vessels 
become constricted, the secretion is reduced. When the general blood- 
pressure is raised, the amount of blood in the kidney is augmented, and 
the production of urine is increased. But if, with an increased general 
blood-pressure, there is constriction of the small arteries of the kidney, 
the amount of urine is lessened. An increased flow of blood through 
the kidney, in addition to increased general blood-pressure, is necessary 
in order to produce increased secretion of urine. This is demonstrated 
by the fact that, if the renal vein be obstructed, although the blood- 
pressure in the kidney rises, the secretion of urine ceases. A marked fall 
in general blood-pressure results in the reduction of the flow through 
the kidney and of the pecaruea ate therein, so that the secretion of 
urine is suspended. 

~ Secretion of Urine.—Divergent views are held in connection with this 
subject. Some accept the view that in the secretion of urine two por- 
tions of the kidney are engaged—viz., the glomerular and the tubular. 
In the glomerular, filtration occurs from the bloodvessels of the tuft into 
Bowman’s capsule. Owing chiefly to the result of varying glomerular 
blood-pressure, the water of the urine, and probably the salts, are 
passed out. In the tubules, as the result of distinct secretory activity of 
their cells, the organic material is excreted; 1t mingles with the fluid 
portion, and enters the pelvis of the kidney, thus forming the urine. 

In addition to the function already mentioned, the cells of the 
tubules are known to be capable of originating glycine, and of bringing 
about a reunion of this substance with benzoic acid to form hippuric 
acid, by acting in conjunction with the oxygen of the blood, and probably 
the active agent in the synthesis is an enzyme (IF. Smith). 

Another view put forward is that the urine, with all its constituents, 
is filtered through the glomeruli as a weak fluid akin to plasma. This 
fluid is then actively concentrated by the cells of the tubules. 

The following points in connection with the urine are of interest to 
the clinician : 


664 SYSTEM OF VETERINARY MEDICINE 


Urea.—This nitrogenous constituent of the urine is of importance in 
consequence of the toxic effects it exerts on the system, when from various 
pathological conditions of the urinary organs it is retained in the system 
(see p. 675). According to F. Smith, “it is by no means decided how 
urea is produced. It must presumably arise from the disintegration of 
proteids, derived either. from proteid food or proteid tissues. As the 
result of their destruction, it is extremely probable that ammonia com- 
pounds are formed, which are discharged into the blood, and are then 
subsequently converted into urea in some organ, which is probably the 
liver.” ! 

Urea is very soluble in water. It exists in the urine im a free and 
uncombined state, but is capable of forming salts with acids. Its amount 
in the urine varies according to the amount of nitrogen in the food, 
being usually increased on a nitrogenous diet; but exceptions occur in 
which, on a diet consisting principally of hay, more urea is excreted than 
on one of oats and hay. The amount cannot be regarded as a measure 
of the work performed by the animal, but under the influence of work 
more urea may be excreted than during rest. According to F. Smith’s 
researches, great variations occur in the amount of urea excreted even 
when conditions as regards diet, rest, and work are identical. The 
average is from 3 to 4 per cent., being higher when the amount of urine 
excreted in twenty-four hours is small in amount than under normal] 
conditions. 

Uric Acid.—According to F. Smith, this substance is entirely absent 
in the horse in health, and probably in all herbivora, unless still suckling 
at the mother. But during sickness, especially when fever is present 
and the animal is living on its own tissues, uric acid may be readily found 
in the urine of herbivora. 

Hippuric Acid occurs in the urine of herbivora only. It is always 
met with in the form of hippurate of lime or potash, but never in the free 
state. The amount excreted varies with the diet; it is increased by using 
meadow hay and oat straw, and decreased by using clover, peas, wheat, 
oats, etc. F. Smith’s observations show that it is generally found 
in the urine of working horses, and but seldom in the urine of horses 
at rest. 

Oxalic Acid, in combination with lime, is constantly present in the 
urine of herbivora, and its origin is probably from the oxalates contained 
in the food. | 

Inorganic Substances.—Potassium salts predominate, sodium and 
magnesium are present in small amounts, while phosphates are practically 
absent, being almost wholly excreted by the intestines. Calcium salts 


DISEASES OF THE KIDNEYS: HORSE _ 665 


are chiefly excreted by the kidneys. Oxalate and carbonate of lime 
crystals are common microscopic deposits in the urine of the horse. 

Characters of the Normal Urine of the Horse—Translucency.—Gener- 
ally turbid, due to suspended carbonate of lime and magnesia. Very 
rarely it is clear, and then only for a short time. As the urine cools, the 
degree of turbidity becomes intense, especially when it undergoes am- 
moniacal fermentation. 

Reaction.—Alkaline, due to carbonate of potash. If the horse be 
fed entirely on oats, the urine becomes acid, probably due to the formation 
of acid phosphates from the food. 

Specific Gravity —Varies according to the diet and the amount of 
dilution. According to F. Smith, the average is 1036, the highest 1050, 
and the lowest 1014. 

Quantity—Varies according to diet, amount of water consumed, 
season, and work. It is increased on a highly nitrogenous diet and the 
larger amount of water which is consumed in consequence of feeding on 
such diet. The amount is also increased in winter, owing to the reduced 
action of the skin. The quantity is lessened in horses at work and in 
warm weather, owing to the increased action of the skin. 

Odour.—The slightly aromatic odour of the horse’s urine is said to be 
due to certain substances of the phenol group. A distinct, though faint, 
smell of ammonia is present in perfectly fresh urine. This may be due 
to fermentative changes occurring in the urea before the urine is passed. 

Colour.—This may be clear yellow, brownish yellow, deep yellow, or 
yellowish-red. On exposure to the air, it rapidly turns brown. Certain 
forms of diet influence the colour. Thus, on green food it may be of a 
yellowish-white. If large amounts of red carrots are allowed, it may 
be of a brownish-red tint, an alteration which may be mistaken for a 
pathological condition. 

Consistency—It is of importance to remember that under certain 
conditions alterations may occur in the consistency of the urine in healthy 
animals which may be mistaken for disease. F. Smith points out that 
some mares excrete a glairy tenacious urine, which, owing to the amount 
of mucin it contains, can be drawn out in strings. Not uncommonly 
it is found as thick as linseed oil, especially during cestrum. On an 
exclusive diet of oats he has found the urine so mucinous as to pour like 
white of egg. This observer also points out that in the pelvis of the kidney 
a material is found composed of the natural mucus of the urine mixed 
with insoluble lime-salts, which resembles pus in appearance, and may be 
mistaken for a pathological condition. 


666 SYSTEM ‘OF VETERINARY MEDICINE 


MORBID CONDITIONS IN CONNECTION WITH THE URINE AND 
THE URINARY SECRETION, 


Oliguria.—This signifies a diminution in the quantity of urine se- 
creted. It varies in degree, and may be associated with one of the 
following conditions: (a) Chronic renal diseases, in which a diminished 
amount of blood passes through the kidneys, owing to shrinkage of the 
renal capillaries and atrophy of the glomeruli. (6) Renal diseases, in 
which the secretory structure of the kidneys suffers from morbid altera- 
tions, and a diminished production of urine results. (c) Cardiac affections, 
in which lowering of the blood-pressure occurs, and the circulation in 
the kidneys becomes impeded. (d) Pressure on the renal veins by 
tumours or by ascitic fluid. (e) In the early (congestive) stage of acute 
nephritis. (f) When large amounts of fluid escape from the body by 
other routes, as in diarrhoea, or when fluid accumulates in the cavities 
of the body, as in the case of extensive exudates and transudates— 
e.g., pleural effusion, hydrothorax, or ascites. 

Anuria.—This is the term applied to total suppression of urine. It 
occurs under the following conditions: (a) Obstructive, in which the urinary 
passages are obstructed by calculi—e.g., blocking of both ureters by 
fragments of a renal calculus, or of the urethra by a calculus. In such 
cases the urine is unable to escape, and is forced backwards on the kidneys; 
pressure atrophy of the renal parenchyma results, and uremia occurs. 
(b) In the intense congestion of acute nephritis anuria may result, but a 
marked reduction in the amount of urine is more often observed. In 
severe nephritis with degeneration of the secreting epithelium, suppression 
may occur ; also in occlusion of the collecting tubules due to the con- 
traction of new connective tissue surrounding them. (c) In acute 
poisoning by turpentine, cantharides, phosphorus, and lead. 

Polyuria.—This signifies an increase in the quantity of urine, especially 
as regards the proportion of water. It is a symptom occurring in a 
variety of conditions, and the urine may exhibit various morbid changes 
according to the associated disease. Polyuria occurs when a larger 
amount of blood than usual passes through the kidneys. This may 
depend on an increase in the general blood-pressure, without any con- 
striction of the renal vessels, or with a normal blood-pressure when the 
renal vessels are dilated. It may also depend on chemical stimulation of | 
the renal parenchyma, with an increased permeability of the dilated 
renal bloodvessels occurring in a secondary manner; or the secretory 
action of the vascular endothelium and of the renal epithelium may be 
increased. Polyuria is met with in various forms of renal disease; in 


DISEASES OF THE KIDNEYS: HORSE 667 


diabetes insipidus and diabetes mellitus; in certain affections of the 
central nervous system; in affections in which copious exudates and 
transudates are comparatively quickly absorbed, such as cases of pneu- 
monia and pleurisy; in certain chronic infectious diseases, such as tuber- 
losis and glanders; and as the result of large doses of diuretic agents. 

Polyuria is sometimes regarded as synonymous with the disease 
known as “ diabetes insipidus,” but Hutyra and Marek consider that the 
former term should be applied to transitory conditions of excessive flow 
of urine, or to morbid states of the urine associated with diuresis and 
albuminuria occurring as a. symptom in connection with various renal 
diseases. On the other hand, the term “diabetes insipidus” should be 
restricted to those cases in which the polyuria depends on improper 
feeding, and runs a more or less chronic course. 

Albuminuria.—The presence of albumin in the urine is generally 
regarded as an indication of the existence of a renal disease, but some 
investigators recognise a condition termed “ physiological albuminuria,” | 
in which minute quantities of albumin occur in the urine of healthy 
animals, especially in the case of dogs and swine, to a less extent in 
ruminants, and very rarely in horses (Simader). According to Kitt, a 
transitory albuminuria may occur after fatigue in the horse, and in the 
case of physiological albuminuria very careful tests have to be applied 
in order to detect the presence of albumin. Some observers state that 
the albumin found in the urine under normal conditions is chiefly nucleo- 
albumin and mucin; while Henn doubts the occurrence of serum albumin 
in the urine of healthy animals. Albuminuria in animals generally 
indicates some lesion of the renal parenchyma, but it may also be asso- 
ciated with other morbid conditions. In the normal kidney only the 
water and the salts are allowed to pass from the blood. When albumin 
transudes, the nutrition of the epithelium of the capillaries of the tuft 
or of the cells surrounding the glomerulus is probably disturbed. 

Albuminuria occurs in acute and chronic organic diseases of the 
kidneys in which the glomeruli or the epithelial cells are affected, also 
in acute and chronic renal congestion. But in affections of the renal 
pelvis, ureters, and bladder, when associated with the formation of pus, 
albumin may be found in the urine; and some authors state that it 
can_even originate from the genital organs. As in such instances it 
is not derived from the renal tissue, the condition is sometimes termed 
spurious albuminuria. Amongst other affections in which albumin may 
be found in the urine, we may mention various diseases of the blood 
associated with alterations in its composition; circulatory disturbances 
of the kidney; certain affections of the nervous system, such as cerebral 


668 SYSTEM OF VETERINARY MEDICINE 


hemorrhage, spinal meningitis, myelitis, ete. According to Kitt, the 
toxins of infectious diseases can cause albuminuria. It may also be 
observed in cases of chronic poisoning by lead and mercury, and is present 
to a variable extent in that affection known as “ azoturia,”’ or “ paralytic 
hemoglobinemia,”’ 

DiaGNosis.—This is carried out by applying certain chemical tests 
to the urine of the suspected animal, so as to detect the presence of albu- 
min. As, however, albuminuria is a symptom met with in various aflec- 
tions, it will be necessary to direct attention to other matters, such as a 
microscopical examination of the urine, and to the presence of symptoms 
which may assist in the diagnosis. 

Tests for Albumin—Heat and Nitric Acid Test—A small amount of 
urine is boiled in a test-tube over a spirit-lamp, and a drop of nitric acid 
is then added. If on boiling a cloudiness occurs, which is not dissolved 
on the addition of an acid, albumin is present. It is generally said that a 
precipitate which dissolves is due to earthy phosphates or carbonates, 
but, as already remarked, F. Smith states that phosphates are practically 
absent from the urine of the horse. Acetic acid may be substituted for 
nitric acid in the above test. 

Heller’s Ring Test.—Pour a small quantity of fuming nitric acid into a 
test-tube, and with a pipette allow the urine to flow gently down the side 
of the tube upon the acid. At the line of junction of the two fluids a 
white ring is formed, the depth of which varies according to the amount 
of albumin present. This test is reliable and convenient for clinical work, 
and is said to demonstrate the presence of 0°02 per cent. of albumin. 
A coloured ring may form at the junction of the acid and the urie, and 
is due to oxidation of the colouring matters in the urine. 

Ferrocyanide of Potassium and Acetic Acid Test.—To a test-tube half- 
full of urine add 5 or 6 ¢.c. of a 5 per cent. solution of ferrocyanide of 
potassium. Mix thoroughly and add 10 to 15 drops of acetic acid. If 
albumin be present, a cloudiness or a flocculent precipitate will be pro- 
duced, the degree of which varies according to the amount of albumin 
present.’ This test precipitates all forms of albumin, but not mucin or 
other substances, and is regarded as very reliable. 

Magnesium-Nitric Test.—Mix 1 volume of strong nitric acid with 
5 volumes of a saturated solution of magnesium sulphate. This 
reagent is to be used in a similar manner to the nitric acid in Heller’s 
test. 

Millard’s Fluid Test.—This is an extremely delicate test for the detec- 
tion of minute traces of albumin. The reagent is prepared thus: Glacial 
carbolic acid (95 per cent.), 2 drachms; pure acetic acid, 7 drachms; 


DISEASES OF THE KIDNEYS: HORSE 669 


liq. potassee, 2 ounces and 6 drachms. Mix. It is employed by the 
contact method as in Heller’s test. 

Trichloracetic Acid Test (after Raabe). This is also advised for the 
detection of minute traces of albumin, and is carried out as follows: 
Add a small crystal of trichloracetic acid to 1 c.c. of urine. If albumin 
be present, a sharply-defined turbid zone occurs at the point of contact. 
For urine-testing in horses and cattle, this test is advised by Henn. 

Salicylic-Sulfonic Acid Test (of Roch). This is also advised by Henn 
for testing the urine of horses and cattle. Add a few crystals of salicylic- 
sulfonic acid to 2 or 3.c.c. of urine. If albumin be present, turbidity 
results. 

Spregler’s Test.—This is recommended by Henn for the testing of the 
urine in cattle. The reagent is prepared as follows: Perchloride of mer- 
cury, 8 parts; tartaric acid, 4 parts; glycerine, 20 parts; water, 300 parts. 
A test-tube is filled one-half with this mixture, and the suspected urine 
is allowed to run down the side of the tube drop by drop. If albumin 
be present, a white ring 1s formed. 

Metaphosphoric Acid Test.— Add an aqueous solution of meta- 
phosphoric to the suspected urine. If albumin be present, opalescence 
or cloudiness results. 

For urine-testing in the dog, Henn advises the heat and nitric acid 
test, the ferrocyanide of potassium and acetic acid test, and the meta- 
phosphoric acid test. 

Quantitative Estimate of Albumin.—This is carried out by means of 
Esbach’s albuminometer. For details of this method the reader is 
referred to works on urinalysis. A rough method consists in boiling a 
certain amount of acidulated urine in a test-tube, and allowing it to 
stand until cool. By comparing the depth*of the deposit with the whole 
amount of urine in the tube, an approximate idea may be gained of the 
amount of albumin present, such as a mere trace, one-fourth, one-half, 
almost solid, etc. 

Source of the Albumin.—It is necessary to distinguish renal albu- 
minuria from the spurious type. In the former, tube casts, epithelial 
casts, hyaline casts, etc., will be present in the urine in addition to albumin. 
In the spurious type a copious organic sediment, containing epithelium 
derived from the urinary passages, is present, with only a small amount 
of albumin. But both forms may be combined. The microscopical 
appearance of epithelial cells when detached without change of form 
may enable us to ascertain the seat of desquamation. Thus, when 
numerous, large, and squamous, they probably come from the bladder. 
If from the renal pelvis or ureters, they are also squamous, but not so 


670 SYSTEM OF VETERINARY MEDICINE 


large nor so numerous. If polyhedral with large nucleus, or columnar, 
they probably come from the uriniferous tubules; and if from the male 
urethra, they are generally columnar. But in cases of catarrhal in- 
flammation of the mucosa these cells are generally passed in large amounts, 
and tend to assume a common form—viz., globular with large nuclei— 
so that their source cannot be definitely determined. 

ProeNnosis.—Except in cases of physiological albuminuria, which, 
as already stated, are rare in the horse, the condition must be regarded 
as very serious. Frequent examinations of the urine should be made, 
both chemical and microscopical, in order to determine whether the con- 
dition is persistent, and other indications of the existence of a serious 
renal disease should be sought for. In addition to the primary affection 
of the kidneys, it must be remembered that serious disturbances of 
nutrition result, due to the albuminous material which jeg: out of the 
system unused. 
| TREATMENT.—As albuminuria is a LS of various conditions, 

treatment must be adopted according to the disease with which it is 
associated. 

Heematuria signifies the presence of blood in the urine. This may 
occur under a variety of conditions, as follows: It may be met with in 
cases of piroplasmosis, in purpura hemorrhagica, and in certain cachectic 
states of the system; also in connection with morbid alterations in the 
kidneys, such as acute renal congestion, acute nephritis, renal infarction, 
rupture of the kidney, new growths, renal calculus, and parasites. Cer- 
tain toxic agents, such as oil of turpentine in large doses, carbolic acid, 
and cantharides, also cause hematuria. Affections of the urinary pas- 
sages, such as calculus in the ureter, vesical calculus, and urethral cal- 
culus, tumour or ulceration bf the bladder, also the careless passage of. 
a catheter, may be associated with the presence of blood in the urine. 
It also occurs in cases of hesmorrhage of the bladder (see p. 719). 

CHARACTERS OF THE URINE.—It may be smoky or a bright red, or a 
dark porter colour. In many instances, in addition to red blood-cor- 
puscles, the urine contains hemoglobin in solution, owing to the destruc- 
tive action of the urimary constituents on the corpuscles. This is said 
to occur more readily in ammoniacal urine, or when the latter is of low 
specific gravity. The sediment is light or dark red in colour, and may 
contain red blood-corpuscles. In some cases blood-clots are present. 
On microscopical examination, the blood-corpuscles can be recognised 
with facility; they may retain their colour, and be free or aggregated in 
masses and of a crenated appearance, or they may occur as simple 
shadows, or they may be imbedded in casts of the uriniferous tubes. 


DISEASES OF THE KIDNEYS: HORSE 671 


DIFFERENTIAL DiAGnosis.—It is of importance to ascertain the source 
of the hemorrhage, but this is not always an easy matter. When 
originating from the kidneys, the blood and urine may be intimately 
mixed. But clots may be present, especially in the case of profuse renal 
hemorrhage, and occur in the form of moulds of the pelvis of the kidney, 
or of the ureter. When the bladder is the source of the hemorrhage, 
blood may only be found with the last portion of urine passed, or be 
observed at the termination of micturition; but in some well-marked 
cases of this nature the blood may be intimately mixed with the urine. 
If the bladder be washed out by instrumental means, the fluid is found 
more or less blood-tinged; but if the source of the bleeding is from the 
ureter or kidney, the fluid withdrawn is clear. Another diagnostic 
feature of importance is that when the hemorrhage is renal, epithelial 
cells and various casts may be detected in the urine. When the bleeding 
occurs from the urethra, due to the presence of a calculus, the blood may 
escape in the intervals between micturition, or may appear as a small 
clot at the commencement of the act, or it may be passed during the 
straining attempts to urinate. WM] 

TREATMENT,—This will depend on the condition of which the hama- 
turia is but a symptom. In the case of free hemorrhage, internal 
styptics are usually advised, such as ergot, adrenalin, etc. But although 
such agents cause constriction of bloodvessels, they also raise blood- 
pressure, and in the case of renal hemorrhage their therapeutic value is 
doubtful in consequence. Atropine is regarded by some practitioners 
as having a special effect in checking all forms of internal hemorrhage. 
In the case of hematuria due to lesions of the bladder, local injections of 
adrenalin (1 in 10,000) are advised. 

Heemoglobinuria.—In this condition the blood-pigment occurs in the 
urine. It is one of the symptoms of the disease known as “ azoturia,” 
but in that affection other abnormal constituents are found in the 
urine as well. The condition is believed to depend on a breaking 
down of the red blood-corpuscles, or on the elimination of the pigment 
from the blood-cells, or both processes may be combined. According to | 
Hutyra and Marek, hemoglobinuria should be regarded as a symptom 
of hamoglobinemia, and the latter is described under two forms—viz. 
simple and paralytic. 

The paralytic corresponds to the affection termed “ azoturia.”’ 

The semple hamoglobinemia is described as an affection of the blood 
in which the blood-plasma contains dissolved hemoglobin, 

Hemoglobinuria occurs chiefly in connection with piroplasmosis, 
more rarely in trypanosomiasis; also as the result of administering large 


672 SYSTEM OF VETERINARY MEDICINE 


doses of potassium chlorate, phenacetin, naphthalin, etc. It is said to be 
sometimes met with during the course of influenza, and after the inges- 
tion of very mouldy clover. The theory advanced for the occurrence of 
hemoglobinuria is that, owmg to the conditions already referred to, the 
hemoglobin is dissolved in the blood-plasma and deposited mostly in the 
spleen and in the bone-marrow; but a considerable part is taken up by the 
liver, and changed into bile-colouring matter. If the blood-plasma becomes 
suddenly charged with blood-pigment, a part of the latter is eliminated 
by the kidneys, thus bringing about hemoglobinuria. According to some 
authors, meth-hemoglobin is the pigment usually present. The urine 
is red, brownish-red, or porter coloured, and shows a heavy brownish-red 
sediment. | 

Tests—Spectral-Analytic, or Heller’s Test—This is specially suitable 
for demonstrating the presence of oxy-hemoglobin and meth-hemoglobin. 
In the case of the former two absorption bands are present, and in the 
latter there are three absorption bands, the one in the red near C bemg 
characteristic. 

The other tests advised are the benzidine test of Schlesinger and the 
guajac oil of turpentine test of Schumm. Particulars of these will be 
found in works on urinalysis. 

Bile-Salts and Pigments in the Urine.—See Icterus (p. 533). 

Glycosuria.—Sugar in the urine. See Diabetes Mellitus. 

Pyuria.—T his signifies the presence of pusin theurine. The condition 
occurs in renal abscess, purulent nephritis, cystitis, urethritis, and also in 
uterine or vaginal catarrh. It may be intermittent in the case of large 
renal abscesses, and continuous in calculous pyelitis. In cases where a 
pelvic or perirenal abscess ruptures into the urinary passages, a large 
amount of pus is excreted in the urine within a short time, and then 
rapidly diminishes, or may cease abruptly. In pyuria the urine is of a 
white or a yellowish-white appearance, and may be strongly ammoniacal, 
and the sediment may be ropy in character. On microscopical examina- 
tion a large number of pus-corpuscles are detected; these, when the pus 
originates in the bladder, are well formed. Associated with the pus are 
epithelial cells from the bladder and pelves of the kidneys, but as these 
cells resemble each other very closely, it is extremely difficult to discover 
the source of the pus. 

For further particulars on the subject of pyuria, see Pyelitis 
(p. 705). 

Organised Casts in the Urine.—A “cast” is the term applied to a 
model of a hollow organ, such as a renal tubule, and is formed by effused 
plastic material. The presence of organised casts in the urine points to 


DISEASES OF THE KIDNEYS: HORSE 673 


the existence of an acute or chronic inflammation of the kidneys. The 
following varieties of casts are recognised: 

Blood Casts are filaments of coagulated fibrin enclosing blood-cor- 
puscles. In some instances the red or white corpuscles may amalgamate 
to form a cast, but more frequently they are found irregularly studding a 
fibrinous mould. 

Epithelial Casts are formed of columnar renal epithelium or of round 
cells. The cast is generally composed of coagulable material containing 
epithelial cells. 

Fatty Casts are made up of material consisting largely of fat globules. 
They are transparent or of a dark granular appearance, and are dotted 
over with minute oil-drops. 

Hyaline Casts are nearly transparent, and are composed of a homo- 
geneous proteid material, which is slightly refractive. Darker-looking 
hyaline casts are sometimes called “ waxy ”’; they appear solid, and are 
highly refractive. 

Granular Casts are dark-coloured renal casts, of a granular, cell-like 
substance; they represent a degenerated form of hyaline or waxy casts. 
Sometimes blood-discs or fat-drops are seen on their surface. 

Renal Casts are cylindriform bodies derived from any of the collecting 
tubes or loops of Henle. 7 

Spiral Casts are renal casts having a spiral or twisted shape. 

Tube Casts.—This term is applied to any casts of a renal tubule found 
in renal diseases. 

Spurious Casts signify mucous casts, and are also termed “ cylin- 
droids.” They may occur in the urine of normal animals, as well as in cases 
of renal disease. They are irregular in shape, and very elastic and mobile. 

Clinical Significance of Casts.—A consideration of the prevailing type 
of casts found in a given case, after several examinations of the urine, is 
of assistance in diagnosis. If epithelial and blood casts, with a large 
amount of renal epithelium, be found, they point to the presence of an 
acute nephritis; oil-drops in the epithelium, or scattered over hyaline 
casts, indicate fatty changes in the kidney. The presence of casts in 
hematuria or pyuria suggests a renal origin for the blood or pus. 

Epithelium in the Urine.—This may be derived from the renal pelvis, 
the uriniferous tubules, the ureters, the bladder, the urethra, or the 
vagina. The source is determined by the prevailing type of cell, by the 
presence or absence of casts, and by the accompanying symptoms. After 
the cells have soaked in the urine it is not possible to differentiate them. 

The detection of organised casts, epithelium, etc., is carried out by a 
microscopical examination of the urine. 

VOL. I. 43° 


674 SYSTEM OF VETERINARY MEDICINE 

Oxaluria.—An excess of oxalic acid in the urine is said by Law to be 
associated with certain forms of indigestion, emaciation, and lameness. 
W. Williams described, under the heading of Oxaluria, an affection 
characterised by dulness, capricious appetite, debility, loss of flesh, stiffness 
in the loins, “ hidebound,” a scurfy condition of the skin, frequent mic- 
turition often accompanied with uneasiness, the urine being scanty, of a 
pale amber colour, and neutral or acid in reaction. These symptoms were 
said to be accompanied by the presence of oxalates of lime in the urine, 
and the continual presence of these was believed to attend a form of 
indigestion. But we have already pointed out (see p. 664) that oxalates 
of lime are constantly present in the urine of herbivora, and are probably 
derived from the food. 

In man the condition known as ‘“oxaluria” is recognised, in 
which the oxalate of lime is present in excess and for a considerable 
time in the urine, and the crystals may be deposited before the urine 
is passed, thus forming a calculus. Nervous dyspepsia, depression, 
debility, lassitude, and neuralgic pains, may be observed in the con- 
dition termed the “oxalic acid diathesis.”” But, according to Osler,* 
“the local and general symptoms are probably dependent upon 
some disturbances of metabolism, of which the oxaluria is one of the 
manifestations.” 

A similar explanation may apply to the condition in the horse, and 
until further evidence is available we cannot recognise oxaluria as a 
distinct affection. Moreover, it is not described by Robertson, Fried- 
berger and Frohner, or Hutyra and Marek. 

Phosphaturia.—Law states that phosphates are present in excess in 
the urine in digestive disorders, and in malnutrition of bones (rachitis, 
osteoporosis, and rheumatoid arthritis), and points out that the alkaline 
phosphates are very soluble and never precipitated, while the earthy 
phosphates dissolve in acid urine, but are precipitated from alkaline. 
We have already mentioned that, according to F. Smith, phosphates are 
practically absent from the normal urine of the horse, but if the horse 
be fed entirely on oats the urine may be rendered acid, probably owing 
to the formation of acid phosphates from the food. 

Lipuria.—This signifies the presence of fat in the urine. According to 
Halliburton, this substance may occur in normal urine when there is excess 
of fat in the food. Pathologically, lipuria occurs in man in cases of fat 
embolism occurring after fractures, in phosphorus-poisoning associated 
with fatty degeneration, in prolonged suppuration, and in the fatty stage 
of chronic ‘nephritis, in which instance fat casts may be present in the 


* “The Principles and Practice of Medicine.” 


DISEASES OF THE KIDNEYS: HORSE 675 


urine. The urine is generally very turbid in appearance, and may 
contain fat-drops and fatty crystals. 

Cases of lipuria in the dog are recorded by Regenbogen aes by 
Hutyra and Marek) in connection with chronic nephritis associated with 
fatty degeneration of the renal epithelium. The urine resembled watery 
milk, and maintained this appearance even on standing or after filtration; 
it contained from # to 1 per cent. of fat, many fat globules and fatty 
casts. 

Ureemia.—This may be regarded as a toxemia occurring in connection 
with certain renal affections, or in conditions where the discharge of 
urine is interfered with. The latter include obstruction of the ureters, 
obstruction of the neck of the bladder by a vesical calculus, paralysis of 
the bladder, rupture of the bladder, urethral calculus, ete. Although the 
clinical phenomena in connection with uremia are recognised, the nature 
of the condition is not definitely determined. The generally accepted 
theory is that, owing to interference with the functions of the kidneys, 
or with the discharge of urine, the excrementitious materials which should 
be removed from the body accumulate in the blood, and exert toxic 
effects. The part played by urea itself, or by the salts and nitrogenous 
extractives, is not determined. Experiments show that the clinical 
picture of uremia cannot be produced by the intravenous injection of 
urea, although it is known that the toxicity of the blood-serum in uremic 
states is increased. Moreover, the estimate of the amount of urea in the 
blood as determined by tests is, in only a small proportion of cases, of 
service in foretelling an attack of uremia. In other words, the clinical 
determination of the urea in the blood cannot be relied on as an index 
of the degree of renal inadequacy. According to Osler:* “ In some cases 
of nephritis without any signs of ee the kidneys are rad eclle as 
insufficient as in the worst uremia cases.’ 

Traube endeavoured to explain the condition on a mechanical theory, 
and believed that the nervous phenomena were due to a localised cedema 
of the brain, depending on increased blood-pressure and a dilution of 
the blood through the retention of water in the system. 

Another theory put forward is that uremia is due to the products of 
abnormal metabolism. According to Brown-Séquard, the kidneys 
produce certain substances by the agency of an internal secretion, and 
these substances are essential for the normal maintenance of organic 
functions. When this process is disturbed, itis believed that the symptoms 
of uremia are produced. The results of Bradford’s experiments show 
that the kidneys have a profound influence on the metabolism of the 


* «The Principles and Practice of Medicine.” 


676 SYSTEM OF VETERINARY MEDICINE 


tissues of the body, especially on the muscles. If more than two-thirds 
of the total kidney weight be removed, a large increase in the production 
of urea and nitrogenous bodies of the creatin class results. According to 
Hughes and Carter, the toxic agent responsible for the production of 
uremia is an albuminous product quite distinct from any constituent 
occurring in normal-urine. 

Symptoms.—The central nervous system and the digestive organs 
are chiefly involved. Acute uremia is said not to be of frequent 
occurrence in animals, and the chronic form not uncommon in the 
dog. This, however, is not our experience, as we have on many 
occasions observed the condition in the horse, but very rarely in 
the dog, although in the latter animal chronic renal lesions are not 
uncommon. 

In the acute form, staggering and vertigo may be observed in the 
early stages, followed by stupor. The horse goes down, muscular tremors 
next appear. followed by general convulsions, inability to rise, and finally 
coma sets in. The respirations may be difficult owing to pulmonary 
cedema, which occurs as a complication; the temperature is high at first, 
but may become subnormal later on. Profuse sweating may occur, the 
skin and mouth exhaling a well-marked urinous odour. Digestive dis- 
turbances are evidenced by loss of appetite and diarrhea; the latter is 
said by Hutyra and Marek to be due to the irritating effects of the dis- 
integration products of urea on the intestinal mucosa, as they are elimi- 
nated through the bowels. 

Death may occur in a short period of time, or the case may last for 
several days, the convulsive attacks recurring at irregular intervals. The 
termination is generally fatal, but Hutyra and Marek record a case 
depending on retention of urine, which recovered after the retention had 
been relieved. 

Chronic uremia is observed in cases of chronic nephritis. The symp- 
toms vary. In the cases that came under our care, stupor, digestive 
disturbance, loss of appetite, a staggering gait, and a urinous odour from 
the body were present; these were succeeded by convulsions, paralysis, 
coma, and death. 

DIFFERENTIAL Dracnosis.—Meningitis may be confounded with 
uremia; the only means of distinction are a chemical and microscopical 
examination of the urine. As symptoms of uremia appearing suddenly ' 
may be the first phenomena presented im cases of chronic nephritis, an 
erroneous diagnosis can easily be given. Unless we are acquainted with 
the history of the case, the secondary stages of azoturia are likely 
to be mistaken for uremia, as the nervous phenomena presented 


DISEASES OF THE KIDNEYS: HORSE 677 


may be similar in both, and the coloration of the urine may have 
disappeared. 

TREATMENT.—This will be considered under the heading of Nephritis 
(see p. 691). | 


GENERAL SYMPTOMS OF RENAL DISEASES. 


We have already mentioned that the symptoms of renal diseases are 
generally obscure, but there are certain phenomena present in some cases 
which are suggestive, and lead the practitioner to make an examination 
of the urine. Before proceeding to discuss these symptoms we may 
point out an important matter with reference to diagnosis which refers 
to other affections as well—viz., that disease of one organ must be studied 
in connection with its dependence and effects on the functions of other 
tissues of the body. Thus renal disease may be in existence although 
no symptoms suggestive of its presence may be observed, such as peculi- 
arities with regard to micturition and alterations in the quantity or 
character of the urine. The effects of renal disease are often far-reaching, 
and symptoms indicative of disturbance of the digestive, circulatory, 
respiratory, or nervous system may be produced, rather than phenomena 
pointing to an affection of the kidneys. Again, a symptom such as ascites 
is common to certain renal affections, and also to certain cardiac dis- 
orders. It is very difficult to determine in cardiac disease associated 
with ascites and albuminuria whether the conditions depend on primary 
cardiac or primary renal disease. 

We must here point out that the general symptoms presented in 
renal affections may occur in other diseases as well, and that a diagnosis, 
unless based on an examination of the urine, is likely to prove erroneous. 
Moreover, it is necessary to carry out several examinations of the urine, 
as, unless this precaution be adopted, it may happen that in one sample 
but little morbid alterations may be present. Again, it is of importance 
to discover whether the evidences of disease, as discovered by urine 
analysis, are temporary or permanent, and thus to decide whether we 
have a chronic affection to deal with or otherwise. In obtaining samples 
of urine for examination precautions should be adopted so as to avoid 
contamination, which may arise from an unclean catheter, or from a 
dirty vessel or bottle. 

Symptoms Connected with Locomotion.—A stiff or straddling gait in 
the hind limbs, difficulty in lying down or rising, or in turning round, 
arching of the back, groaning when sharply turned, etc., are generally 
regarded as phenomena suggestive of renal disorder; but they may be 


678 SYSTEM OF VETERINARY MEDICINE 


observed in other affections, such as injuries to the spinal muscles, 
muscular rheumatism, etc. 

Pain on Palpation of the Region of the Loins.—This is a very popular 
symptom of renal disease, but in reality one of doubtful importance, as 
many healthy horses will resent this procedure. Pain evinced on pal- 
pation is a very deceptive symptom in all affections and in all regions of 
the body, and dependence on it is certain to convey an erroneous idea of 
the nature of a case. This statement can be verified by practising pal- 
pation on a number of healthy horses, and observing how frequently they 
will flinch and show resistance. 

Obscure Colicky Pains may be observed in cases of nephritis, renal 
calculus, distension of the bladder, and other morbid conditions of the 
urinary organs. They are termed “colicky” because it is difficult to 
distinguish them from dull pains due to intestinal disorders. Indeed, 
we must admit that even the most experienced clinician should be excused 
for overlooking a renal affection on his first attendance on the case, and 
until further symptoms develop. 

The term “ nephritic colic ” is sometimes applied to the pain associated 
with renal affections. 

Certain Attitudes and Postures.—In many cases of nephritis the horse 
assumes the recumbent position, and either has difficulty in rising, or 
becomes unable to get on his feet. After a time convulsive struggling 
may occur, and the case, if seen for the first time, may be mistaken for 
one of meningitis. We have met with several cases of renal abscess, in 
which the abrupt occurrence of the above-mentioned symptoms was the 
first indication of illness in the animals. It is probable that the inability 
to rise and the convulsions depend on uremia. 

Symptoms in Connection with Micturition.—In the early stages of 
acute nephritis small amounts of urine are passed at frequent intervals, 
But this also occurs in cases of cystitis. The urine is scanty in some cases 
of nephritis, and may even be suppressed. Frequent micturition and the 
passage of large amounts of urine of low specific gravity is observed in 
cases of chronic interstitial nephritis. It is, of course, obvious that a 
diagnosis cannot be based on such phenomena; they simply lead us to 
suspect the presence of a renal affection, and to carry out an examination 
of the urine. Again, it must be remembered that in certain intestinal - 
affections the horse may frequently assume the suena of micturition, 
and strain as if endeavouring to pass urine. 

Evidences obtained by Rectal Exploration.—In cases where the kidneys 
are enlarged as the result of disease it is possible to palpate them by 
rectal exploration. The left kidney, being more posteriorly situated, is 


DISEASES OF THE KIDNEYS: HORSE 679 


more readily reached, as under normal conditions its anterior border 
reaches as far forward as the last rib, and its posterior border to the 
transverse process of the third lumbar vertebra. The right kidney has 
its anterior border reaching as far forward as the sixteenth rib, and its 
posterior border extends back to the first lumbar vertebra. The enlarged 
size of the organs can be noted, also tenderness on palpation when suffering 
from inflammation, and a feeling of fluctuation when renal abscess is 
present. 

Constitutional Symptoms.—In some cases we observe interference with 
appetite, thirst, emaciation, evidences of dyspepsia, swollen limbs, 
debility, anasarca on the sternal and abdominal regions. In the later 
stages a distinct urinous odour may be detected from the patient. In 
rare instances only are evidences of ascites observed in the horse. 


CONGESTION OF THE KIDNEYS. 


Synonym.—Renal congestion. 

This is to be regarded as depending on circulatory disturbances, and 
occurs in two forms—viz., active and passive. 

Active, or Acute, Congestion is recognised by some authors as a 
disease per se, distinct from the first stage of acute nephritis. But 
according to Friedberger and Froéhner, it is either a passing condition or 
altogether secondary, and in consequence can rarely be diagnosed as an 
independent affection; also, as the first stage of acute nephritis consists 
of renal congestion, it is difficult to distinguish the conditions. According 
to Osler, the most typical congestion of the kidney is seen post mortem in 
the early stage of acute Bright’s disease. Cadéac admits that, although 
renal congestion is a common pathological condition, it is frequently 
overlooked, as its duration is so often ephemeral. 

ErioLogy.—Various causes are suggested as etiological factors, as 
follows: : 

Certain Infectious Diseases.—Influenza and contagious pneumonia 
are not infrequently accompanied by acute renal congestion. The con- 
dition is believed to be due to the presence of bacterial toxins circulating 
in the blood, which produce an irritating effect on the kidneys, or to the 
altered metabolism of the tissues, rather than to circulatory disturbances. 
This is probably the explanation of the polyuria, which is sometimes 
observed in connection with the affections mentioned. 

Certain Drugs, such as nitrates, oil of turpentine, etc., if administered | 
in large doses, also cantharides, whether given internally or absorbed 
from the skin, may produce renal congestion. The ingestion of certain, 


680 SYSTEM OF VETERINARY MEDICINE 


toxic plants, such as bryony, hellebore, etc., have a similar effect. In 
Denmark the stems of onions have been known to induce the condition, 
Mouldy foods and impure water are also recognised as causes. 

Exposure to cold and chills, by increasing blood-pressure in the kidneys 
in a reflex manner, may lead to renal congestion. Contusions, falls, violent 
efforts during work, are regarded by some authors as etiological factors. 

Morsiw ANAatomy.—It is admitted that as cases of renal congestion 

usually recover, but few opportunities are presented for observing the 
morbid anatomy of the condition. The organs are increased in volume, 
soft, and show a dark red coloration of the surface. On section, blood 
drips freely from them, and the morbid alterations occur in the cortex. 
The congested glomeruli often appear as dark red spots. On micro- 
‘scopical examination the renal capillaries are dilated and engorged with 
blood. In very acute cases rupture of the capillaries may take place, 
and the renal tissue may be infiltrated with blood. Hemorrhage from 
the glomeruli has been observed, and blood-corpuscles appear between 
the vascular tuft and Bowman’s capsule. In very intense cases of con- 
gestion interstitial hemorrhage and even rupture of the kidney may 
occur (see p. 683). | 

Symptoms.—In some of the cases recorded urgent symptoms were 
manifested suddenly while the animal was at work. The countenance 
was anxious, the gait was stiff, the respirations accelerated, sweating and 
dull colicky pains were also observed. But, according to Robertson, the 
only attractive symptom may be an alteration in the urinary secretion. 
There appears to be a difference of opinion with reference to the alteration 
in the amount of urine passed. Some authors state that, owing to the 
increased amount of blood passing through the kidneys in a given time, 
the amount of urine is augmented, and its specific gravity is lowered. 
On the other hand, Robertson found that the urine in all established cases 
was usually lessened in amount and of high specific gravity, due to the 
presence of an extra amount of solid materials, and probably albumin and 
blood, or hemoglobin. Ina few of the milder cases at the commencement 
the urine was of a more watery character, and increased in bulk. Accord- 
ing to Leblanc, micturition may be absent at first, but in an hour or more 
a large amount of urine of low specific gravity is passed. The appearance 
of the urine, in the absence of blood-extravasation, is clear and limpid; | 
but when rupture of capillaries takes place, hematuria is observed. In 
renal congestion, occurring in the primary stage of acute nephritis, the 
urine is scanty, and passed in small amounts at frequent intervals. 

CoursE.—In mild cases the course is rapid, and after a few days 
recovery may occur. In other instances, that terminate favourably, the 


DISEASES OF THE KIDNEYS: HORSE 681 


evidences of improvement are the restoration of the urine to its normal 
character and the disappearance of the symptoms already mentioned. 
In severe cases characterised by hemorrhage, albumin as well as blood is 
found in the urine, colicky pains become more marked, the animal shows 
evidences of exhaustion, and assumes the recumbent position; death 
may occur from exhaustion or from rupture of the kidney. 

DIFFERENTIAL DIAGNosiIs.—lIt is evident that, owing to the obscure 
nature of the symptoms, diagnosis 1s attended with considerable difficulty, 
and in many instances the affection will be mistaken for other conditions. 
The stiff gait and the occurrence of polyuria may lead us to suspect the 
presence of the affection; the history of the case must also be taken into 
consideration. An examination of the urine will enable us to exclude 
nephritis in those cases where renal congestion occurs as a disease per se. 

Diabetes insipidus may present similar symptoms, and the more acute 
course of renal congestion is the only distinguishing feature. In the 
hemorrhagic cases the colour of the urine will attract attention, but it 
must be remembered that hematuria is a symptom of various diseases 
of the urinary organs. 

Prognosis.—This should always be guarded, as the condition may 
develop into nephritis, or complications may occur. 

TREATMENT.—Some Continental authors advise venesection in the 
early stages. Nitrate of potassium is contra-indicated, as it is likely to 
increase the renal congestion. Probably the most common treatment in 
ordinary practice, when in the early stages micturition seems interfered 
with, is a dose of sweet spirit of nitre, but as this causes dilatation of the 
renal vessels it cannot be regarded as a safe agent under the circumstances. 

Full doses of bicarbonate of soda are advised by some practitioners. 
A purgative dose of raw linseed oil should be given, so as to secure 
elimination by the intestines. All highly nitrogenous diet should be 
interdicted; the animal’s food must consist of boiled flax-seed, bran mash, 
-barley-water, hay tea, etc. Local applications to the loins are indicated, 
the best being a large cataplasm composed of kaolin and glycerine applied 
hot and covered with cotton-wool. Some practitioners advise counter- 
irritation by means of mustard-paste applied to the loins. 

Passive or Chronic Congestion of the Kidneys.—This is also known as 
venous hyperemia, mechanical hyperemia, or cyanotic induration. It 
is a condition accompanying other diseases, such as chronic valvular 
affections of the heart, pulmonary emphysema, chronic interstitial pneu- 
monia, pressure on the renal veins by tumours or by ascitic fluid, etc. 
The effect of such conditions is to impede the outflow of venous blood 
from the kidneys, and to bring about blood-stasis. Chronic renal con- 


682 SYSTEM OF VETERINARY MEDICINE 


gestion not infrequently occurs in association with tuberculosis in the 
horse. 

Morsip Anatomy.—The kidneys are enlarged and firm, and of a dark, 
bluish-red colour; the capsule is usually removed with facility ; the cortex 
is of a deep red colour, and the pyramids of a purple red. On section the 
kidney substance is found to be firm, due to small-celled infiltration 
between the tubules, and an increase in the interstitial tissue. Amongst 
other morbid alterations observed are sclerosis of the Malpighian tufts 
in places, thickening of the bloodvessels, and granular, fatty, or hyaline 
changes to a varying extent in the epithelium of the tubules. When this 
condition is associated with chronic heart disease it is termed cardzac 
kidney. In the later stages contraction of the newly-formed connective 
tissue occurs, and atrophy of the organs may result. 

Symptoms.—There are no characteristic symptoms in connection with 
venous hyperemia of the kidneys, and usually the phenomena of the 
primary disease predominate. Owing to the rapidity of the blood- 
current in the kidneys being lowered, the urine is diminished in amount; 
and as the epithelial cells are deprived of the necessary amount of oxygen 
when blood-stasis is prolonged, their nutrition is interfered with. 
Albumin to a variable extent is found in the urine, and the specific gravity 
of the latter is increased. On microscopical examination hyaline tube- 
casts and blood-corpuscles may be detected in the urine. 

TREATMENT.—Therapeutical measures must be directed to the 
primary disease, and as a rule agents which tend to bring about an 
increase in the blood-pressure will be indicated. 


INFARCTS OF THE KIDNEY. 


This pathological condition occurs as the result of obstruction of 
the renal artery or some of its smaller branches by emboli carried from | 
a distance, or by a thrombus which forms at the seat of the infarction. 
Occlusion or marked stenosis of one of the renal arteries produces the 
following effects: The blood-pressure in the kidney is greatly reduced, 
but owing to the anastomoses that exist between the renal vessels and 
those of the capsule and ureter, arterial blood still enters the organ to a 
limited extent; this, however, is insufficient to carry on the circulation’ 
properly in the area involved. The result is that, owing to the 
marked diminution of blood-pressure, stasis and extravasation of blood 
occur. 

An aseptic embolus produces a necrotic lesion only, without appreciable 
symptoms. When of long standing and multiple, a partial atrophy of the 


DISEASES OF THE KIDNEYS: HORSE 683 


kidney, with irregularities on the surface of the organ, result, also in- 
durative changes. A septic embolus induces purulent nephritis. 

Renal infarcts in the horse may occur in connection with ulcerative 
endocarditis, valvular cardiac affections, and venous hyperemia of the 
kidney. Leblanc has observed the condition in connection with aortitis, 
and records a case in a foal associated with joint-ill. Cases of infarction 
due to thrombosis of the renal arteries, depending on the presence of 
larval sclerostoma, are reported by various observers. According to 
Hutyra and Marek, the thrombosis probably is but rarely situated in 
the renal artery proper; it usually occurs in the abdominal aorta immedi- 
ately before the origin of the renal arteries, or even in the anterior 
mesenteric artery, in which instance the thrombus projects into the lumen 
of the aorta. Occlusion or stenosis of either one or the other renal 
artery may be produced by such a thrombus if it extends as far as the 
origin of the vessel named; or the thrombus, being freely movable in its 
upper end, may be pressed against the opening of the renal artery by the. 
circulating blood. 

Symproms.—According to Leblanc, if only one kidney be involved, 
no special symptoms are observed. In some instances blood, albumin, 
and pus are found in the urine. When both organs are involved, ascites 
occurs, and death may result from uremia. 

According to Hutyra and Marek, the leading symptom is profuse fénal 
hemorrhage, which is evidenced by hematuria. The urine is of a light 
or dark red colour, and is passed at short intervals; it sometimes contains 
cylindrical clots, which are often casts of the ureters. In eats to 
blood, albumin and tube-casts are found in the urine. 

The attacks may disappear after a short period, but are likely to 
recur. The above authors record a case in which the hemorrhage con- 
tinued, and death occurred in the course of a few days. 

TREATMENT.—Agents which increase the blood-pressure are advised 
by some authors. Probably the hypodermic injection of adrenalin would 
be indicated. Rest and attention to diet are of importance. 


RUPTURE OF THE KIDNEY. 


Several cases of this lesion have been recorded by Continental ob- 
servers. The etiological factors were very intense renal congestion, 
violent exertion, and injuries to the region of the loins. In some of the 
cases a microscopical examination did not reveal any evidences of amyloid 
or fatty degeneration. In some cases of extensive hemorrhage from 
the kidney, the histological examination of the organ showed necrotic 


684 SYSTEM OF VETERINARY MEDICINE 


patches, while in others no vascular alterations could be discovered to 
account for the hemorrhage. Cadéac observed a case of rupture of the 
kidney that occurred during the course of an attack of pleuro-pneumonia. 
In the cases recorded the rupture varied in extent. In some instances 
the hemorrhage was underneath the capsule, and produced a cyst-like 
formation; in others both the capsule and the cortex were ruptured, and 
blood-clots were found in the abdominal cavity or in the perirenal con- 
nective tissue. Cases were observed in which the accumulation of blood 
in the perirenal connective tissue formed an extensive tumour, which was 
limited by a fibrous membrane; the interior contained large blood-clots, 
in the centre of which the kidney was found slightly atrophied as the 
result of compression. In other instances both kidneys were involved, 
and their weight was enormously increased. In a case of this kind re- 
corded by Leblanc the seat of the rupture was found to be at a point in 
the junction of the cortical and medullary portions of the kidneys. The 
extravasated blood led to the formation of a brown-coloured region, of the 
diameter of an ordinary pen-handle, which extended to the capsule, and 
the latter was ruptured. On microscopical examination of the affected 
region and the parts in its vicinity, the tubules in the locality invaded by 
the hemorrhage were completely destroyed, and the renal tissue in 
contact with the clot was infiltrated with blood. 

There are no characteristic symptoms of rupture of the kidney. In 
complete rupture death may occur from internal hemorrhage. In the 
case of a less extensive lesion hematuria is observed, but whether this 
depends on rupture of the organ or on hemorrhage due to intense hyper- 
emia cannot be determined. Probably in the large majority of instances 
the lesion is discovered as a surprise at the autopsy. 


NEPHRITIS (INFLAMMATION OF THE KIDNEYS). 


GENERAL REMARKS.—Our knowledge of nephritis in the horse is 
limited. Not only are the symptoms often obscure and the development 
of the disease insidious, but there is still much to be learned with reference 
to the pathology of the affection. In ordinary practice it is not un- 
common to find renal lesions at post-mortem examinations, although no 
symptoms suggestive of kidney disease were apparent during life. On 
the other hand, there is a tendency to make a casual diagnosis of “ disease 
of the kidneys,” based on the presence of certain symptoms which in 
reality are common to various disorders. Judging by our clinical ex- 
perience, and also from a consideration of recorded cases and of the 
descriptions given by various authors, we feel justified in stating that 


DISEASES OF THE KIDNEYS: HORSE 685 


acute nephritis cannot be regarded as a common affection in the horse, 
while the chronic forms are often overlooked and the symptoms ascribed 
to other diseases. Again, as nephritis, when present, is in many instances 
associated with, or secondary to, other affections, its diagnosis 1s attended 
with considerable difficulty. 

Various attempts have been made to classify the different forms of 
nephritis according to the renal tissues that are specially involved. These 
have not been successful either from a pathological or from a clinical 
point of view. The tendency of most modern authorities, both medical 
and veterinary, is to regard the majority of cases of nephritis as deffuse 
in character—+.e., the lesions occur in the epithelial, vascular, and inter- 
stitial tissues of the kidney, and vary in intensity in different forms. In 
one of the latest works on renal disorders in human medicine—viz., 
““ Kidney Diseases,” by Dr. W. P. Herringham, the author recognises 
three types of nephritis: (1) Acute nephritis, which is always diffuse in 
character, affecting in varying degree the convoluted tubules, the glomeruli, 
and the interstitial tissue. (2) Subacute and chronic diffuse nephrites, 
comprising those forms of renal disease which are variously termed 
“chronic parenchymatous nephritis,” “large white kidney,” ‘“ con- 
tracted kidney,” and “small pale kidney,” in all of which the changes, 
as in the acute variety, are diffuse. (3) Chronic interstitial nephritis , 
which is identical with what is known as the arterio-sclerotic kidney, and 
is in reality a disease of the circulatory system rather than of the kidney. 
Any case of granular kidney in which there are parenchymatous changes 
is to be regarded as an example of chronic diffuse nephritis. Now, having 
regard to the difficulties in diagnosis of renal affections in equine practice, 
and recognising the fact that it is not possible to differentiate these 
various forms clinically, it is apparent that the simpler the classification 
we adopt, the more likely it is to be useful in practice. Moreover, we 
must remember that if we are able to diagnose definitely the existence of 
- a renal disease in the horse which is likely to be of a permanent character, 
treatment is not desirable from an economical point of view. Hence a 
detailed consideration of the various renal lesions which may or do occur 
is of more interest to the pathologist than to the clinician. 

For practical purposes we may consider nephritis under two main 
headings—viz., (1) acute, (2) chronic, and then briefly draw attention 
to the more important types of the disease that are recognised. 

As regards the mode of origin of the affection, it may be described 
as descending when arising from influences acting by way of the blood, 
and as ascending when it originates from causes arising in the urinary 
passages. In some instances the origin may be of a mixed character. 


686 SYSTEM OF VETERINARY MEDICINE 


The effects of nephritis are serious, and not only depend on inter- 
ference with the function of the kidneys, but also on secondary morbid 
conditions resulting in other organs of the body. 


Acute Nephritis. 


Synonyms.—Acute diffuse nephritis; Acute Bright’s disease. 

As already remarked, morbid alterations occur in all the renal tissues, 
but the intensity varies in different forms of the disease. Hutyra and 
Marek recognise two forms—viz. : 

1. Acute Parenchymatous Nephritis, said to be a very frequent disease 
of animals, and the most common form of acute renal inflammation. 
The lesions are chiefly confined to the epithelium of the glomeruli 
and uriniferous tubules, the interstitial tissue being only slightly in- 
volved. , | 

2. Acute Diffuse Nephritis, in which inflammatory changes occur in 
the interstitial tissue, in addition to parenchymatous lesions. 

Now, while admitting that a distinction may be made between these 
two forms on histological grounds, we have yet to learn how they are 
to be differentiated clinically, as from the description of the symptoms 
given by the above authors the parenchymatous form would seem to be a 
mild type of the diffuse. Moreover, it is admitted that the latter may 
occasionally develop from the former. The symptoms given of the 
parenchymatous form are very obscure, as neither functional nor general- 
ised disturbances are described. When it occurs, it is said to be generally 
associated with acute febrile infectious diseases. The alterations in the 
urine are not well marked, the amount of albumin is but moderate, the 
quantity of urine generally normal, but in some instances slightly dimin- 
ished; the organic sediment is either very slight or absent, and when 
present consists only of_a small number of renal epithelial cells, and 
sometimes of hyaline, granular, or epithelial casts, and occasionally red 
or white blood-corpuscles. 

It is quite evident that unless a careful examination of the urine was 
carried out, this form of the disease would not be recognised; and as 
there are no phenomena present which suggest a renal affection, we are 
forced to the conclusion that the classification is an artificial one. Hence 
we consider that, from a clinical point of view, it is desirable to discuss | 
acute nephritis as a diffuse inflammation of the kidneys. 

ETIoLOGY.—Various causes are suggested for the occurrence of acute 
nephritis, but 1t must be admitted that in some of these at least the 
modus operandt is not clear. 

1. Traumatic.—These include injuries in the vicinity of the kidneys— 


DISEASES OF THE KIDNEYS: HORSE 687 


contusions, falls, over-exertion, sudden reining-in when the horse is going 
at full speed, etc. | 

2. Exposure to Cold and Chills —This is recognised as an etiological 
factor both in man and animals. It is well known that the circulation 
of the kidneys is markedly influenced by reflex stimuli coming from the 
skin, and that exposure to cold raises the blood-pressure within the 
kidneys, and causes an increased secretion of urine. This, however, does 
not explain the occurrence of nephritis, so it is suggested that the vital 
resistance of the renal tissue is reduced by the action of cold, and thus it 
is exposed to the invasion of microbial agents. 

3. Toxic Agents—These include agents possessing an irritant action 
on the kidneys, such as oil of turpentine in large doses, cantharides, coal- 
tar products, carbolic acid, potassium chlorate, etc., also agents which 
tend to produce fatty changes in the organs, such as arsenic and phos- 
phorus, etc. The long-continued ingestion of lead may induce interstitial 
nephritis. 

4. Damaged Fodder, such as that affected by mould, smut, blight, etc., 
is said by some authors to be a cause of nephritis. 

5. Infectious Diseases —According to some authors the majority of 
cases of acute nephritis occur under this heading. When the disease is 
associated with certain affections, such as influenza, contagious pneu- 
monia, septicemia, etc., the renal lesions are believed to depend on the 
action of bacterial toxins on the kidneys during their elimination from 
the system. Nephritis may also occur in connection with glanders or 
tuberculosis. Some cases of severe gastro-enteritis are complicated 
by nephritis. 

Amongst other etiological factors, we may mention the irritating 
effects of hemoglobin in the urine, as exemplified in the occasional occur- 
rence of nephritis in cases of azoturia, in which instances, as pointed out 
by Hutyra and Marek, the agencies on which the azoturia depend, and 
- the products of disintegration, are probably associated with the hemo- 
globin in bringing about the renal lesions. 

Nephritis has also been observed to follow extensive burns of the 
skin, and to accompany certain skin diseases, such as mange and eczema. 
The modus operandi is not definitely determined. 

Morpip ANATOMy.—In mild cases, which correspond to the acute 
parenchymatous form of Kitt, and Hutyra and Marek, the kidneys are 
only slightly enlarged, or may be of normal size, and may present no 
evident alterations to the naked eye. The essential lesion is a cloudy 
swelling and necrosis of the epithelial cells of the glomeruli and uriniferous 
tubules, due to nutritive disturbances. On palpation the organs are found 


688 SYSTEM OF VETERINARY MEDICINE 


either fairly firm or slightly softened, and the capsule is easily removed. 
On section, the cortical substance is of a grey or greyish-red colour, while 
the medullary substance is congested and of a deep red tint. The 
glomeruli are engorged with blood, and stand out in a prominent manner. 
On histological examination the renal capillaries and veins are found 
engorged, a fibrinous exudation, with or without slight cellular infiltra- 
tion, occurs in the interstitial tissue; a similar exudation is observed in 
the capsules of Bowman, the epithelial cells are swollen, undergo de- 
generative changes, and tend to become detached, and the tubules contain 
hyaline and epithelial casts. 

In the severe forms (acute diffuse nephritis) in the early stages 
the kidneys are congested, swollen, friable, and dark in colour, and on 
section may drip blood. In other instances the surface of the organs 
is pale and mottled. The capsule may be thickened by infiltration, 
but is readily removed. On section the cortex presents a swollen, turbid 
appearance, and is of a greyish-red colour, while the pyramids are of a 
deep red tint. On applying pressure to the cut surface a reddish, turbid 
fluid exudes therefrom. On microscopical examination the following 
alterations can be detected: 

The glomeruli are increased in volume and the capillaries are dis- 
tended with blood, or may be filled with cells and thrombi. In very 
severe cases extravasation of blood may take place. The epithelium of 
the tuft and of Bowman’s capsule undergoes degenerative changes, and 
leucocytes with red blood-corpuscles are found in the cavity of the capsule. 
The contents of the capsule and the walls of the capillaries of the tuft 
may undergo hyaline degeneration. The result of these changes is inter- 
ference with the circulation in the tufts and with the nutrition of the 
epithelium. 

The tubular epithelium suffers from cloudy swelling, fatty changes, 
and hyaline degeneration. Desquamation of the epithelium in the 
convoluted tubules may occur, and the former, with hyaline casts, 
leucocytes, and red blood-corpuscles, may cause obstruction in the lumen 
of the tubes. The collecting tubes also become involved. 

The interstitial tissue shows small-celled infiltration, which may be 
generalised throughout the organ or more marked in certain regions. 
Heemorrhages into the interstitial tissue may be observed in some | 
cases. 

Leblanc describes gangrene of the kidney as a lesion occasionally 
met with, but considers that it is in reality a softening of the renal tissue 
consecutive to multiple hemorrhages. The organ is of a blackish colour, 
it is putrid, and reduced in size; in some cases partial zones of gangrene 


DISEASES OF THE KIDNEYS: HORSE 689 


occur throughout the renal texture, and the parenchyma is altered to a 
blackish friable pulp. 

The lesions in other organs will depend on the complications that 
have existed. Dropsical effusions in the cavities of the body and in the 
subcutaneous connective tissue may be present. 

Symptoms.—In the mild form of the affection as described by some 
authors, no marked symptoms may be observed, and unless the urine 
be examined the disorder may be overlooked. As already mentioned, 
the albumin in the urine is only moderate in amount, and other morbid 
elements are either limited or absent, while the quantity of urins 
excreted shows little alteration from the normal. 

In the acute diffuse form, although the symptoms are by no means 
characteristic, still there are often certain phenomena present which 
suggest an examination of the urine, and thus enable us to detect the 
existence of the disease. It is said that the affection may commence 
as the diffuse type from the start, or may follow the mild form of 
nephritis. 

Various attitudes are sometimes regarded as significant of nephritis, 
but, as we have already remarked, these may also be present in other 
diseases. A stiff, straddling gait, dragging of the hind-limbs, arching 
of the back, difficulty in turning round, etc., do certainly accompany 
many of the cases. Tenderness on palpation over the region of the 
kidneys is a symptom on which some stress is laid, but we have already 
pointed out that it may prove a very deceptive one. In the cases that 
we have observed the prominent symptoms were—the occurrence of dull 
colicky pains of various duration; frequent attempts at micturition, but 
only small amounts of high-coloured urine were passed at short intervals; 
the animal lay down with care, but did not remain in the recumbent 
position for long; fever to a varying degree was also present, and genera] 
constitutional disturbance. 

Amongst other symptoms observed by various authors we may 
mention oliguria or anuria; and cases are recorded in which there was 
entire suppression of urine for several days. In the case of stallions, 
incomplete erections of the penis and retraction of one or both testicles 
have been observed. 

According to Hutyra and Marek, the explanation of the oliguria is 
as follows: Reduced elimination of water in the kidneys results from the 
retarded blood-flow in the capillaries of the glomeruli, and also from the 
compression of the latter, and the obstruction of the capillaries by 
desquamated endothelium. Again, any urine that is secreted is pre- 
vented from flowing freely through the uriniferous tubules owing 

Vou. I. 44 


690 SYSTEM OF VETERINARY MEDICINE 


to obstruction caused by the presence of renal epithelium and casts, or 
by compression due to interstitial infiltration. 

Characters of the Urine.—The amount is greatly diminished ; the specific 
gravity is increased; the colour, in the early stages especially, is smoky 
or a brown-red, seldom of a bright red; the amount of urea is diminished 
so far as the total excretion is concerned, but the percentage is high. 
Albumin is present in variable amounts; occasionally it may be abundant, 
forming a curdy, thick precipitate on standing. The sediment on standing 
is copious, and consists of renal epithelium and hyaline, blood and epi- 
thelial tube-casts, and often leucocytes and red blood-corpuscles. Accord- 
ing to Leblanc, small blood-clots may sometimes be found in the urine. 

CoursE anD Duration.—As the case proceeds, cedematous swellings 
often develop in the subcutaneous connective tissue of the sternum, 
abdomen, sheath, extremities, and occasionally on the eyelids and in the 
larynx. Serous effusions may occur in the pleural, pericardial, and 
peritoneal cavities. Angemia and debility are well marked. In the mild 
form recovery is said to occur in a period which varies from a few days 
to one or two weeks, provided the associated disease does not endanger 
the life of the animal. According to Hutyra and Marek, this form 
rarely passes into diffuse nephritis, but may be the precursor of the 
chronic type of the disease. In diffuse nephritis the average duration 
is said to be from one to two weeks, but death may occur in a shorter 
time. According to Friedberger and Frohner, the cases of recovery and 
death are about equal, and development into the chronic form is rare. 
' Unfavourable symptoms are—the occurrence of oliguria or anuria, the 
presence of a large amount of albumin and of red blood-corpuscles and 
leucocytes in the urine. When evidences of uremia appear (see p. 676) 
the termination is always fatal. According to Trasbot, even severe cases 
are capable of recovery; the symptoms gradually disappear, the urine 
increases in amount, the epithelium becomes regenerated, but albumin 
continues in the urine for a variable period, and finally disappears. Some 
authors observed evidences of uremia with anuria at the onset of the 
attack, but generally the former occurred at a later stage. In the cases 
observed by Leblanc of gangrene of the kidney following acute nephritis 
the urine was found to be deeply coloured, foetid, and contained débris of 
renal parenchyma; the pulse became gradually imperceptible, marked, 
prostration, cold sweats, and a urinous odour from the skin were also 
observed. 

Various complications are recorded, such as the occurrence of double 
amaurosis, adhesion of a loop of bowel to the affected kidney, and the 
presence of an abscess which opened into the intestine. 


DISEASES OF THE KIDNEYS: HORSE 691 


Pyelitis and cystitis have also been observed as complications. 

DIFFERENTIAL D1aGnosis.—This is based on an examination of the 
urine. The presence of albumin alone does not justify a diagnosis of 
acute nephritis, as it may be observed in various affections; but if present 
in large amount and persistent, and accompanied by the acute symptoms 
we have mentioned above, it is an important diagnostic feature, especially 
if in addition the various forms of casts are detected in the urine. A 
general consideration of the symptoms is essential to a correct diagnosis. 
Errors can easily occur, as the symptoms of the primary disease may 
mask those resulting from renal lesions. As already remarked, the mild 
form of nephritis can easily be overlooked, and probably this is 
often the case, as there is little present to direct attention to the 
kidneys. 

Proenosis.—Except in mild cases, prognosis is always unfavourable; 
and as it may happen that instances presenting but slight symptoms may 
develop into a more serious form or into the chronic type, a guarded 
opinion should always be given. 

TREATMENT.—The cardinal principles in the treatment are to give 
as much rest as possible to the kidneys by acting on the bowels and skin, 
and to treat symptoms as they arise. Nitrogenous food should be avoided, 
and the diet should consist of bran mashes, linseed gruel, barley-water, 
milk, hay tea, etc. Plenty of fluids should be allowed, so as to flush the 
kidneys without irritating them. Suitable clothing should be applied, 
so as to maintain the functions of the skin. An oleaginous purgative is 
indicated. If pain be a prominent symptom, a small dose of chloral 
hydrate with bromide of potassium may be given; but opiates are contra- 
indicated, as they interfere with the secretion of urine. If the urine is 
scanty, mild diuretics, such as citrate of potassium, acetate of potassium, 
or diuretin, may be prescribed; but diuretic agents having an irritating 
action on the kidneys are contra-indicated. In cases where suppression 
of urine is present, the hypodermic injection of pilocarpine is advised 
to produce diaphoretic effects, and thus to remove effete materials by way 
of the skin. 

But several observers have not found any diaphoretic effects to 
ensue from the use of this drug in the horse, although its sialagogic 
action was well marked. In cases where arterial tension is low and 
the cardiac impulse is not forcible, it is found that after the early 
symptoms are lessened in intensity digitalis is a useful diuretic. Local 
applications to the region of the kidneys are believed to have a favourable 
action on the secretion of urine; the most serviceable of these is a large 
cataplasm composed of kaolin and glycerine, applied hot and covered with 


692 SYSTEM OF VETERINARY MEDICINE 


cotton-wool and a blanket. There are no drugs, so far as is known, 
which have any direct effect on the morbid alterations present in the 
kidneys. 

When symptoms of uremia occur, all treatment generally proves 
ineffectual. 

As regards the prevention of nephritis, care should be taken that 
animals recovering from affections such as influenza are not sent to work 
too soon or exposed to chills, etc., also during convalescence large 
amounts of highly nitrogenous foods should not be allowed. Discretion 
should be used in prescribing agents such as oil of turpentine and in 
applying blistering omtments containing cantharides. 


Chronic Nephritis. 


The cases recorded in British veterinary literature of chronic nephritis 
in all its forms are comparatively few in number, but it is highly probable 
that, owing to the obscure character of the symptoms, these affections 
may be overlooked, and the phenomena accompanying them ascribed 
to other causes. 

According to Trasbot, the affection is not of common occurrence, 
but Leblanc points out that numerous cases have been recorded in the 
various professional journals. 

Various classifications of chronic nephritis have been adopted accord- 
ing to the renal structures that are chiefly involved, but most modern 
authorities admit that in all forms of the disease the pathological altera- 
tions are of a diffuse character, involving the epithelial, the glomerular, 
and the interstitial tissues, but with a varying ceerte of intensity so far 
as the latter of these is concerned. 

According to Leblanc, it is well known that at autopsies on animals 
dead of chronic nephritis the kidneys may present the most varied aspects, 
and many types may be met with. 

For practical purposes it will suffice to describe two chief forms, and 
to point out certain varieties of these that may be met with. In con- 
nection with these two forms, not only are there certain distinctions 
pathologically, but also clinically; and while admitting the difficulties 
attached to a differential diagnosis, we are of opinion that by careful 
attention to some of the clinical data it may be possible to distinguish 
one from the other. A diagnosis is of importance from the point of 
view of prognosis, because one form (chronic parenchymatous nephritis) 
is of a far more fatal nature than the other (chronic interstitial 


nephritis). 


DISEASES OF THE KIDNEYS: HORSE 693 


Of course, we must remember that in an animal like the horse, that is 
kept for utilitarian purposes, any chronic disease likely to permanently 
interfere with his ability for work will not repay the cost of treatment. 
But it is of importance to know that the interstitial form, although 
eventually fatal, may be compatible with a fairly long existence, provided 
complications do not ensue. Hence, the practitioner must exercise his 
powers of discretion when dealing with a case in which the examination 
of the urine points to the existence of a chronic renal disorder, and we 
shall endeavour to indicate in the description of the two forms of the 
disease how the more serious variety can be differentiated from the type 
compatible with a period of utility. 


I. Chronic Parenchymatous Nephritis. 

Synonyms.—Chronic non-indurative nephritis; Chronic desquamative 
and chronic tubal nephritis; Chronic diffuse nephritis with exudation; 
Nephritis mixta (Kitt); Nephritis with large white kidney; Chronic 
Bright’s disease. 

In this form of nephritis the lesions are diffuse, but the parenchyma 
suffers far more than the interstitial tissue. The latter, although in- 
creased to a certain extent, does not undergo atrophy. This form is of 
less frequent occurrence than the chronic interstitial type. 

In human medicine certain varieties of chronic parenchymatous 
nephritis are recognised : 

1. The large white kidney, which corresponds to the type described 
by veterinary authors. 

2. The small white, also termed the “‘ pale granular” or the small granular 
fatty kidney. We have not succeeded in finding records of this variety 
in the horse, but have met with cases of it in the dog. According to 
Thomassen, chronic nephritis in the horse is generally of a mixed type— 
viz., both parenchymatous and interstitial. The small white kidney 
may be a later stage of the large white variety ; there is a gradual increase 
in the connective tissue and subsequent shrinkage, the organ becomes 
smaller in size, the capsule is thickened, and the surface is rough and 
granular. The lesions may be briefly described as a combination of con- 
tracted kidney with areas of marked fatty degeneration. The convoluted 
tubules contain accumulations of fatty epithelium, which cause a section 
of the organ to present numerous opaque white or whitish-yellow foci. 
The morbid alterations include interstitial changes, destruction of many 
glomeruli, degeneration of epithelium, and thickening of the bloodvessels 
—a veritable mixed nephritis. According to some observers, this variety 
may be a primary independent form. 


694 SYSTEM OF VETERINARY MEDICINE 


3. Chronic Hemorrhagic Nephritis—This variety is described by 
Leblanc, and is said to be rarely met with. The organs are greatly 
enlarged and yellowish-white or brownish-red in colour. On section, the 
cortex shows a hemorrhagic, spotted aspect, or may present brownish- 
red areas, due to hemorrhage into and about the tubes. In other respects 
the lesions resemble those occurring in the large white kidney. This 
variety is sometimes termed the “ large red kidney.” 

Kt1oLocy.—The affection may develop from the acute form, or may 
arise insidiously. According to Friedberger and Frohner, the causes are 
practically unknown. Bacterial toxins are recognised as etiological 
factors, and the malady has been met with in association with certain 
diseases such as contagious pneumonia, glanders, tuberculosis, intestinal 
ulcers, etc., in which the toxins are eliminated by the kidneys. In some 
instances no causes can be discovered. 

Morpip ANAtoMy.—The kidney is enlarged and the capsule is thin. 
According to Hutyra and Marek, on peeling off the capsule, its internal 
surface is more or less mottled, and small shreds of renal tissue adhere 
to it. The kidney is of a uniform yellowish-white colour. On section, the 
cortex 1s swollen and yellowish-white in colour, and may show opaque 
areas or white lines or spots. The pyramids are deep red and congested. 
The renal tissue is softened, and on microscopical examination the epi- 
thelium of the convoluted tubes is granular, fatty, or altered by hyaline 
changes; the tubules of the cortex are dilated and contain tube casts. 
Other morbid alterations include enlargement of the glomeruli, thickening 
of Bowman’s capsules, hyaline degeneration of the capillaries, and de- 
generative changes in the epithelium of the tuft and of the capsule. 
The interstitial tissue is increased throughout the organ, due to a cellular 
infiltration; but this lesion is not extensive, and atrophy does not occur. 
According to Thomassen, the glomeruli are surrounded by a plastic 
exudation. | 

The other lesions which may be met with are—serous effusions 
into the cavities of the body, and into the subcutaneous connec- 
tive tissue, and in some instances cardiac hypertrophy; but this 
latter condition is of far more frequent occurrence in chronic interstitial 
nephritis. 

Symproms.—When the affection follows an acute attack of nephritis, 
the symptoms of the latter become modified, but may again start with 
renewed vigour. But in many instances, and, according to Hutyra and 
Marek, in the large majority of cases, the chronic form sets in insidiously. 
The early symptoms are deceptive, and may easily be ascribed to other 
causes. We may observe loss of condition without any apparent cause, 


DISEASES OF THE KIDNEYS:}HORSE 695 


dulness, lessened capacity for work, a capricious appetite, and a tendency 
to swelling of the hind-limbs. 

These may continue for an indefinite period before any other pheno- 
mena are present that suggest a renal disorder. Then stiffness in progres- 
sion may be observed in the hind-limbs and dropsical swellings appear 
beneath the sternum and on the inferior aspect of the abdomen; attention, 
too, will probably be directed to the urine, owing to the small amount 
that is passed. Marked thirst is observed in some cases. Later on dull, 
colicky pains are manifested, and the animal tends to assume the recum- 
bent position for long intervals. It must be remembered that a chronic 
renal affection may be in existence for some time without showing 
characteristic symptoms, but if the animal be exposed to chills, excessive 
fatigue, or allowed too large an amount of highly nitrogenous food, acute 
symptoms of renal disorder may suddenly develop. 

The special phenomena of chronic parenchymatous nephritis are—the 
presence of dropsical effusions both internally and externally, and a large 
amount of albumin and other morbid elements in the urine. 

Characters of the Urine.—The amount is diminished and the specific 
gravity is Increased. The colour may be a dirty yellow, but in some 
cases it is of a smoky hue. In the earlier stages the appearance of the 
urine may not be altered to any extent. On standing, the sediment is 
heavy, and contains numerous tube casts, which vary in form and size, 
hyaline casts, granular, epithelial, and fatty casts, also epithelium from 
the uriniferous tubules and from the renal pelves. Leucocytes are also 
present, and in some cases red blood-corpuscles. The albumin may be 
abundant, and may reach 4 to 6 per cent., but it is subject to great varia- 
tions in different cases. 

Complications may occur, such as pleurisy, pneumonia, and pericard- 
itis, and prove fatal, or death may result from pulmonary cedema or from 
uremia. Gastro-intestinal lesions may develop during the course of 
-the disease, and an obstinate constipation or a foetid diarrhoea may 
occur. 

When, in the later stages, the interstitial tissue becomes affected to 
a marked extent, the urine is increased in amount, is of low specific 
gravity, and the symptoms simulate more or less those accompanying 
the chronic. interstitial form. 

We met with a case of chronic parenchymatous nephritis, which 
illustrates clearly the clinical picture of this form of the disease. The 
animal was a brood-mare aged ten years, a noted prize-winner, with 
foal at foot. She was observed by the owner to be gradually losing 
condition while at grass, and both hind-limbs were swollen. Dull, colicky 


696 SYSTEM OF VETERINARY MEDICINE 


pains of an intermittent type were present, and the animal lay down 
for long intervals. Constipation was also present, which was relieved 
by oleaginous aperients. These symptoms were observed for ten days 
prior to our attendance. On examination we found evidences of dull 
pain, stiffness in progression, and weakness in the hind-limbs. The 
animal turned her head towards the right flank occasionally, and lay 
down for long intervals on her side with the limbs and head stretched 
out. The urine was drawn off by the catheter and was scanty, thick, and 
high-coloured. No straining was present, and the urine was passed 
without effort. The appetite was completely in abeyance, and there was 
free purging, which was attributed to a dose of castor oil administered 
on the previous evening. The temperature was 101° F., the pulse quick 
and weak, and the respiration accelerated. On the following day all pain 
had disappeared, and the urine was passed in larger amounts. On the 
next day the symptoms returned. At intervals the animal would bring 
the off hind-leg forwards and make attempts to bite it. She maintained 
this posture for a minute or two, and then lay down at full length. She 
showed some difficulty in rising, and rested for a short time on her 
haunches while in the act of getting up. A consultant was called in, 
and he made a definite diagnosis that the symptoms were due to the 
presence of an abdominal tumour which he was positive he felt by rectal 
examination. This diagnosis we did not agree with, and forwarded a 
sample of the urine to an expert for examination. The report showed 
the presence of albumin, casts of the uriniferous tubes, epithelial, granular, 
and fatty casts, and fat globules, also red blood-corpuscles. . 

From this time onwards the urime was very scanty, dark red in 
colour, and on some occasions distinct blood-clots were passed. The 
limbs were much swollen, and large dropsical effusions appeared on the 
sternal region and on the inferior aspect of the abdomen. The lower 
aspect of the face and the nostrils were oedematous, sweating occurred 
at intervals, and there was a well-marked urinous odour from the skin. 
Marked irritability of the skin was present, and the animal made frequent 
attempts to bite any parts within reach. A favourite posture of the 
animal was to rest on the sternum with the fore-limbs stretched out; 
at other times she lay at full length. The appetite was poor, and after 
food was taken, symptoms of pain occurred accompanied by eructations 
of gas. The patient got gradually weaker, and coma set in, followed 
by death. The period of illness was twenty-three days. The autopsy 
revealed both kidneys greatly enlarged, and showing on examination 
the characteristics of the large white kidney. A moderate amount of 
fluid was found in the peritoneal, pleural, and pericardial cavities. The 


DISEASES OF THE KIDNEYS: HORSE 697 


heart showed evidences of fatty degeneration. No cause could be 
assigned for this case, as up to the time of the first symptoms being 
observed the animal was apparently healthy. 

DIFFERENTIAL D1agnosis.—From what has already been remarked, 
the reader will observe that the diagnosis must be based on an examina- 
tion of the urine. The insidious nature of the symptoms in the early 
stages renders this course essential. Chronic parenchymatous nephritis 
is’ differentiated from chronic interstitial nephritis by the presence in 
the former of dropsical swellings, the characters of the urine—viz., 
scanty in amount, high specific gravity, large amount of albumin and 
of renal elements. | 

In chronic interstitial nephritis polyuria is present, the specific gravity 
is low, the amount of albumin small, while cardiac symptoms are also 
in evidence (see p. 700). 

In cases where a mixed lesion of the kidneys is present—+.e., when 
marked interstitial changes are associated with the parenchymatous— 
a differential diagnosis may be impossible. 

Proanosis.—This is always extremely grave in consequence of the 
complications that may occur. Moreover, although an improvement 
may take place in some cases, it is usually but temporary, and the serious 
alterations in the renal structures generally prove fatal. Even in the 
less severe forms the special care that can be given to human beings 
similarly affected cannot be applied to the horse, as when the latter 
becomes an invalid, his utilitarian value is nil, and on economical grounds 
treatment cannot be carried out. 

TREATMENT.—As in the early stages it may not be possible to ascertain 
the extent to which renal alterations have progressed, treatment must 
be attempted. The principles to be adopted are similar to those advised 
in cases of acute nephritis. When the lesions are far advanced, treat- 
ment of any kind is useless. 


II. Chronic Interstitial Nephritis. 

SyNonyms.—Chronic indurative nephritis; Contracted kidney ; Granu- 
Jar or atrophied kidney; Cirrhosis of the kidney; Renal sclerosis; Nephritis 
with small red kidney. 

In this form of nephritis the course is very protracted. The renal 
connective tissue is increased in amount, and then undergoes atrophy; 
the secreting structures, both glomerular and tubal, suffer from degenera- 
tion and atrophy; but the interstitial changes predominate and give 
the main characters to the lesion. Although regarded as rare in the 
horse, it is believed to occur more frequently than the chronic parenchy- 
matous form. It is of comparatively frequent occurrence in the dog, 


698 SYSTEM OF VETERINARY MEDICINE 


especially in aged animals, and according to some authors is often met 
with in swine. 

In human medicine an arterio-sclerotic form of the disease is recog- 
nised, which is secondary to arterio-sclerosis, and the cardio-vascular 
changes are the most important so far as the outlook of the disease 1s 
concerned. Herringham holds that a pure interstitial nephritis exists— 
t.e., without parenchymatous changes. This is identical with the arterio- 
sclerotic kidney, and is in reality a disease of the circulatory system rather 
than of the kidney. According to Hutyra and Marek, a primary affection 
of the arteries is only rarely responsible for chronic nephritis in the 
horse. But as we shall point out later on, cardiac lesions occur in con- 
nection with ordinary cases of chronic interstitial nephritis. 

Eriotocy.—The affection may occasionally result as a later stage 
of chronic parenchymatous nephritis, but, according to Hutyra and 
Marek, this only occurs in an extremely small proportion of cases. In 
the majority of instances it is a primary affection having a chronic course 
from the outset. Very little is known with reference to the etiological 
factors of the disease in animals. Some authors are of opinion that it 
may possibly occur as a sequel to acute nephritis. It is sometimes 
observed after recovery from acute infectious diseases. Frohner ob- 
served a case which occurred as a sequel to azoturia. Instances are also 
recorded in connection with renal calculi and parasites in the kidney; 
also a few cases have been observed in association with aortic aneurism 
and degeneration of the renal artery. Experimentally, the disease has been 
produced by the long-continued administration of salts of lead and copper. 

Morsip ANatomy.—Both kidneys are nearly always involved; the 
organs are small and of lighter weight than normal. The capsule is 
thick and adherent, and in stripping it off portions of the renal tissue 
are also removed. The surface is irregular, and shows small nodules and 
depressions due to the unequal atrophy of the newly-formed connective 
tissue. The colour is reddish, but a verv dark red is often observed. 
In some cases small cysts occur on the surface. The organ feels hard, 
and on section the texture is very firm, giving great resistance to the 
knife. The cortex is thin and atrophied; the small arteries are much 
thickened and prominent. Marked histological changes are found on 
microscopical examination. In the early stages of the process of increase 
in the interstitial tissue, a small-celled infiltration occurs between the 
tubes and around the glomeruli, but finally this becomes fibrillated, and 
encircles the tubules and Bowman’s capsules. Although this increase 
in the fibrous elements occurs throughout the organ, it is more advanced 
in the cortex. 


DISEASES OF THE KIDNEYS: HORSE 699 


In advanced cases a number of the glomeruli show complete atrophy, 
which may be due in part to each of the following conditions—viz., 
alterations in the capillary walls, proliferation of cells between the loops, 
extensive hyaline degeneration, and alterations in the afferent vessels. 
According to Thomassen, the endothelial cells of the bloodvessels dis- 
appear or become affected by fatty degeneration. The cortex contains 
but little blood, but the medullary region is congested. 

Important alterations occur in the renal epithelium. In cases where 
the increase in connective tissue is advanced; atrophy of the epithelial 
cells is observed, and small cubical cells are found in their place. In 
other instances desquamation of the epithelium occurs. Dilatation 
of the tubules, and hyaline, fatty, and granular changes in the epithelium 
may also be present. According to Kitt, the contraction of the connec- 
tive tissue causes constriction of some of the urinary tubules, while 
others are obstructed by masses of disintegrated epithelial cells and by 
casts. Urine accumulates above the obstructed parts, and dilatation 
of the tubules and of the corresponding Bowman’s capsules occurs, the 
latter being transferred into small retention cysts. 

As regards the sequence of the lesions, it is generally held that the 
overgrowth of connective tissue is secondary to the morbid alterations 
in the secreting tissues of the tubules and the glomeruli. 

Cardiac Lesions—These are generally associated with chronic inter- 
stitial nephritis. The lesions at first consist of cardiac hypertrophy 
which may involve the entire heart, or be confined to the left ventricle. 
The condition is sometimes termed “the renal heart.’’ According to 
Thomassen, the left ventricle is the seat of a degenerative myocarditis, 
The hypertrophy at first is a compensatory one, and overcomes the results 
of the renal disease; but later on degenerative changes set In, compensa- 
tion fails, and pulmonary cedema, with other complications, result. 
These morbid phenomena do not occur so frequently in animals as in 
man, but cases are recorded by various observers in which typical cardiac 
symptoms have been associated with renal disease. They are by no 
means uncommon in the dog. As regards the origin or explanation of 
this hypertrophy, there are various views held. Conheim’s explanation 
is accepted by many. It is based on the idea that when parts of both 
kidneys have undergone atrophy, the capillary area is very restricted ; 
and in order that the requisite amount of blood should pass through 
this area, an excessive pressure is necessary, which can only be brought 
about by the exertion of more than the normal degree of force on the 
part of the left ventricle, combined with the maintenance of a corre- 
Sponding resistance in all other districts of the arterial system. Amongst 


700 SYSTEM OF VETERINARY MEDICINE 


other lesions which may be met with, are catarrh of the respiratory 
passages, hemorrhages in serous membranes, gastric and intestinal 
catarrh, and ulceration of the stomach and intestine. 

Symproms.—In many instances the disease sets in insidiously, and 
its presence may not be recognised until serious symptoms develop, 
A period of loss of condition, inaptitude for work, diminished appetite, 
and fatigue on slight exertion, may be observed in some cases. The 
leading features of the affection are polyuria, the presence of albumin 
in moderate amounts in the urine, and of a small number of epithelial 
cells and hyaline casts. Cidematous swellings and dropsical effusions 
are generally absent. The urine is passed in large amounts, its specific 
gravity is very low, and on standing very little sediment forms. The 
explanation of the polyuria in this form of nephritis is not definitely 
settled. According to Hutyra and Marek, it may depend on several 
causes. Thus more or less atrophied portions of the kidneys alternate 
with areas that may be practically normal, and the latter assume the 
function of the diseased parts. Hence the watery portion of the urine 
does not diminish under these conditions. Again, owing to morbid — 
alterations in the bloodvessels of the affected parts, the vessels in the 
normal portions dilate, this being assisted by the cardiac hypertrophy 
that is present. A more or less lasting hyperemia and increased cir- 
culation in the normal areas occur, and thus increased amounts of dilute 
urine are secreted. Under the conditions named it is only the elimination 
of water that is increased; the solid constituents of the urine are not 
augmented. 

The above explanations, however, are not definitely accepted, and some 
authorities consider that, owing to the divergent views at present held 
in regard to the secretion of urine, it is almost impossible to offer a correct 
explanation of the occurrence of polyuria in chronic interstitial nephritis. 
They do not regard the general raising of the arterial pressure as neces- 
sarily meaning that more urine is filtered through the kidney. The 
experiments of Bradford, and also of Biedl, show that excision of a 
portion of the kidney equal to about a quarter of the organ causes a 
marked daily rise in the secretion of urine, of from two to five times the 
normal amount. Probably an explanation might be suggested on these 
grounds. ti 

In the later stages, when the cardiac hypertrophy fails, the quantity 
of urme may be diminished, and the proportion of albumin may be 
increased. It is of importance to remember that in some cases the traces 
of albumin are so slight that delicate tests are necessary to determine 
its presence, also that it may be absent at times. The quantity of the 


DISEASES OF THE KIDNEYS: HORSE 701] 


solid constituents of the urine is generally diminished, but occasionally 
the urea may be excreted in full amount. 

Thirst is generally present, but its intensity depends on the amount 
of urine eliminated. The cardiac symptoms are sometimes well marked, 
and consist, in the early stages, of palpitation on slight exertion, and later 
on evidences of cardiac weakness are present, such as a tumultuous heart- 
beat, and a feeble and rapid pulse. Under these conditions the amount 
of urine may become diminished, and dropsical effusions occur in the 
dependent parts of the body. Death may occur from various complica- 
tions, such as pulmonary cedema, uremia, and gradual exhaustion. Occa- 
sionally uremic symptoms may develop suddenly, without any previous 
suspicion of the presence of renal disease. We suggest that some at 
least of those obscure cases in the horse vaguely termed “‘ meningitis ” 
may really depend on a renal affection which is overlooked, as attention 
is not sufficiently directed to a careful examination of the urine and of 
the kidneys. 

CoursE.—The disease generally runs a protracted course, but as it 
is difficult or impossible to ascertain its period of origin owing to lack 
of symptoms, its exact duration cannot be determined. Leblanc has 
met with cases that terminated fatally within twelve hours after the 
first appearance of symptoms. According to Friedberger and Frohner, 
in the later stages of the disease various symptoms may appear, such 
as a feeble, irregular pulse, bronchial and gastric catarrh, shortness of 
breath, diffuse cedema of the sternal and abdominal regions, cardiac 
palpitation, scanty albuminous urine of high specific gravity, and finally 
death from uremia. 

DIFFERENTIAL D1acnosis.—The history of the case must be taken 
into consideration, but the diagnosis must be based on the examination 
of the urine. The presence of polyuria, the urine containing a large 
proportion of water, the specific gravity low, the amount of albumin 
‘small, the renal elements few in number, and the association of evidences 
of cardiac hypertrophy with the above phenomena, are suggestive of 
chronic interstitial nephritis. In the later stages of this affection a 
differential diagnosis between it and chronic parenchymatous nephritis 
may be impossible, but as a fatal termination in both conditions is 
inevitable, an erroneous opinion is of no practical importance. In 
many instances the real nature of the case may be overlooked, as the 
symptoms may not point to a renal disorder. It is advisable in all 
cases showing obscure symptoms to make an examination of the 
urine. 

Care should be taken not to mistake a temporary albuminuria for 


702 SYSTEM OF VETERINARY MEDICINE 


a case of interstitial nephritis, and frequent examinations of the urine 
should be carried out by an expert. 

Proanosis.—This is always grave, as, although the course may be 
protracted, death eventually occurs, and complications may supervene 
at any time. It is, however, of importance to avoid giving a hasty 
opinion as to results, as this disease is one in which great care is essential 
in arriving at a diagnosis, especially as the symptoms are so often obscure. 

TREATMENT.—In cases where a definite diagnosis can be made and 
the disease is advanced, it is quite obvious that treatment, although 
alleviating the symptoms, cannot prove of permanent benefit. Hence, 
in the case of horses, therapeutical measures cannot, on economical 
grounds, beadvised. But there are instances in which, although evidences 
exist of the presence of the disease, yet by careful treatment the animals 
can be rendered useful for slow work. In the case of favourite horses, 
too, treatment will be demanded by the owner. Attention to diet is 
essential, and highly nitrogenous foods should be avoided. Severe 
exertion and exposure to chills should also be guarded against. Symp- 
toms must receive attention as they arise. Cardiac dilatation is best 
treated with digitalis and strychnine, but when this stage is reached the 
case is seldom worth the cost of treatment. 

It is doubtful if any medicinal agents can exert a beneficial action 
on the altered structures in the kidneys, but the administration of 
potassium iodide is suggested for this purpose. Preparations of iron 
are advised to combat the anemia that is present. 

When symptoms of uremia set in, the case is hopeless; and when 
the animal goes down and is unable to rise, destruction should be advised. 


PURULENT NEPHRITIS. 


Synonyms.—Purulent inflammation of the kidneys; Acute suppura- 
tive nephritis; Pyonephrosis; Renal abscess; ‘‘ Surgical kidney.” 

This is a nephritis complicated with pyogenic infection. Some 
authorities describe it under the heading of “ pyelitis,” as it often occurs 
in connection with that condition; but it seems desirable to discuss these 
affections separately. It generally occurs as a secondary affection, and 
in our experience it 1s not uncommon as a post-mortem lesion, although | 
its presence was not suspected during life. 

Etiotocy.—The infection may reach the kidneys in two ways— 
viz.: (1) descending, and (2) ascending. 

In the descending, the micro-organisms are carried by the blood- 
stream, This form may occur in connection with any purulent diseases 


DISEASES OF THE KIDNEYS: HORSE 703 


affecting other organs of the body, such as pyemia, strangles, joint-ill, 
etc. It is also met with in cases of contagious pneumonia, endocarditis, 
influenza, tuberculosis, glanders, etc. According to Hutyra and Marek 
it is only exceptionally that micro-organisms reach the kidney from a 
perirenal abscess—1.e., an abscess formed in the connective tissue about 
the kidney (see p. 707). 

According to Leblanc, the micro-organisms reaching the kidneys 
by the blood become arrested in the capillaries of the cortical portion, 
and cause the formation of an infarction; the affected tissue then becomes 
necrotic, suppurates, and an abscess results. 

In the ascending form the infecting agent arises from affections of 
the urinary passages, such as cystitis and pyelitis. 

Traumatic causes are suggested, such as contusions affecting the 
region of the kidneys; but these are believed to act by lowering the vital 
resistance, and thus favouring the occurrence of infection. 

Morsip Anatomy.—In cases of descending infection both kidneys 
are generally involved, but in the other forms one of the organs only 
may be affected. Exceptions to this may occur, as in a pyelitis con- 
secutive to cystitis, suppurative nephritis may result and involve both 
kidneys. 

Two varieties of the disease are recognised—viz., (a) Diffuse, in 
which numerous small abscesses occur in the cortex, being often situated 
just beneath the capsule. Lines of suppuration may be observed ex- 
tending along the pyramids. 

In some instances the abscesses may be wedge-shaped. On section 
the kidney shows various shades of colour. Lesions of acute diffuse 
nephritis are also present. According to Kitt, microscopical examina- 
tion reveals collections of pus cells in the centre of small foci, and cellular 
infiltration containing pyogenic bacteria is observed in the surrounding 
tissues. The epithelial cells suffer from fatty degeneration and dis- 
integration, the glomeruli may sometimes be surrounded by pus, and 
casts, leucocytes, and red blood-corpuscles, may be observed in the urinary 
tubules in some instances. The acute suppurative nephritis that results 
from pyelitis consecutive to cystitis is sometimes termed “ surgical 
kidney.’ The pyogenic organisms may reach the kidneys by way of 
the tubules, but according to some authorities they travel thereto through 
the lymphatics. 

The diffuse form occurs more frequently in pigs and calves than in 
horses. 

(b) Pyonephrosis, or abscess of the kidney. In this variety the pus 
cavity may be single, or there may be anumber of abscesses present. The 


704 SYSTEM OF VETERINARY MEDICINE 


size varies, and in extreme cases the entire kidney may be changed into a 
large fluctuating abscess. The thickened capsule and indurated cortical 
substance form the wall of the abscess cavity. 

In some instances pus may collect under the capsule and burrow 
through it, and find its way into the perirenal tissue (see p. 707). 

The kidney may attain very large dimensions, and in some of the 
cases recorded the abscess cavity contained 2 litres of pus. The pus 
in certain cases does not communicate with the pelvis of the kidney. 
Fried berger and Fréhner record instances in which small miliary abscesses 
associated with softening of the renal tissue were the leading features. 
In tuberculous cases inspissation of the pus may occur, and it may be 
converted into a putty-like substance, with deposition of lime salts. 

Care should be taken not to mistake the material which occurs in 
the normal renal pelvis for pus. This, as pointed out by F. Smith, is 
really the natural mucus of the urine, mixed with insoluble lime salts. 

Symptoms.—In the majority of instances there are no characteristic 
symptoms. We have met with several cases in which uremic symptoms 
developed in horses that were apparently healthy prior to the attack. 
The animals assumed the recumbent position, were unable to rise, showed 
fits of convulsive struggling, and the autopsy revealed the presence of 
a purulent nephritis. In one instance, where an apparently healthy 
horse died as the result of rupture of an aneurism of the external iliac 
artery, an abscess was found in each kidney. This horse had never 
shown any evidences of renal disorder, and was in excellent condition. 

When the purulent form occurs during the course of ordinary nephritis, 
the existing symptoms become suddenly aggravated, the temperature 
rises, rigors appear, and various complications develop. 

On examination of the urine it is found thick and glairy, and in 
advanced cases pus is present, and the urine may be of a milky colour, 
these alterations being in addition to the ordinary changes occurring 
in nephritis. But if the abscesses do not communicate with the renal 
pelvis, and if the course of the disease 1s slow, there may be little altera- 
tion in the urine, and pyuria is absent. In rare instances the sediment 
contains small portions of kidney substance, and is foetid; occasionally 
blood is present. By rectal examination it is possible to detect the 
lesion when the abscess is of large size. Some authors state that by: 
palpation below the transverse processes of the lumbar vertebre the 
enlargement of the kidney can be detected, and even the presence of 
fluctuation if the abscess is extensive. According to Hutyra and Marek, 
in very rare cases the enlarged kidney or a perirenal abscess produces 
a painful swelling above the lumbar region. 


DISEASES OF THE KIDNEYS: HORSE T05 


DIFFERENTIAL Dracnosis.—The disease may be suspected, but a 
definite diagnosis can only be formed when the presence of pus is deter- 
mined in the urine. But it must be remembered that pyuria can also 
occur in connection with diseases of the urinary passages. The associa- 
tion of renal elements, albumin, and pus in the urine, with the other 
symptoms we have mentioned, is suggestive of purulent nephritis. 
Finally, we must again point out that renal abscess may be present, but 
the pus may not appear in the urine owing to lack of communication of 
the abscess with the renal pelvis, also that clinical symptoms may be 
absent if the course of the disease be slow and the lesion confined to one 
kidney. 

Proagnosis.—The disease always terminates fatally. There are 
instances in which its course is slow, and when confined to one kidney 
life may be prolonged until some intercurrent affection sets in and causes 
the death of the patient. 

TREATMENT.—There are no medicinal agents capable of influencing 
the course of the disease in a favourable manner. Trasbot suggests 
puncturing the kidney and removing the pus by means of a trocar and 
cannula. This is said by Hutyra and Marek to give good results in only 
rare instances. Nephrectomy (extirpation of the affected kidney) is 
suggested, but the impossibility of deciding with reference to the normal 
condition of the other kidney is pointed out. Maksutow performed the 
operation on a horse successfully. At the clinic at Budapest the cathe- 
terization of the ureters was carried out successfully on a horse, and the 
cystoscope employed with a view to determining the functional activity 
of the kidney (Hutyra and Marek). 


PYELITIS. 


This signifies inflammation of the pelvis of the kidney. When, in 
addition, the renal tissue is involved, the condition is termed “ pyelo- 
nephritis.” A special form of the latter affection occurs in cattle, and 
is known as “ bacillary pyelonephritis ”’ (see Vol. I.), and, according to 
Hutyra and Marek, a case of this malady has been observed by Schmidt 
in a colt. | 

Some authors recognise various types of pyelitis, such as catarrhal, 
hemorrhagic, ulcerous, and membranous. 

EtioLtogy.—The majority of cases arise from inflammation and 
infection extending from the bladder or the kidney to the mucosa of 
the renal pelvis. Under normal conditions it is said that the kidney 
can eliminate with impunity all bacteria carried to it. but when from 

VOL, II. 45 


706 SYSTEM OF VETERINARY MEDICINE 


any cause its vitality is lowered, infection may take place. When stasis 
of the urine occurs owing to a more or less complete obstruction in the 
urinary passages, infection is facilitated by decomposition of the urine. 
Pyelitis may be associated with infectious diseases. The infective 
material passing through the kidneys during its excretion from the body 
exerts a pathogenic action on the mucosa of the renal pelvis. The affec- 
tion has been observed in connection with influenza, glanders, and 
tuberculosis. 

Irritating diuretic agents, if administered in large and repeated 
amounts, may cause the disease. Oil of turpentine and cantharides 
are especially liable to induce it. Renal calculi, owing to the irritation 
they produce, may induce the disease (calculous pyelitis). Animal 
parasites in the renal pelvis have a similar effect. The presence of 
certain fungi in food is said to produce irritation of the renal pelvic 
mucosa, followed by pyelitis. The disease may be associated with purulent 
nephritis, and also with prolonged venous stasis in the kidneys, leading 
to a chronic catarrh of the renal pelvis. 

Various micro-organisms have been isolated from the lesions, such 
as pyogenic streptococci, staphylococci, and the colon bacillus. 

Morsip AnAtomMy.—lIn simple catarrhal pyelitis the mucosa of the 
renal pelvis is swollen and congested, and in some instances may present 
small hemorrhages. It may be covered with a layer of mucus containing 
desquamated epithelial cells. In chronic cases the renal pelvis is dilated, 
the mucosa is thickened, and shows a brownish or a slate-grey discolora- 
tion, and is covered with a thick mucus, a purulent material, or a granular 
deposit. Submucous infiltration and ulceration may also be present. 

In the hemorrhagic form, hemorrhagic foci are found in the mucosa 
and a quantity of blood in the renal pelvis. Hutyra and Marek describe 
an ulcerous form in which there is ulcerous destruction of the mucosa, 
also a membranous form in which membranous deposits occur on the 
mucous membrane of the renal pelvis. The condition may be com- 
plicated with hydronephrosis (see p. 709). According to Friedberger 
and Fréhner, pyelitis soon becomes complicated by nephritis and cystitis, 
and the purulent type is especially lable to be followed by purulent 
nephritis and pyonephrosis. 

Symptoms.—The general symptoms resemble those met with in, 
nephritis, but in some instances micturition is normal. The general 
health is affected, and a varying degree of colicky pains is manifested. 
Oscillations of temperature may occur, and evidences of slow uremic 
intoxication may appear. The tendency to complications renders it 
impossible to describe a clinical picture of the disease. 


DISEASES OF THE KIDNEYS: HORSE 107 


The urine may not show much alteration in colour or specific gravity. 
It contains albumin, pus, and a large amount of mucus. The urinary 
sediment is generally copious. It contains pus cells, and epithelial cells 
derived from the deeper layers of the mucosa of the renal pelvis. These 
cells are of a peculiar shape with long tails; they have pointed projections 
at one or both ends, and have been compared to molar teeth. 

Pavement epithelium is also present, and in some instances red 
blood-corpuscles, small blood-clots, and shreds of necrotic mucous tissue, 
these latter constituents varying according to the type of pyelitis present. 
When the affection depends on the presence of renal calculi, sandy granules 
of a whitish or yellowish colour may be detected. When parasites are 
present in the renal pelvis (Hustrongylus gigas) the ova may be found in 
the urine. 

- DrifFeRENTIAL Diacgnosis.—This is always difficult. The epithelial 
cells described above occur in the bladder as well, so that they are also 
present in the urine in cases of cystitis. In cases due to tuberculosis 
the bacilli may be detected by microscopical examination of the urine. 

Proenosis.—As the disease is always either the precursor or sequel 
of a serious affection, the prognosis 1s very grave. 

TREATMENT.—Urinary disinfectants are suggested, such as salol, uro- 
tropin, etc., but the benefits to be derived therefrom are very doubtful. 


PERINEPHRIC ABSCESS. 


Synonyms.—Paranephritic abscess; Perirenal abscess; Psoas abscess. 

This condition depends on suppuration in the connective tissue about 
the kidney. According to Friedberger and Frohner, it is of rare occur- 
rence in the horse. The abscess generally burrows inwards, and fistule 
form which extend to the inguinal or lumbar regions. The condition 
may depend on extension of the inflammation from the renal pelvis, the 
kidney itself, or the ureter. A renal abscess may burrow through the 
capsule; the pus then reaches the perirenal tissue, and a perinephric 
abscess is formed. The kidney may be surrounded by pus, or the pus 
may lie between the organ and the peritoneum. 


AMYLOID DISEASE OF THE KIDNEYS. 


Synonyms.—Amyloid degeneration of the kidneys; Amyloid (larda- 
ceous or waxy) kidney. 

The majority of authors make no mention of this condition as occurring 
in the horse, but, according to Hutyra and Marek, it has been observed, 


708 SYSTEM OF VETERINARY MEDICINE 


not very rarely, in horses and cattle by Rabe. Cases are also recorded 
in dogs by Rivolta, Kitt, Rabe, Dérflinger, and in the cat by Mathis. 
It must be regarded as an event in the process of chronic nephritis, and 
not as a distinct affection. Although, in some instances, the morbid 
changes may be limited to the kidneys, in the majority of cases they 
are associated with amyloid degeneration in other organs, such as the 
liver and spleen. 

Morsip AnatomMy.—The kidneys are enlarged, firm, pale, smooth on 
the surface, and the stellate veins are well marked. On section the 
chief morbid alterations are found in the cortex. It is anemic, appears 
larger than normal, and has a glistening appearance. The glomeruli 
are prominent, the pyramids are of a deep red colour, and contrast strongly 
with the pale cortex. The Malpighian tufts are the first structures to 
undergo the amyloid change, the afferent and efferent vessels and the 
straight vessels being next involved. The tubules are not involved until 
a later stage, the lining membrane, and not the epithelium, being affected. 
Lesions of diffuse nephritis are also present. In the cases observed by 
Rabe the medullary substance alone was affected by the degeneration. 

If a section of the kidney be soaked in dilute tincture of iodine, spots 
of a walnut or mahogany-brown colour are observed. This staining is 
chiefly marked in the glomeruli and walls of the arterioles. If dilute 
sulphuric acid be now applied to the section, the colour alters to a steel- 
blue. Another test for the condition is to treat the section with a solution 
of methyl-violet; an intense purple-red colour is produced (Friedberger 
and Frohner). 

Symptoms.—Very little is known as regards the clinical aspect. The 
symptoms resemble, to a great extent, those presented in chronic nephritis. 
The urine may be increased in amount, pale, clear, and of low specific 
gravity, and usually a large amount of albumin is present. The amount 
of organic sediment is small, and consists of tube casts, which are usually 
hyaline, but may be fatty or finely granular. thi; 

DIFFERENTIAL Diagnosis.—This is very difficult. Occasionally amy- 
loid changes may be detected in the hyaline casts. The occurrence of an 
increased amount of urine, or a normal quantity with a large amount of 
albumin and few tube casts, may suggest the presence of the condition; 
but there are cases in which the albumin may be scanty or even absent. 
The common association of amyloid kidney with similar changes in 
other organs increases the difficulties in diagnosis. 

TREATMENT.—Very little benefit can result from medicinal treatment, 
more especially as complications are generally present. 


DISEASES OF THE KIDNEYS: HORSE 709 


HYDRONEPHROSIS. 


Synonym.—Renal dropsy. 

This is a condition in which the pelvis and the calyces of the kidney 
become dilated and the renal tissue atrophied, due to an accumulation 
of urine, the-result of obstruction in some of the urinary passages. The 
affection has been observed in the horse by Kitt and others, but it is of 
far more frequent occurrence in cattle, pigs, and sheep. One or both 
kidneys may be affected, and when the obstruction is anterior to the 
bladder the disease is usually unilateral. The urine accumulates in front 
of the obstruction, and the process of dilatation is a gradual one. The 
occlusion is not complete, and recurring attacks, followed by patency, 
is the usual condition. The pressure exerted on the renal tissue induces 
atrophic changes, and in the far-advanced stages the organ is transformed 
into a large sac containing fluid. 

Et1ioLocy.—The following affections may be causes of hydronephrosis: 
Morbid conditions of the ureter, such as inflammation of this structure, 
or obstruction by a calculus, compression by tumours, congenital defects, 
etc.; obstruction of the neck of the bladder, due to pressure exerted by 
neoplasms in the vicinity, or in the organ itself; obstructions in the 
urethra, such as a stenosis from various causes. 

-Morsrp Anatomy.—In early cases the lesions observed are a dilata- 
tion of the calyces and pelvis of the kidney. If the disease is advanced, 
the cortex is atrophied to such an extent that the entire organ is con- 
verted into a large sac, the wall of which is composed of the thickened 
capsule, with a variable amount of the cortical tissue. The organ is 
much enlarged, and the interior of the sac may be divided into compart- 
ments; in many instances the ureter is dilated. The contents consist 
of urine more or less altered; in old-standing cases the urinary salts may 
disappear from the contained fluid. In some instances the fluid is of 
a red or dark brown tint, and may contain blood, albumin, colloid sub- 
stance, and occasionally cholesterin. After removal of the fluid, a more 
or less abundant glairy mucous material may be found on the inner 
surface of the sac. When only one kidney is involved, the other is hyper- 
trophied, and may be double its normal size. 

Symproms.—In unilateral disease no symptoms pointing to a renal 
disorder may be observed, as the other kidney, by compensatory hyper- 
trophy, is enabled to do the work of both organs. When both kidneys 
are involved, oliguria occurs, or even anuria, which may be intermittent, 
this depending on whether the obstruction to the flow of urine is perma- 
nent or otherwise. Uremic symptoms appear if the anuria persists, or 


710 SYSTEM OF VETERINARY MEDICINE 


if both kidneys be extensively involved. Cases are recorded by Leblanc 
in which the urine was whitish in appearance, very albuminous, and 
contained epithelial cells, pus-cells, shreds of renal tissue, and sediments 
composed of phosphate and carbonate of lime. 

DIFFERENTIAL DiaGNosis.—In the majority of cases the disease is 
not recognised during life. On rectal examination it may, be possible 
to recognise the enlarged organs by palpation, and also the dilated 
ureter. 

Prognosis.—This is grave, as, although the sound kidney may perform 
the functions of both organs, there is always the danger of a secondary 
infection occurring in it. 

TREATMENT.—As in the majority of cases it is impossible to remove 
the obstruction to the flow of urine, medicinal treatment cannot be 
successful. Nephrectomy (excision of the kidney) is suggested by some 
Continental authorities in cases of unilateral disease, when the other 
kidney is sound, but an operation of this kind has not yet extended 
beyond the experimental stage so far as the larger animals are concerned. 


CYSTIC DISEASE OF THE KIDNEY. 


Cysts of the kidney are of rare occurrence in the horse. They are of 
various sizes, and are believed to depend on obstruction in one of the 
uriniferous tubes—generally a convoluted tubule—which results in dila- 
tation, and may extend to Bowman’s capsule. The lesion may be 
regarded as a localised hydronephrosis. The contents consist of a clear 
transparent liquid, resembling urine in its composition. Cysts are 
located in the cortex, and may be present in considerable number. In 
some cases of chronic nephritis small cysts may he present, resulting from 
dilatation of obstructed tubules or of Bowman’s capsules. Colloid cysts 
of the kidney are very rarely met with. 

Polycystic Kidney.—In this condition the organ is greatly enlarged 
and transformed into a conglomeration of cysts, and the surface is 
lobulated. Nothing is definitely known as regards the origin of the lesion. 
It has been observed in the fostus as well as in the young animal and 
adult, and is regarded by some authorities as a defect in development. 
Pflug and Gurlt recorded a case in a foal, and Morot met with an instance: 
of itina donkey. The symptoms of cystic disease of the kidney present 
nothing characteristic, and no treatment is of any value. 


DISEASES OF THE KIDNEYS: HORSE 711 


NEPHROLITHIASIS. 


SynonyM.—Renal calculus. 

The deposition of certain of the solid constituents of the urine gives 
rise to concretions, and when these are formed in the kidney or in its 
pelvis, the condition is known as nephrolithiasis, or renal calculus. 
Although the affection has been recognised from early times, it is difficult 
to ascertain its comparative frequency in the horse, and most practi- 
tioners will agree with the opinion expressed by Woodruff* that “‘ renal 
calculi are not very common in either horses or dogs, and are extremely 
difficult to diagnose, while vesical calculi are of more frequent occur- 
rence.’ Judging by our own experience, we would regard the condition 
as rare; but, of course, we admit that a number of cases may be overlooked 
in consequence of the obscure nature of the symptoms, and owing to the 
fact that systematic post-mortem examinations are not the rule in 
veterinary practice. 

EtroLogy.—Various factors have been dirs sates to account for the 
formation of renal calculi, but up to the present time definite information 
is not forthcoming. Klimmery states that the principal condition in 
the development of urinary calculi is the presence of an excess of salts in 
the urine, or the formation of slightly soluble or insoluble salts in it when 
within the urinary passages. These salts become deposited on a nucleus 
formed by some element derived from the urinary organs, such as epi- 
thelial cells, casts, blood-clots, shreds of fibrin, etc., and, in the case of 
vesical calculi, the nucleus may in rare instances be a foreign body which 
has entered the urinary passages from the outside. 

Food rich in calcium or mixed with earthy substances, and drinking- 
water containing much lime or many earthy constituents, influence the 
amount of salts present in the urine. In the dog, experiments carried out 
by administering oxamide for some weeks produced renal calculi, com- 
posed of oxamide and oxalate of lime. 

Morsip ANAToMy.—Renal calculi may be of various sizes. When 
very small, they occur in the form of either fine or coarse gritty particles 
termed “ gravel”’ on the mucous membrane of the renal pelvis and calyces, 
or mixed with the urine, and may be passed during micturition. In other 
instances distinct calculi are formed, or a single large calculus, which 
occupies the entire renal pelvis. In the former case they have smooth 
surfaces, owing to contact with each other. The large calculi have an 

* “ Urinary Calculi in the Horse and Dog,”’ Veterinary News, December 16, 1911. 


t Quoted by Hutyra and Marek, “‘ Pathology and Therapeutics of Diseases 
of Domestic Animals.” 


712 SYSTEM OF VETERINARY MEDICINE 


irregular coral shape and a mammillated surface, owing to being com- 
pletely moulded to the infundibula and calyces. Fusion of small calculi 
may occur to form a large mass. Several varieties of calculi are described 
by Verheyn and Kitt, based on their external appearance. Cases are 
recorded in which the masses were of very large size. Kitt describes 
those having a semilunar or bicornuate shape, the colour varying from 
brown, yellowish-brown, greyish-yellow, or iron grey. According to 
Hutyra and Marek, the colour may be greyish-white, brown, or mottled. 
In composition they consist largely of calcium carbonate and magne- 
sium carbonate, which form multicoloured layers around a nucleus formed 
of organic substances. In rare instances they may consist of calcium 
oxalate. According to Leblanc, large renal calculi are composed of 
69 per cent. to 85 per cent. of calcium carbonate, with calcium oxalate, 
magnesium carbonate, and organic material. 

Various morbid alterations are found in the tissues of the kidney and 
the renal pelvis. In cases where several calculi are present, pyelitis 
occurs, and the mucous membrane may show ecchymoses, ulcers, or may 
be covered by falsemembranes. Dilatation of the renal pelvis, with thick- 
ening of its walls, may be observed; and if a calculus lodges in the ureter, 
a chronic inflammation of this structure may be present. Atrophy of 
the renal tissue occurs, and, in the case of a very large calculus, the renal 
substance may almost entirely disappear. In other instances evidences 
of an acute or chronic nephritis are present. Amongst other lesions 
recorded are numerous renal cysts in various stages of development. 
Rupture of the kidney has also been observed. 

SYMPTOMS.—Several instances are recorded in which a large calculus, 
associated with total atrophy of one kidney,.was present, and no symptoms 
were observed. In others, when a calculus has entered the ureter from 
the renal pelvis and caused occlusion of this structure, severe pain is 
manifested, which is known as “ renal colic.” In such a case the pain 
arises from the mechanical irritation produced by the calculus in the 
ureter and the stasis of urine which is brought about. This pain disap- 
pears when the calculus passes into the bladder. When the calculi are 
numerous, hematuria may occur, also pyelitis and hydronephrosis. 
Although the sound kidney is able to perform the functions of both organs, 
instances occur in which by reflex action the healthy kidney may cease | 
temporarily to secrete urine, and anuria then results. The attacks of renal 
colic recur at irregular intervals, and depend on the passage of small calculi 
from the renal pelvis to the bladder. During these attacks frequent at- 
tempts at micturition are made, and the animal shows stiffness in progres- 
sion, and marked tenderness when the region of the kidneys is palpated. 


DISEASES OF THE KIDNEYS: HORSE 713 


On examination of the urine we may find pus-cells, epithelial cells 
from the renal pelvis,and sometimes blood-cells and fine fibrinous coagula; 
a sandy sediment may also be detected. The course of the disease is 
slow, and various complications may occur, such as pyelitis and acute 
or chronic nephritis. If both kidneys are involved, uremia may result. 
Necrosis of the wall of the ureter due to compression by the calculus, and 
leading to rupture of the organ and peritonitis, has been observed. 
Vesical and urethral calculi may be sequels to renal calculi. 

DIFFERENTIAL DiaaNnosis.—As already remarked, this often pre- 
sents marked difficulty. The presence of sandy or gritty material in 
the uriary sediment, associated with evidences of pyelitis and hsema- 
turia, the detection of a calculus in the ureter by rectal examination, or, 
as pointed out by Hutyra and Marek, the trembling feel obtained by 
palpation of the renal pelvis, owing to the rubbing of the calculi on one 
another when several are present, are phenomena pointing to the exist- 
ence of the affection. But, unfortunately, all these signs may be absent. 
Probably, when more experience is gained in the employment of the 
Réntgen rays in veterinary practice, we shall be enabled to utilise this 
means of diagnosis in the detection of renal calculi in animals. 

PRroenosis.—Owing to the complications that are likely to occur, the 
prognosis must be regarded as grave. 

‘TREATMENT.—The repeated administration of bicarbonate of soda, 
with nitrate of potash, is advised by Leblanc, with a view to facilitate 
the elimination of small calculi. Bran should be withdrawn from the 
diet, and the supply of corn should be limited. According to Hutyra 
and Marek, operative removal of the calculi by means of nephrotomy 
has been attempted with satisfactory results by Lorge and Rubay, but 
they do not state whether the patient was of the equine species. In 
cases of renal colic, morphine or chloral hydrate is indicated, so as to 
relieve pain and to facilitate the passage of the calculus through the ureter 
by causing relaxation of the walls of this organ. 


TUMOURS OF THE KIDNEY. 


These possess little interest from a clinical point of view, as their pre- 
sence is only discovered after the death of the animal. According to 
Hutyra and Marek, adenomata and carcinomata are the types generally 
met with, primary sarcomata being very rare, but as a secondary condition 
they occasionally occur. 

Several cases are recorded in veterinary literature in which renal 
tumours of very large size have been met with; in some of the earlier 


714 SYSTEM OF VETERINARY MEDICINE 


records the nature of the neoplasms was not determined. Instances of 
encephaloid carcinomata have been observed by various writers. Kitt 
met with cases of adeno-carcinomata, also of sarcomata, which attained 
a very large size. Kiener described a case of myxoma of enormous 
volume which developed in the perirenal tissue. 

The Draenosis is very difficult or impossible. If one or both organs 
are considerably enlarged, rectal examination will enable us to suspect 
the condition, especially if malignant growths are present in other parts 
of the body, or if the inguinal glands be involved. 

TREATMENT of any kind is useless. 


PARASITES IN THE KIDNEYS. 


These include the Hustrongylus gigas, which may occur in the renal 
pelvis and set up a purulent or hemorrhagic pyelitis, and may terminate 
in nephritis and renal atrophy. The diagnosis is based on the detection 
of the eggs of the parasite inthe urine. For further details, see Section 
on Parasites. ; 

The larve of Strongylus vulgaris may localise in the renal artery or its 
branches, and cause hemorrhage in the kidney. They have also been 
observed in the substance of the kidney or in the perirenal tissue. 

Ecchinococci have been met with in the kidney of the horse by 
Cadéac and Malet, also by Blanc in the donkey. Coccidia have been 
observed by Pachinga, and by Railliet and Lucet. 


DISEASES OF THE URETERS. 


In connection with the subject of renal calculi, we have drawn atten- 
tion to ureteral calculi, which are often associated with the former condition. 
We must confess that from a clinical point of view very little is known 
with reference to morbid conditions of the ureters. That certain lesions 
occur we are satisfied from a perusal of recorded cases, but in the ordinary 
routine of practice the ureter receives little attention, either clinically or 
at post-mortem examinations. 

Amongst the affections and surgical conditions recorded of this struc- 
ture, we may mention inflammation (ureteritis), tumours of various kinds 
encroaching on the ureter, ulcers of its lining membrane causing obstruc- 


‘ 


DISEASES OF THE URETERS: HORSE 715 


tion, the presence of calculi or parasites, injuries occurring during difficult 
parturition, or by blows, kicks, etc., resulting in rupture. Blocking of the 
ureter has also been observed, due to pressure of an intra-abdominal 
scirrhous cord, or to polypiin the bladder occupying the trigonum vesice. 
Rupture of the ureter is followed by septic peritonitis, if the urine con- 
tains infective material derived from the kidney or from the organ itself. 
Law states that if the urine is aseptic, complete rupture of the ureter 
may not lead to serious results, as the edges of the wound may cicatrise, 
and the urine is retained in the ureter and renal pelvis, and leads to renal 
atrophy and hydronephrosis. Weshould imagine, however, that in the 
majority of instances the urine would prove infective. 

The Symptoms recorded are not characteristic. In rupture of the 
ureter it is said that the urine may infiltrate the sub-peritoneal connective 
tissue and form a doughy swelling on the loin or flank. The presence of 
a calculus may sometimes be detected by rectal examination, and it is 
associated with attacks of renal colic. 

Inflammation of the ureter is recorded, and is said to be recognised 
by rectal examination as a swollen tender cord. Cases of rupture of the 
ureter in connection with injuries to the uterine or vaginal walls during 
difficult parturition have been met with, and occasional recoveries are 
recorded with a uretero-uterine or uretero-vaginal fistula (Law). 

Nothing can be done in the way of TrEaTMENT for any of the above 
conditions. The suggestions for therapeutical measures made by some 
writers are purely theoretical. 


DISEASES OF THE BLADDER. 


Before proceeding to deal with the above affections, it is desirable to 
consider certain disturbances of micturition. . 

Dysuria is the term applied to a difficulty in micturition. It depends 
on any condition which interferes with the passage of urine, such as cystic 
calculus, urethral calculus, stricture of the urethra, paraphymosis, 
phimosis, etc. It is evidenced by frequent attempts at urination, and 
a varying degree of restlessness and pain. But in some cases of intestinal 
obstruction, as we have already pointed out, frequent attempts at mic- 
turition may be observed, and a careful examination is necessary in order 
to arrive at a correct diagnosis. 


716 SYSTEM OF VETERINARY MEDICINE 


Strangury signifies painful, imperfect micturition, accompanied by 
straining and the frequent passage of small amounts of urine. It is a 
characteristic symptom in acute cystitis, especially when the affection is 
due to the toxic effects of cantharides. 

Retention of Urine is an abnormal accumulation of urine in the bladder. 
It is a symptom occurring in connection with various disorders, such as 
cystic and urethral calculi, foreign bodies in the urethra, polypoid tumours 
obstructing the neck of the bladder, enlarged prostate gland, and any 
conditions which impede the flow of urine. Also, it occurs in paralysis 
of the bladder (see p. 717), and in’spasm of the sphincter vesice, and, in 
a reflex manner, in connection with colic and tetanus. Paraplegia is 
often associated with retention of urine. 

Symproms.—Hither a complete absence of urination may be observed 
(ischuria), or very small amounts of urine may be passed, accompanied 
by pain. The degree of pain varies, and it is associated with frequent 
attempts at micturition. When occurring in connection with nervous 
affections, and depending on paralysis of the bladder, pain may be absent, 
and the condition is only detected after a rectal examination has been 
made. If not relieved, rupture of the bladder may occur (see p. 719), or 
uremia. In less urgent cases, such as cystitis, where small amounts of 
urine are passed, but the major portion is retained, pyelitis or hydrone- 
phrosis may result, or even nephritis and uremia may set in. 

DIFFERENTIAL D1aGNosis.—When the condition is accompanied by 
pain, it may be mistaken for the so-called spasmodic colic, as in the latter 
affection retention of urine is not uncommon, owing to a spasmodic con- 
traction of the neck of the bladder being present. But on withdrawing 
the urine by means of a catheter, the differentiation can be made, as in 
the case of simple retention relief will be afforded, while in the other in- 
stance the colicky pains will continue. By the use of the catheter it will 
also be possible to ascertain the presence of certain conditions which lead 
to retention of urine. 

TREATMENT.—The first indication is to draw off the urine by means 
of a catheter. If this is not at hand, careful pressure on the distended 
bladder by the palm of the hand, exerted by manipulation per rectum 
often succeeds in bringing about micturition, especially inthe mare. The 
conditions on which the retention depends must receive special treatment. 

Incontinence of Urine.—In this condition the bladder is unable to . 
retain the urine, and the latter is passed in an involuntary manner, and 
causes excoriation of those regions with which it comes in contact, 
especially in the mare. Incontinence of urine is a symptom met with 
in various affections, such as certain forms of cystitis, certain spinal 


DISEASES OF THE BLADDER: HORSE T17 


diseases accompanied by paralysis of the sphincter vesice, distension 
of the sphincter by a polypus, etc. We have also observed it in the mare 
as the result of injuries to the urethra received during difficult parturition. 

The TREATMENT will vary according to the morbid condition on which 
the symptom depends. 


PARALYSIS OF THE BLADDER. 


In hig condition there may be inability to pass the urine (ischuria or 
retention), or to retain it (incontinence). 

Et1oLocy.—A transitory paralysis in which the muscular structure 
of the organ is involved may be observed when a horse is obliged to 
retain the urine for a long period, owing to prolonged work and no oppor- 
tunity being given for the performance of micturition. In the male, 
any circumstance interfering with the act of micturition may induce 
paralysis of the bladder. The result is that, owing to the accumulation 
of urime in the bladder, the muscular structure of the organ becomes 
stretched to such an extent that its power of contraction is temporarily | 
reduced. Occasionally the muscular structure of the bladder becomes 
paralysed, leading to retention of urine, in connection with cases of cys- 
titis (inflammation of the bladder), or in deep-seated inflammations of 
organs or structures in the vicinity. More especially is this likely to occur 
in peritonitis, by the inflammatory action extending to the external wall 
of the bladder. Some authors hold that in such instances the retention 
is more probably due to spasm of the sphincter vesice. Persistent 
paralysis of the bladder occurs in connection with certain diseases of the 
nervous system. These include, especially, injuries of the posterior 
lumbar and sacral divisions of the spinal cord, and of their nerve-roots 
and nerves; but lesions of other portions of the cord may also induce the 
condition, when there is interference with the functions of the sensory 
and motor tracts. Paralysis of the bladder may also be observed in 
certain brain lesions and in connection with urethral calculi; also in cases 
of polypus blocking the neck of the bladder. 

Symproms.—In cases of temporary paralysis of the organ, retention 
of urine occurs, and the animal exhibits evidences of pain and makes 
frequent attempts at micturition, but only very small amounts of urine 
are passed in a feeble manner. After a time, owing to the increased 
tension in the sphincter, this structure becomes relaxed, and the urine 
is passed involuntarily in a dribbling manner. On rectal examination 
the distended bladder is readily discovered. In cases where the sphincter 
is completely paralysed incontinence of urine occurs. 


718 SYSTEM OF VETERINARY MEDICINE 


Coursr.—Complications may set in, such as cystitis due to the 
presence of bacteria and to decomposition of the urine retained in the 
bladder. 

DIFFERENTIAL Dracnosis.—In temporary cases, recovery may result 
after the urine has been withdrawn by the catheter. In persistent 
paralysis, the retention of urine recurs after the use of the catheter. The 
presence or absence of associated conditions must be sought for. 

TREATMENT.—Prophylactic treatment consists in always examining 
into the condition of the bladder, especially in cases where horses assume 
the recumbent position for long periods, or in those unable to rise. The 
judicious employment of the catheter is necessary whenever the bladder 
becomes full. 

When the paralysis is established, the hypodermic injection of strych- 
nineisindicated. Irrigation of the bladder with cold water is advised by 
some authors. Law recommends in cases of extreme distension that 
only a portion of the urine should be removed by the catheter; then a 
few ounces of borax or boric acid solution should be injected. By these 
measures collapse and cystitis are avoided. According to Hutyra and 
Marek, the employment of electricity is useless, either in cases charac- 
terised by retention or by dribbling of urine. 


SPASM OF THE BLADDER. 


This may occur in the absence of local inflammatory changes. Ac- 
cording to some authors, it is the neck of the organ that suffers from 
spasm. It may occur under the following conditions: Prolonged reten- 
tion owing to protracted work and lack of opportunity for micturition, 
especially in the male; acute colicky pains; tetanus; and, according to 
some observers, intense fear may induce it. The animal makes several 
ineffectual attempts to micturate, or only a few drops of urine may be 
passed at one time. On rectal examination the bladder is found dis- 
tended and sensitive to palpation. In some instances the condition is 
relieved spontaneously after the horse is put into a box-stall containing 
a clean straw bed; in other cases the catheter must be employed. Con- 
tinental authors advise enemata containing chloral hydrate to overcome 
the spasm. If the condition is not relieved, either paralysis, cystitis, or 
rupture of the organ, will result, or uremia may occur. In all cases of 
ischuria or dysuria the condition of the bladder should be examined per 
rectum. The irrational custom of administering diuretic agents indis- 
criminately when difficulty in micturition or ischuria is present cannot 
be too strongly condemned, as such practice in the case of a distended 
bladder is simply aggravating the condition. 


DISEASES OF THE BLADDER: HORSE T19 


HAMORRHAGE OF THE BLADDER. 


This occurs in connection with various conditions, such as the presence 
of a cystic calculus, contusions from falls, severe pressure in the case of 
pelvic fractures, hemorrhagic cystitis, acute inflammation due to toxic 
agents such as cantharides, hemorrhoidal enlargement of the veins of 
the bladder associated with chronic inflammation, and the presence of 
neoplasms undergoing suppuration or ulceration. 

Symproms.—The leading symptom is hematuria (see p. 670). If the 
hemorrhage be excessive, anemia and weakness are observed. Cases are 
recorded in which the condition proved fatal. 

TREATMENT.—The injection of weak solutions of iron perchloride, 
alum, tannin, etc., into the bladder is advised by some authors. Hazeline 
is also recommended. A solution of adrenalin (1 to 1,000), administered 
in a similar manner, is more likely to prove successful. Atropine given 
hypodermically is highly spoken of by some authorities as being very 
valuable in checking internal hemorrhage from any source, and should 
be tried in severe cases. Friedberger and Frohner advise that it is of 
importance to prevent decomposition of the blood in the bladder, and 
for this purpose they recommend the internal use of boric acid, salicylic 
acid, chlorate of potash, etc., and washing out the organ with disinfectant 
solutions. For directions with reference to irrigation of the bladder, 
seep. 723. 


RUPTURE OF THE BLADDER. 


This lesion may occur as the result of extreme distension of the 
bladder in cases of retention of urine from any cause. It has also been 
observed in connection with ulceration and gangrene of the vesical walls 
following an acute attack of cystitis. A case is recorded by Peuch in 
which the lesion occurred as the result of a fall, the bladder being at the 
time distended. Other observers describe similar cases. The symptoms 
recorded are a sudden cessation of uneasiness and pain, and of attempts at 
micturition. The freedom from pain is of short duration, and is succeeded 
by evidences of diffuse peritonitis associated with uremia. Rigors, serious 
alterations in the pulse and respirations, high fever, tympany, and 
muscular tremors, are observed, and death occurs in one or two days. 
It is said that cattle may live for eight to fourteen days after rupture 
of the bladder has taken place. The autopsy shows diffuse peritonitis 
and the presence of a considerable amount of urine in the peritoneal 
cavity; but, owing to absorption by the peritoneum, no urine may be 
detected in some cases. According to Leblanc, the rupture may be of 


720 SYSTEM OF VETERINARY MEDICINE 


very small dimensions. When depending on ulceration or gangrene of 
the vesical walls, it is generally situated at the base of an ulcer, and 
presents tumefied and hemorrhagic borders. He points out that gan- 
grene of the bladder is a rare condition. 

Rupture of the bladder is always a fatal condition, and treatment 1s 
out of the question. 


CYSTITIS. © 


SynonyM.—Inflammation of the bladder. 

Some authorities describe various forms of this affection, based. on 
the nature of the lesions present, such as catarrhal, purulent, croupous, 
hemorrhagic, etc.; but as these forms cannot be recognised clinically, 
we deem it advisable to describe the affection under two headings—viz., 
acute and chronic. 

Acute Cystitis, also known as acute catarrh of the bladder and acute 
inflammation of the bladder. This is not a common affection in the 
equine species. It varies in severity from a simple catarrh to an intense 
inflammation with deep-seated lesions of the vesical walls. 

Et1oLogy.—I'wo main etiological factors are recognised: 

1. Drugs having an irritant action on the vesical mucosa, such as 
cantharides and oil of turpentine. Cantharides produces this effect, 
whether given internally or absorbed in the form of cantharidine from 
an extensively blistered surface. W. Williams has observed similar 
effects arising from the absorption of croton oil, and stated that all the 
cases of acute cystitis he met with were due either to this agent or to 
cantharides when used in an irrational manner-as.counter-irritants. It 
is not definitely settled as to whether the inflammatory action is set up 
while these agents are circulating in the blood or when they enter the 
urine, and come into contact with the mucosa of the bladder. 

2. Bacterval Invasion of the Bladder—This occurs under various con-. 
ditions. The infection may be a descending one, such as occurs in sup- 
purative nephritis, pyelitis, etc.; or it may be ascending, as in cases 
associated with metritis, vaginitis, etc., in the female, where the infection 
reaches the bladder by way of the urethra. Traumatic sources of infec- 
tion include injuries inflicted during the careless passage of a catheter, 
more especially if the instrument is septic or has to be employed fre- 
quently.. Vesical calculi may induce cystitis by injuring the mucous 
membrane of the organ. According to Hutyra and Marek, cystitis may 
develop in connection with general acute infectious diseases, the bacteria 
being carried to the vesical mucosa by the circulating blood; or the micro- 
organisms may reach the bladder from distant organs, especially from 


DISEASES OF THE BLADDER: HORSE 721 


the intestines, by way of the kidneys, although these latter organs may 
be normal. The above authors state that the chief pathogenic agents 
in the production of the disease are the pyogenic bacteria, and in cystitis 
of intestinal origin the colon bacillus and its related bacteria are especially 
incriminated. The length of time that the urine remains in the bladder 
renders infection more liable to occur in this organ than in the other 
urinary passages. 

Prolonged retention of urine from any cause is also recognised as an 
etiological factor, as it leads to rapid decomposition of the urine, and 
thus favours infection. Injuries to the urethra and bladder occurring 
during parturition, also inflammatory processes in neighbouring organs, 
may induce cystitis. In diffuse septic peritonitis the serous covering 
of the bladder becomes involved, and a pericystitis results. Chills are 
said to bring about cystitis, but it is possible that they lower the vital 
resistance of the vesical mucosa, and thus favour infection. 

Morsip Anatomy.—The lesions vary according to the intensity of 
the inflammatory action. In the simple catarrhal form the mucosa is 
hyperemic, swollen, and covered with a layer of viscid mucus containing 
desquamated epithelial cells. Ecchymoses may be present in some cases, 
also infiltration of the submucous tissue. In the severe forms a croupous 
exudate of a yellowish or greenish-yellow colour, or diphtheritic deposits, 
may be observed on the mucosa. Ulceration may occur, and occasionally 
abscess formation in the walls of the bladder. Incrustations of urinary 
salts may be observed in patches on the mucosa in some cases. The 
muscular coat may be infiltrated, and in some instances areas of inflam- 
mation occur on the peritoneal covering (pericystitis). Necrotic changes 
are observed in rare cases, and the mucosa becomes gangrenous. This is 
generally followed by rupture of the bladder (see p. 719). 

Symptoms.—Cystitis is characterised by frequent and painful attempts 
at micturition, but only small amounts of urine are passed in intermittent 
jets or in drops (strangury). The animal is restless, paws at intervals, 
and the tail twitches constantly. In the stallion the testicles are re- 
tracted, and erections of the penis occur, especially in cases of cystitis 
due to the toxic effects of cantharides. In the mare the lips of the 
vulva are open, and the clitoris is turgescent. Some authors state that 
the bladder is distended with urine, but this is not our experience. We 
find, as pointed out by Hutyra and Marek, that, owing to the irritability 
of the bladder, there is a constant desire to urinate, and, owing to the 
repeated contraction of the bladder muscles, the urine is discharged in 
driblets; hence the organ is generally found empty. In exceptional 
cases, however, retention of urine may occur, probably owing to con- 

VOL, IT, 46 


722 SYSTEM OF VETERINARY MEDICINE 


vulsive contraction of the sphincter, or to swelling of the mucosa at the 
neck of the bladder, or to obstruction of the urethral opening by exuda- 
tion. 

In simple acute cystitis, fever and constitutional symptoms are 
generally absent; but in the more severe forms, a rise in temperature, 
marked pain, and serious alterations in the character of the pulse and 
respirations, are observed. Rectal examination is resented by the animal, 
and palpation of the bladder causes pain. Defzcation is painful, and in 
consequence the feeces may be retained in the rectum. 

The urine is generally cloudy, thick, and high-coloured. The amount 
of albumin present is small, the amount of mucus is increased, and flocculi 
of pus and occasionally portions of false membranes or shreds of tissue 
may be detected; also the urine undergoes ammoniacal fermentation in 
the bladder. A copious sediment is present, consisting of pus-cells, red 
blood-corpuscles, and epithelium. The epithelium is of the large pavement 
variety, and also “ molar-shaped ” (see p. 707). Crystals of ammonio- 
magnesium phosphate may also be present, and likewise various bacteria. 

Course.—In the simple catarrhal form, subjected to rational treat- 
ment, recovery may take place in a comparatively short period of time. 
Some cases, however, terminate in the chronic form of the disease. In 
the serious forms, abscess formation, ulceration, or necrosis, may result, 
associated with various complications, such as pyelitis, suppurative 
nephritis, uremia, and occasionally rupture of the bladder (see p. 719). 
In cases of cystitis accompanied by necrosis of the vesical walls (a rare 
condition), severe colicky pains are present, the urine is very foetid, dark 
in colour, and may contain fragments of necrotic tissue. These cases 
generally terminate in rupture of the bladder. 

DIFFERENTIAL DiaGnosts.—This is based on the history of the case, 
the presence of strangury, and of dysuria, the evidences obtained by rectal 
examination and by an examination of the urine. 

Proenosis.—Even in the simple catarrhal form the prognosis should 
be guarded, in consequence of the tendency to complications. In the 
severe forms it is always grave. 

TREATMENT.—The indications are to lessen the irritating properties 
of the urine, to disinfect the bladder, and to reduce the vesical inflamma- 
tion. Perfect rest is essential, and the food should be of a non-stimulating 
nature. Mucilaginous drinks should be allowed ad lib., such as linseed 
tea, barley water, etc., and the more fluids taken the better. The con- 
dition of the bladder should be examined per rectum, so that relief may 
be given by the use of the catheter in case retention of urine is present. 
In the employment of the catheter great care should be taken so as to 


DISEASES OF THE BLADDER: HORSE 723 


avoid adding to the infection already existing. If possible, it is advisable 
to promote emptying of the bladder by careful manual compression of 
the organ rather than by the use of the catheter. Alkaline diuretics, 
such as full doses of bicarbonate of soda, are advised by some authors, 
in order to lessen the irritating properties of the ure. When micturition 
is difficult, bromide of potassium or bromide of camphor is advised by 
Leblanc. To reduce the irritation of the bladder, extract of hyoscyamus, 
with alkalies, such as bicarbonate of potassium, is a time-honoured 
remedy. Asa disinfectant for the bladder and urine, Hutyra and Marek 
recommend urotropin, administered in a dose of 1 to 2 drachms, well 
diluted, two or three times daily. This agent is said to exert a disin- 
fecting action after its absorption and elimination through the kidneys, 
owing to its ability to give off formaldehyde in the acid gastric 
juice. Helmitol (in doses of 24 to 34 drachms, twice daily) is also 
advised. This gives off formaldehyde in alkaline solution, and can be 
used subcutaneously. Both of the above agents are said to diminish 
ammoniacal fermentation in the urine, and to alter the alkaline into the 
acid reaction. Amongst other agents advised are salicylic acid, salol, 
resorcin, and benzoic acid. Irrigation of the bladder is regarded by 
some authorities as the most important treatment in cystitis, although 
others believe that it is of more utility in the chronic form of the disease. 
The procedure, according to the directions of Hutyra and Marek, is 
carried out as follows: The urine is withdrawn by the catheter, a funnel 
is then connected to the catheter by means of a rubber tube, and a 3 per 
cent. lukewarm solution of sodium chloride is allowed to run into the 
bladder through the funnel, the amount employed being about 10 ounces. 
By lowering the funnel, the solution is then allowed to flow out, the 
disinfectant solution is then injected, and removed after a few minutes 
in a similar manner. Amongst the disinfectant agents advised are boric 
acid, alum, tannin, lead acetate (1 to 3 per cent.), resorcin (3 to 5 per cent.), 
- nitrate of silver (0-1 per cent.), helmitol (2 per cent.), ichthyol (4 to 2 per 
cent.). We presume, however, that the above directions refer to cystitis 
in the mare. In the male a strong injection syringe would be necessary 
in order to force the injection upwards along the urethra. Leblanc 
advises that in very severe cases in males urethrotomy should be per- 
formed, and the bladder irrigated by this route. Thouton recommends 
a solution of quinine (1 in 300 of distilled water) as an injection. 

Chronic Cystitis—This may occur as a sequel to the acute form of 
the disease, but it is said to be more frequently due to infection extending 
from the urethra or vagina, or it may be associated with the presence of 
a vesical calculus. 


124 SYSTEM OF VETERINARY MEDICINE 


Morspip ANATOMyY.—The mucosa is thickened, and may be covered 
with proliferations of a villous character. Hypertrophy of the walls of 
the organ may also be present. Friedberger and Frohner describe a 
varicose enlargement of the vessels of the mucosa, and, especially in 
mares, an incrustation of this structure with lime salts. Secondary 
lesions may be present, such as dilatation of the ureters, nephritis, or 
renal atrophy, associated with dilatation of the renal pelvis. In cases 
of old standing Leblanc found areas of ulceration and granulations on 
the mucosa, and in some instances the latter was covered by faise mem- 
branes of a greenish colour. He also observed abscesses in the sub- 
mucosa which penetrated between the layers of the wall of the bladder. 
Law describes cases in which the thickening and contraction of the 
mucosa and muscular coat were so marked that the bladder could not 
contain more than a few ounces of urine. 

Symproms.—The clinical phenomena resemble those observed in the 
acute form, but pain and distress are less marked, and may be absent. 
Friedberger and Frohner state that not infrequently chronic cystitis 
may run its course without presenting any well-marked symptoms. 
Leblanc observed stiffness in progression, especially during the trot, and 
dysuria, sometimes preceded by the expulsion of a semi-fluid material 
resembling pus. In the mare the vaginal mucosa was injected, and ulcers 
associated with excoriations were present thereon. The urine was dark 
coloured, glairy, and contained abundant particles of mucus. In some 
instances it was whitish, opaque, and very foetid. The disease had a 
variable course and duration, and was associated with capricious appetite, 
general emaciation, and digestive disturbances. 

TREATMENT.—Similar remedies to those advised for the acute form 
are indicated. Hutyra and Marek recommend oil of turpentine and 
copaiba; St. Cyr advised tar-water given internally. Irrigation of the 
bladder should also be carried out (see p. 723). 


VESICAL CALCULUS.* 


Synonym.—Cystic calculus. 

This condition is not of common occurrence in the horse, but is more 
frequently met with than renal calculus. As regards composition, the 
majority consists of carbonate of calctum. This variety is generally 
single, but may be multiple. It is oval in shape, the surface is nodular 

* For much of the information on the above subject we are indebted to the 


excellent article on “‘ Urinary Calculi,” by Professor Woodruff, Veterinary News, 
December 16, 1911. 


DISEASES OF THE BLADDER: HORSE 7125 


or irregular, and the colour is usually buff. The phosphatic calculus is 
lesscommon. Itis composed of either calcium phosphate or of ammonio- 
magnesium phosphate (triple phosphates). It is lighter in colour and 
has a smoother surface than the carbonate of calcium calculus. Not 
uncommonly a vesical calculus may be composed of a major portion of 
calcium carbonate and partly of calcium phosphate, and occasionally 
there may be a small admixture of calcium oxalate. According to 
W. Williams, the other forms of deposit in the bladder, in addition to 
calculus, are—(1) A sabulous deposit, consisting of an amorphous im- 
palpable powder or sediment; (2) a crystalline form known as “ gravel.” 
In his experience the sabulous deposit was more commonly met with in 
the mare, and calculus in the horse. 

Etiotogy.—The formation of calculi depends on certain conditions 
which favour the precipitation of salts from the urine. These conditions 
are various, and include the following: 

1. Bacterial invasion of the bladder, such as may occur in the mare 
aiter parturition, especially when vaginitis or metritis is present; also in 
both sexes as the result of using a septic catheter or from infection carried 
from the urethra. Suppurative conditions of the kidney have a similar 
effect. The result of bacterial invasion is to render the urine abnormally 
ammoniacal, and thus an excess of calcium carbonate is thrown down 
owing to the decomposition of urea. 

2. Concentration of the urine, such as may result from an insufficient 
allowance of drinking-water, favours the precipitation of salts from the 
urine. Retention of urine from any cause has a similar effect, and, in 
addition, the stagnant condition of the urine favours infection. Accord- 
ing to Williams, horses that are compelled to retain their urine for long 
periods, such as hunters, are most subject to calculi. 

3. A calculus may form round a nucleus, such as a blood-clot, a col- 
lection of mucin, inspissated pus, renal casts, etc., that may be present 
in the bladder. Williams met with cases in the mare in which a calculus 
formed around a foreign body, such as a piece of straw, a small stone, a 
piece of metal, etc. Cases are recorded in which the end of a broken 
catheter left in the bladder has served as a nucleus. One small calculus 
may serve as a nucleus for deposition of salts, and the latter may be of a 
different composition to the nucleus. The calculus serving as the nucleus 
may be derived from the kidney or formed in the bladder. 

4. Nature of the Food and Water.—According to W. Williams, the 
ingestion of certain clovers may cause the deposition in the bladder of a 
reddish-yellow deposit of sand formed of urine salts, and, if irritation of 
the vesical mucosa be present, an increase of mucus occurs, forming a 


726 SYSTEM OF VETERINARY MEDICINE 


nucleus around which the salts may be deposited. According to Moller, 
calculi may arise from an abnormally high percentage of salts in the urine 
produced by food and water rich in lime, and from a special tendency 
(lithiasis). 

It would appear, however, that the influence of food is of less im- 
portance in the production of vesical calculi in the horse than is the case 
with other animals. . 

Symptoms.—The following symptoms are regarded by Williams as 
suggestive of calculus: Stiffness in the hind-limbs, repeated twitching of 
the tail, frequent attempts at micturition. In some cases the urine may 
appear to be passed normally at the commencement of micturition, but 
the flow suddenly ceases, and further attempts fail to give relief. The 
animal stretches out, and may kick at his belly and show evidences of 
pain. These symptoms are due to the calculus being forced into the 
neck of the bladder, and thus interfering with the flow of urine. In 
some instances, especially in the mare, there may be incontinence of 
urine. In the horse dribbling of urine generally succeeds the act of 
urination. The urine is high coloured, strongly ammoniacal, and may 
contain blood. The sediment is copious. Woodruff states that the 
urine may be foetid as well as strongly ammoniacal. According to Moller, 
the urine may be blood-stained after the horse has been subjected to 
exertion, owing to the calculus injuring the vesical mucosa. 

CoMPLiIcATIONS.—Cystitis may occur, and, owing to the infection 
extending up the ureter, pyelonephritis may result. Retention of urine, 
followed by rupture of the bladder, has been observed. Woodruff* 
draws attention to an important sequel—viz., a chronic thickening of 
the wall of the bladder, with more or less ulceration of its mucosa, due 
to irritation caused by the calculus. Also, it may sometimes happen that, 
owing to the stretching of the vesical walls by the retention of urine, the 
mucous coat is pushed out in the form of sacculi between the network 
of muscular fibres. Salts may be deposited in these sacculi, and thus 
calculi imbedded in the vesical wall are formed, which are very difficult 
to remove by operation. Again, calculi of sufficiently small size may be 
passed into the urethra, forming urethral calculi (see p. 729). 

DIFFERENTIAL DiaGNnosis.—Rectal examination affords the only 
reliable means of diagnosis. Williams advises that the bladder be emptied 
by means of the catheter before the examination is carried out; Percival] 
recommends that in cases where a difficulty exists in detecting the cal- 
culus, the horse should be cast, and secured in the dorsal position prior 
to making the examination. 


* Op. cit. 


DISEASES OF THE BLADDER: HORSE 127 


In the differentiation of calculus from tumour of the bladder, Wood- 
ruff points out that in the latter condition the flow of urine is rarely 
obstructed in a complete manner, the tumour is soft in consistence as 
compared with a calculus, and it does not give a grating feel such as is 
observed when the catheter impinges on a calculus; also, in the case of a 
tumour shreds or particles of the growth may be frequently detected in 
the urine. 

TREATMENT,—This is entirely surgical, and the reader is referred to 
works on veterinary surgery for details of the operations necessary—viz., 
lithotomy or lithotrity; also to the excellent article by Woodruff to which 
we have already referred. 


SABULOUS DEPOSITS IN THE BLADDER. 


A collection of an amorphous impalpable powder or deposit not in- 
frequently occurs in the bladder, and in some instances may occupy a 
considerable extent of the organ, and be of a sandy character. It is 
detected by a rectal examination. 

TREATMENT.—In the mare the bladder can be washed out by means 
of a double-channelled catheter attached to the ordinary enema pump. 
In the horse it will be necessary to perform urethrotomy, and to wash 
out the bladder by inserting the catheter into the bladder through the 
urethral wound, and employing copious irrigation. 


TUMOURS OF THE BLADDER. 


These may be simple or malignant. Of the simple variety, the 
papillomata are most frequently met with. They may be complicated 
with small multiple calculi and gravel. Lipomata or myxomata have 
also been observed. Of the malignant variety, cases of carcinomata, 
epitheliomata, and sarcomata are recorded. 

The symptoms observed are frequent micturition and hematuria. 
If the tumour is situated in the vicinity of the neck of the bladder, 
dysuria may occur. In some cases pyuria is present. Shreds or por- 
tions of the neoplasm can sometimes be detected in the urine. 

The diagnosis is based on an examination of the bladder per rectum. 
In the mare the presence of the tumour can sometimes be detected by 
digital examination through the urethra. 

For the differential diagnosis between tumour of the bladder and 
vesical calculus, see above. 

The treatment is essentially surgical, and for details the reader is 
referred to Dollar’s work on “ Veterinary Surgery.” 


728 SYSTEM OF VETERINARY MEDICINE 


INVERSION OF THE BLADDER. 


Obviously, this can only occur in the female. The bladder is turned 
inside out and passes through the urethra. It is recognised as a red 
spherical tumour-like elastic body, covered by the vesical mucous mem- 
brane, situated either in the vagina or protruding beyond the vulva. 
On careful examination the orifices of the ureters can be detected on 
the upper surface close to the neck of the organ, and on pressing the 
swelling or during straining on the part of the animal the urine may be 
discharged in drops or in jets. Owing to exposure to the air and to dust 
and contamination from the surroundings, the mucous membrane becomes 
dry, congested, and then muco-purulent on the surface, and finally 
necrotic, unless means are adopted to place and retain the organ an siti. 
The bladder may become strangulated owing to congestion, and to the 
pressure exerted on it by the urethra. When the condition has existed 
for a long period, a fatal termination may result from septic absorption. 

Inversion of the bladder generally depends on violent expulsive efforts 
occurring during parturition. It has also been observed during preg- 
nancy and succeeding parturition, and as the result of forcible dilatation 
of the urethra practised for the removal of a vesical calculus. 

The treatment is surgical, and the reader is referred to Dollar’s 
“ Veterinary Surgery ”’ for details of the technique. 


PROLAPSE OF THE BLADDER. 


SyNonyM.—Hernia of the bladder. 

In this condition the bladder passes through a rent in the lower wall 
of the vagina, which results from an injury during difficult parturition. 
The organ becomes distended with urine, and projects beyond the vulva 
in the form of a spherical swelling covered by serous membrane. Care 
should be taken not to mistake the swelling for presenting foetal envelopes, 
and a proper examination is essential to avoid such an error. By an 
examination of the vagina the rent in the lower vaginal wall may be 
detected. Prolapse of the bladder is regarded as a more serious condi- 
tion than inversion, owing to the peritoneal covering of the organ being 
exposed, and the danger of septic peritonitis resulting unless reposition 
is quickly effected. Owing to the constriction of the neck of the bladder, 
which may result from the altered position of the organ, the flow of urine 
is obstructed, and, unless relieved, uremia may occur. 

Surgical treatment is indicated, for details of which consult the work 
on surgery already alluded to. 


DISEASES OF THE URETHRA: HORSE 729 


A form of hernia of the bladder has been met with in the absence of 
a rent in the vaginal floor. Such cases may occur either in the male or 
female, ‘“‘ the bladder forming a cystocele of the vagina or bulging between 
the anus and the ischium ”’ (Law). 


ANOMALIES OF THE BLADDER AND CONGENITAL 
MALFORMATIONS. 


These being essentially surgical conditions, the reader is referred to 
works on veterinary surgery for description and treatment. 


DISEASES OF THE URETHRA. 


URETHRITIS (INFLAMMATION OF THE URETHRA—CATARRH OF 
THE URETHRA). 


This may result from the accidental entrance of foreign bodies, such 
as awns of wheat, into the urethra. Some authors state that the con- 
dition occurs more frequently in the stallion, owing to infections sus- 
tained during copulation. W. Williams attributed it to excessive copu- 
lation. The symptoms observed are frequent and difficult micturition, 
sometimes straining, and, in the later stages, a small amount of 
muco-purulent fluid may be pressed from the urethra. The urethral 
orifice may be congested and swollen. The swelling of the urethral 
mucous membrane may occasionally be so extensive that symptoms 
similar to those of urethral calculus may be observed (see p. 730). 

Treatment consists of demulcent drinks containing alkaline car- 
bonates. Urethral injections of solutions of mild antiseptic agents are 
indicated. In the later stages solutions of zinc sulphate, 1 per cent., 
are of service. 


URETHRAL CALCULI. 


Calculi of sufficiently small size may enter the urethra from the 
bladder, and cause obstruction, either partial or complete, in the tube 
at various points. The most common seat of predilection is in the 
vicinity of the perineum, about an inch or two below the anus, and 
less frequently at the external orifice of the tube. It is not a common 
condition in the horse, and practically unknown in the mare, in conse- 
quence of the width and dilatability of the urethra in the latter animal. 


730 SYSTEM OF VETERINARY MEDICINE 


The symptoms observed are dysuria, frequent attempts at micturition, 
but only small amounts of urine are passed. When the calculus com- 
pletely occludes the urethra, retention of urine occurs, and, unless relief 
be given, uremia, or rupture of the bladder, will result. On examina- 
tion of the perineum a distinct distension or swelling will be detected 
when the calculus is situated in this portion of the urethra. Ifa catheter 
be employed, it will be found to strike on a hard substance—z.e., the 
calculus. The treatment will be found fully discussed in the paper by 
Woodruff, already referred to, or in works on Veterinary Surgery. 

Preputial Calculi—In the horse these are generally composed of the 
sebaceous secretion of the sheath mixed with dirt. In some instances 
they are true calculi. They may cause obstruction to the flow of urine 
by blocking the orifice of the urethra. In other cases large collections 
of sebaceous material are found within the prepuce, and interfere with 
urination. Treatment consists in washing out the prepuce and also the 
orifice of the urethra. 


TUMOURS OF THE URETHRA. 


This is a rare condition. A case of polypusin the urethra is recorded 
by Matthias. It was 6 inches long, and situated not far from the orifice 
of the tube. The symptoms met with in the cases recorded were a 
gradually increasing difficulty in micturition, the stream of urine during 
the act becoming smaller and smaller, until, finally, it passed in drops. 
Displacement of the tumour, slight swelling of the mucosa, or the for- 
mation of a blood-clot, may induce the sudden appearance of symptoms 
(Moller and Dollar). Treatment is essentially surgical (wzde works on 
Veterinary Surgery). | 

For a consideration of other affections of the urethra, such as stric- 
ture, and for diseases of the prostate gland, see Dollar’s “ Veterinary 
Surgery.” 


DISEASES OF THE URINARY ORGANS 
IN CATTLE 


By E. WALLIS HOARE, F.R.C.V.S., anp G. L. INGRAM, M.RB.C.V.S. 


DISEASES OF THE KIDNEYS. 
GENERAL REMARKS. 


In ordinary practice very few cases of urinary diseases are met with 
in cattle, or, to put it more correctly, are recognised. The bulk of infor- 
mation we possess is gathered from post-mortem examinations, and 
as the latter are not systematically carried out, it follows that our know- 
ledge of this subject is very limited. Of late years, owing to the atten- 
tion devoted to scientific meat inspection, many pathological conditions 
of the kidneys have been met with which previously were unobserved. 
But the clinical aspect of the subject is lamentably deficient, and this 
is In great part accounted for by the obscure nature of the symptoms, 
and the fact that, owing to the dull, phlegmatic temperament of cattle, 
symptoms suggestive of even acute renal disorders may not be observed, 
and any phenomena presented may be attributed to other causes. 
Another point worthy of mention is that cattle, being chiefly kept for 
either the production of milk or of meat, are not permitted to reach a 
period of life similar to what obtains in the case of the horse, and it is 
well known that renal affections are more common in aged than in young 
adult animals. 

Experience teaches us that certain diseases of the urinary organs do 
occur in cattle, but we must confess that, in the large majority of instances, 
we have only recognised the nature of the cases at post-mortem exami- 
nations, in many of which the lesions presented were in the form of a 
surprise. As we shall point out later on, there is little to guide us in 
the clinical phenomena, except in those cases in which the urine presents 
alterations in colour and appearance, and even then a careful exami- 
nation is necessary in order to decide whether the alterations in the 
urine depend on a urinary disorder, or on an affection of the blood. 
Again, the frequent association of symptoms attributable to the digestive 

731 


732 SYSTEM OF VETERINARY MEDICINE 


organs with those arising from urinary disorders adds still further to 
the difficulties in diagnosis; moreover, the former may predominate 
and mask the phenomena which would suggest the presence of renal 
disease. 

The Urine of the Ox.—The following characteristics are given by 
F. Smith:* The amount secreted is larger than in the horse, being from 
10 to 40 pints in twenty-four hours. The more nitrogenous the diet, 
the larger the amount of water consumed, and hence the quantity of 
urine is increased. The urine is clear, yellowish, alkaline in reaction, 
and of an aromatic odour. The specific gravity is lower than that of 
the horse, being 1007 to 1030, owing to the larger amount of water 
secreted. The nitrogenous matter is mainly represented by urea and 
hippuric acid. “The phosphates are either absent or only occur in 
small amounts.” 

“In suckling calves the urine is acid, and is rich in phosphates, 
uric acid, creatinin, and a peculiar substance known as allantoin. It 
is poor in urea, and, according to Moeller, contains hardly 1 per cent. 
of solids.” | 

With reference to micturition, “the urine simply dribbles away, 
owing to the curves in the urethral canal, and is directed towards the 
ground by the tuft of hair found on the extremity of the sheath. The 
ox can pass his urine while walking. The cow arches her back to mic- 
turate, but instead of extending her hind-limbs, as does the mare, she 
brings them under the body, at the same time raising her tail.”’ 


CONGESTION OF THE KIDNEYS. 


This condition is met with in the acute and chronic form in cattle. 

Acute Congestion of the Kidneys.—According to Moussu, this is 
generally the precursor of acute nephritis, and a differential diagnosis 
between the two conditions is difficult. Cadéac states that it is almost 
always of alimentary origin, and generally accompanied by lesions of 
the digestive organs. 

Et1oLogy.—Acute renal congestion may be associated with certain 
infectious maladies and affections of the blood, such as anthrax, ma- 
lignant catarrh, and piroplasmosis. In such instances the lesion is 
attributed to the irritating effects of toxins during their excretion by, 
the kidneys, resulting in hyperemia of the organs. 

As in the horse, the administration of irritating diuretics constitutes 
an etiological factor; and some authors observed the affection to follow 


* “ Veterinary Physiology.” 


DISEASES OF THE KIDNEYS: CATTLE 733 


the consumption of musty or spoiled fodder. In France it is found that 
in spring-time the ingestion of the young shoots of the oak, elm, ash, 
pine, etc., causes acute renal congestion, probably by the irritating effects 
produced on the kidneys by some special principles in the agents 
mentioned. 

Morsip ANAToMy.—The kidneys are greatly increased in size, 
especially in the cortex; ecchymoses occurs on the surface of the organs; 
the parenchyma is soft and friable, and may present hemorrhagic foci. 
The urine may be blood-stained, may contain red blood-corpuscles and 
albumin, and shows a copious sediment. According to Moussu, red 
blood-corpuscles are generally present. Amongst other substances 
stated to be present are crystals of urate of ammonia and small amounts 
of carbonate of lime and oxalate of lime. 

Symproms.—In addition to the usual constitutional symptoms 
common to so many affections in cattle—viz., impairment of appetite 
and rumination, staring coat, dulness, etc.—we may observe rigors, 
arching of the back, tenderness of the loins when palpated, the limbs 
drawn close together under the body, disinclination for movement, 
frequent attempts at micturition, and the passage of small amounts of 
urine, which may be blood-stained, red, or in some cases black in colour. 
Cadéac observed dull colicky pains. The course is generally rapid in 
mild cases, aS recovery may ensue in two or three days. In severe 
instances serious alterations occur in the pulse, and cardiac palpitation, 
extreme weakness, marked hematuria, and a tendency to assume the 
recumbent position, are observed. Death may take place from the sixth 
to the tenth day, or from the fourth to the sixth day. 

DIFFERENTIAL Dragnosis.—The affection must be distinguished from 
other conditions in which red-coloured urine is also a symptom. In 
red-water (piroplasmosis) the colouring matter of the blood is present 
in the urine, but no red blood-corpuscles. The other conditions likely 
to be mistaken for acute renal congestion are: chronic hemorrhagic 
cystitis, renal calculus, and cystic calculus. These have special characters, 
which will be found under their respective headings. Nephritis will be 
distinguished by an examination of the urine. 

Prognosis.—In mild cases the prognosis is favourable. In other 
instances it is grave, as, even if the animal does not succumb to the 
malady, the case may terminate in nephritis. 

TREATMENT.—French authors recommend venesection. Others ad- 
vise free purgation by means of castor oil or linseed oil. Flaxseed tea 
and other demulcent drinks are indicated. The other details of treat- 
ment are similar to those advised for the horse (see p. 681). 


734 SYSTEM OF VETERINARY MEDICINE 


Passive or Chronic Congestion of the Kidneys.—According to Leblanc, 
this condition is of frequent occurrence in cattle, and is associated with 
diseases of the lungs and heart, such as pulmonary emphysema, pleuro- 
pneumonia, traumatic pericarditis, pulmonary tuberculosis, and tuber- 
culosis affecting the heart. It may also occur in connection with chronic 
indigestion, accompanied by repeated attacks of tympany in the case 
of twin pregnancy, and in dropsy of the foetal envelopes, all of which 
conditions may interfere with the renal circulation. The lesions and 
symptoms are similar to those met with in the horse, and the disease is 
seldom recognised during life. 


INFARCTS OF THE KIDNEY. 


Synonyms.—White-spotted kidney ; Nephritis fibro-plastica ; a 
maculosa alba (Kitt). 

Infarcts of the kidney may be met with in cattle during the course 
of infectious diseases, such as malignant catarrh, anthrax, tuberculosis, 
pyemia, etc. 

But a most interesting variety occurs, chiefly in calves, and 
occasionally in adult cattle, and is known as “ white-spotted kidney,” 

r “ fibro-plastic nephritis.” This affection has been specially studied 
by Bleck, Kitt, and others. Some Continental observers have found 
the disease very common in fattened calves at abattoirs, although the 
animals appeared otherwise healthy. 

ETroLogy.—Various views are held with reference to the etiology 
of the affection. Leblanc regards it as originating from omphalo- 
phlebitis, as he found the characteristic renal lesions in a case of poly- 
arthritis of umbilical origin; also because of the large number of calves 
affected. According to Kitt, the affection is the result of an indurative 
process induced by micro-organisms which traverse the kidney without 
causing suppuration therein; and the presence of hemorrhages in the 
affected organ indicated a hematogenous embolic process. The source 
of the micro-organisms is most probably through the umbilicus. 

Morsip Anatomy.—The following lesions are described by Kitt: 
The surface of the kidney has a characteristic appearance, as it shows 
numerous white, greyish-white, or yellowish round spots. These are 
variable in size, rarely isolated, and generally collected in groups, but: 
in exceptional cases may be confluent and cover a large extent of surface. 
The unaffected areas show a brown or deep red coloration, which con- 
trasts strongly with the pale spots. The consistence of the kidneys 
may be normal, slightly softened, or rather firm, but in old lesions it 


DISEASES OF THE KIDNEYS: CATTLE 735 


tends to become firmer. The white spots are also found in the cortical 
and medullary layers, and in exceptional cases they show softening or 
suppuration in their centres. They may result in a multiple sclerosis, 
owing to cicatrisation of necrotic foci. 

Microscopical Appearances.—The lesions show an irregular distri- 
bution, and only small areas of the kidney present marked necrotic 
changes. In many of the uriniferous tubules the epithelium has dis- 
appeared, or is desquamating, and has undergone necrotic changes and 
disintegration. These changes are best marked in the convoluted 
tubules. The tubules may contain red blood-corpuscles, or intra- 
tubal hemorrhage may occur. 

The vascular changes include arteritis, with thickening of the walls 
of the vessels, and desquamation of the endothelium, also an excess of 
leucocytes. Some of the arterioles may be obstructed by a substance 
resembling fibrm. In aged cows a section of the affected kidney through 
the pale areas shows the lesions in the form of cones, of which the summits 
correspond to the vascular area of the organ (Leblanc). 

Symptroms.—As a rule, no symptoms are observed. According to 
Blieck, a moderate albuminuria is present in cases where, in addition 
to the white spots, diffuse disease of the parenchyma or multiple hemor- 
rhages have developed. The urine may contain white blood-corpuscles, 
renal epithelium, and renal or granular casts. In severe cases the animals 
show a diminished appetite, are dull, and, in rare instances, suffer from 
diarrhoea (Hutyra and Marek). 

TREATMENT.—This need not be considered, as in the majority of 
instances the disease is not recognised, and in the severe cases the animals 
would probably not be worth the expense of treatment. 


NEPHRITIS. 
Acute Nephritis. 


According to Moussu, the lesions in acute nephritis of cattle are of 
a mixed type, and all the tissues of the organ are affected, although in 
some instances the morbid alterations may predominate in certain 
structures. As regards the incidence of the disease in cattle, there is 
some difference of opinion. According to Leblanc, it is of frequent 
occurrence on the Continent; but this is certainly not the experience of 
British practitioners. Of course, we must admit that, owing to neglect 
in examining the urine, it is possible that cases of the disease may be 
overlooked. In the Report of the Veterinary Director-General, Depart- 
ment of Agriculture, Canada, for 1912, the statistics for meat inspec- 


736 SYSTEM OF VETERINARY MEDICINE 


tion show that fourteen carcasses of cattle were condemned for 
nephritis. 

Errotogy.—Acute nephritis may be associated with certain in- 
fectious maladies, such as pneumonia, malignant catarrh, metritis, etc., 
and in calves with omphalo-phlebitis and septic pneumonia. 

Experimentally, nephritis has been produced in cattle by injections 
of tuberculin. Carrieri has found that the toxins of tubercle bacilli 
cause a necrotic condition of the renal secretory epithelium and other 
lesions of the kidneys. 

As in the horse, certain toxic agents and irritating diuretics can pro- 
duce nephritis, also certain poisonous plants. Godbille observed cases 
in cows after the ingestion of acorns. Other authors record instances in 
which some varieties of clover in the green state were capable of inducing 
the disease. Exposure to cold and chills acts as a predisposing cause of 
the affection. Injuries to the region of the kidneys are regarded by some 
observers as etiological factors. Cruzel recorded a case of intense 
nephritis in an ox which occurred as the result of the animal having 
been chased by a dog. 

Morsip Anatomy.—The renal lesions are similar to those occurring 
in the horse. According to Kitt, when the affection develops rapidly, 
the parenchyma alone is involved, and there is an absence of cellular 
infiltration of the interstitial tissue. 

Symptoms.—These resemble the phenomena met with in acute renal 
congestion, but the constitutional symptoms are more marked. The 
animal stands almost immovable, with arched back and loins, and limbs 
drawn under the body. The urine is passed in small amounts and at 
frequent intervals; it is always albuminous, and hematuria may be 
present. According to Moussu, anuria is rare, and when it occurs.it is 
transitory. Funk has observed cases in which anuria continued for five 
days. Pressure on the region of the loins causes pain. On forcing the 
animal to move, the hind-quarters show stiffness and a lack of power. 
A quick pulse, accelerated respirations, and a rise in temperature, are 
also present. On examining the urine, similar morbid alterations to 
those described as occurring in the horse are found. Loss of appetite, 
cessation of rumination, injected visible mucous membranes, and a 
variable degree of pain, are also present. In very acute cases tympany 
of the rumen, accompanied by constipation, occurs, and symptoms of 
uremia may set in. These latter consist of vertigo and convulsions, 
succeeded by a profound coma. According to Moussu, cedema or 
anasarca does not occur to any extent except in a very intense 
nephritis. 


DISEASES OF THE KIDNEYS: CATTLE 737 


The course of the disease is generally rapid, but cases occur in which 
its advent is insidious and the symptoms are obscure. Cases are re- 
corded in which the duration was seven days, the affection terminating 
favourably. 

DIFFERENTIAL Draqnosis.—This must be based on an examination 
of the urine. It is important to note that Moussu, owing to his observa- 
tions, is of opinion that albuminuria of moderate degree is frequently 
present in the cow during pregnancy. Hence it is necessary to conduct 
a careful microscopical examination of the urine before coming to a con- 
clusion as to the presence of nephritis in pregnant animals, as the detec- 
tion of albumin alone does not warrant a diagnosis of inflammation of the 
kidneys. 

Proenosis.—Although it is said that acute nephritis in cattle is less 
frequently fatal than the same disease in horses, still a guarded prognosis 
should always be given. According to Cruzel, if proper treatment be 
adopted, the affection terminates favourably in the majority of instances. 
This, however, is not the usual experience. 

TREATMENT.—Cruzel advises early and copious venesection. The 
principles of treatment are similar to those suggested for acute nephritis 
in the horse. 

Chronic Nephritis. 

Considerable difference of opinion exists amongst authors and ob- 
servers with reference to the frequency of chronic nephritis in cattle. 
Thus, Leblanc states that it is a rare affection, and is of opinion that a 
large proportion of the cases recorded are in reality associated with pyelo- 
nephritis. Moussu remarks that it is little known in cattle. On the 
other hand, Hutyra and Marek state that chronic indurative nephritis 
occurs in cattle and buffaloes fairly frequently, although admitting that 
itis seldom observed clinically. Seuffert describes the disease as occurring 
with comparative frequency in cattle. 

Etrotogy.—Very little is definitely known in connection with the 
etiological factors. The affection is said to occur occasionally as a 
sequel to acute nephritis. Law states that it has been observed in cattle 
fed on distillery and brewery dregs, and also in cows through drinking 
water contaminated with lead, such as may occur when soft water has 
run through lead pipes or stood in leaden cisterns. Hutyra and Marek 
are of opinion that mechanical irritation of the kidney, such as that 
produced by the presence of renal calculi, and anything causing periodical 
interference with the outflow of urine, may be special causes of chronic 
nephritis in cattle. The same authors have met with cases of the disease 
associated with chronic hepatitis, and ascribed them to the animals 

VOL, II. 47 


738 SYSTEM OF VETERINARY MEDICINE 


having fed on sour plants on wet pastures. Seuffert regards prolonged 
exposure to cold, chills, etc., as an etiological factor. 

Morsip Anatomy.—According to Seuffert, the lesion always met 
with is a chronic hypertrophic form of nephritis (large white sclerotic 
kidney, with lardaceous degeneration and sometimes marbling). He is of 
opinion that if the animal were permitted to live sufficiently long atrophy 
of the kidneys would result. The kidneys are hypertrophied, and the 
right organ occupies the entire sublumbar space as far as the extremities 
of the transverse processes of the lumbar vertebre. On section, the 
cortical portion is bright red, and the medullary portion is of a pale tint. 
The parenchyma is firm and dense, and may be resistant. Kitt has met 
with a diffuse fibrous or indurative nephritis, with similar histological 
appearances to those described as present in the corresponding affection in 
the horse; also a fibrous multiple nephritis (sclerosis maculata), in which 
the surface of the kidney shows yellowish or greyish-white furrows; and 
in the cortical substance white wedge-shaped foci are found consisting of 
fibrous connective tissue, round cells, and isolated urinary tubules with 
disintegrating epithelium. He regards these lesions as being probably due 
to embolism, and in some cases to a diffuse purulent nephritis. Leblanc 
records cases in which the lesions occurred in only a portion of the kidney. 
The affected areas, variable in extent, are imbedded in the healthy 
tissues; they are irregular in outline, and of a pale yellow, and give the 
appearance of large cicatrices; the cortical substance is chiefly involved. 
These lesions are similar to those described under Chronic Interstitial 
Nephritis in the Horse. 

Symproms.—Hutyra and Marek point out the lack of clinical know- 
ledge existing with reference to chronic nephritis in cattle, and remark 
that, owing to the investigations carried out by Vémos in affected 
buffaloes, it is reasonable to assume that morbid alterations frequently 
occur in the urine during the course of the disease in ruminants, although 
the animals appear otherwise healthy. A consideration of the clinical 
phenomena described by a number of authors leads us to conclude that 
in the large majority of instances the presence of the disease is likely 
to be overlooked, more especially in the early stages, and also when 
digestive disturbances accompany the condition. Amongst the symptoms 
described are frequent micturition, arching of the back, the passage of 
small amounts of urine at a time, which is albuminous, of high specific 
gravity, and may be red in colour, but in some instances is clear. Accord- 
ing to Seuffert, the hypertrophied kidneys, especially the right organ, 
can be detected by palpation of the lumbar region near the hollow of the 
flank, as well.as by rectal exploration. Kmaciation occurs as the disease 


DISEASES OF THE KIDNEYS: CATTLE 739 


progresses, and, according to Leblanc, digestive disturbances almost 
always accompany the condition, such as irregular rumination; also con- 
stipation, the feces being dark in colour, and covered by a coating of 
mucus. In the later stages this author observed a well-marked venous 
pulse, injected visible mucous membranes, oedematous swellings extending 
from the region of the neck to the fore-limbs, and also to the pectoral and 
inferior abdominal regions. Thomassen observed hypertrophy of the 
heart, increased cardiac tension, and a hard, quick pulse. The emacia- 
tion and debility increase, and death occurs in a state of marasmus. 
According to Moussu, neither cardiac complications nor uremia occur 
in cattle. 

DIFFERENTIAL Diacnosis.—This is based on an examination of the 
urine, on the history of the case, and on the results of a rectal examina- 
tion. As already remarked, the majority of the cases are likely to be 
overlooked or mistaken for other diseases. 

TREATMENT.—Obviously, if a diagnosis of chronic nephritis can be 
arrived at, treatment is useless, as the disease always terminates fatally. 


PURULENT NEPHRITIS AND PYONEPHRITIS. 


This is acknowledged by all authors to be of frequent occurrence in 
cattle, but some regard it as being associated with pyelonephritis in 
many instances. It has been observed as a sequel to metritis in cows, 
and also in connection with pyzmia and tuberculosis, and in calves it 
may arise from infection of the umbilicus. 

Morsip ANAtomy.—According to Kitt, the lesions may be similar 
to those met with in purulent nephritis in the horse—-viz., as a diffuse form 
and as a renal abscess. In some of the cases of renal abscess recorded 
the kidney was an enormous size, and contained a very large amount of 
pus. Kitt observed in calves that the lesions in each kidney varied. In 
one an abscess was present, and in the other an infarct, but both lesions 
were due to an embolic process. 

Law describes, under the heading of Perinephritis, a suppuration in 
the connective tissue between the kidney and its capsule, occurring in 
cattle in low condition pastured on damp, low-lying lands. 

Symptoms.—These are very deceptive, and in some instances consist 
only of emaciation and the frequent passage of ure. The urine may 
be purulent or contain blood. Examination per rectum in a case of large 
renal abscess may enable us to detect the lesion, and in some of the cases 
recorded a swelling appeared on the flank, which, on palpation, showed 
fluctuation and was sensitive. In one case that we observed in a valuable 


740 SYSTEM OF VETERINARY MEDICINE 


thoroughbred bull the animal simply passed large amounts of clear urine 
and showed digestive disturbances for a long period, with gradual emacia- 
tion. The nature of the case was not suspected, and the post-mortem 
revealed an enormous abscess in one kidney. 

The course of the disease is generally slow, but cases are reported in 
which death occurred in from four to eleven days. 

DIFFERENTIAL Diacnosis.—The presence of pyuria and the evidences 
obtained from a rectal examination constitute the basis for a diagnosis. 
In the majority of instances the disease will be overlooked. 

TREATMENT.—For economical reasons it is apparent that when the 
affection is diagnosed slaughter of the animal is the wisest course to 
adopt. 


PERINEPHRIC ABSCESS. 


Synonym.—Perinephritic cellulitis. 

This is described by Moussu as an inflammation, with abscess-forma- 
tion in the connective tissue and adipose layer surrounding the kidney, 
and occurring in suppurative nephritis or in pyelonephritis in cattle. 
It is said to occasionally follow direct mechanical injury to the region of 
the loins, but is generally to be regarded as a complication of the affections 
mentioned above. The infecting organisms are believed to pass from 
the kidney and reach the perirenal tissue, or they may extend by way 
of the lymphatics. The perirenal and fatty tissue is infiltrated with a 
reddish serosity, is inflamed, and becomes the seat of a large abscess, 
which may communicate with a renal abscess, or be quite distinct 
from the latter. The diagnosis is based on a rectal examination, 
and in some instances by the detection of a fluctuating swelling in 
the hollow of the flank close to the transverse processes of the lumbar 
vertebre. 

Pyelitis and Pyelonephritis.—There is nothing special to record with 
reference to the..e conditions in cattle as regards etiology, morbid anatomy, 
and symptoms. In some instances they are associated with tuberculosis. 

Bacillary Pyelonephritis is a special form of renal disease of cattle, not 
infrequently met with on the Continent, but its existence in the British 
Isles has not yet been definitely demonstrated. It will be found fully 
described in Vol. I. of this work. 

Amyloid Disease of the Kidneys.—This affection has been observed 
in cattle by Gerlach, and also by Rabe. According to the latter, the 
lesions involve the glomeruli, and not the medullary portion of the 
kidney. 


DISEASES OF THE KIDNEYS: CATTLE T41 


HYDRONEPHROSIS. 


Most authors describe this lesion as being of somewhat common 
occurrence in cattle. The affection is usually unilateral, and the etiology 
is generally similar to that described in the case of horses. Moussu has 
observed instances in which the disease was caused by a “ kink” or 
torsion of the ureter. He also records cases where the ureter was enor- 
mously dilated, and the affected kidney double or treble its normal size. 
Breuer has met with instances where the left ureter was bent by the dis- 
tended rumen, and the left kidney displaced so that hydronephrosis 
resulted ; also where the ureter was compressed by an overfilled stomach. 
According to Kitt, the kidney may be changed into a large undulating 
bladder, whose wall is formed by the thickened capsule of the organ. 
Up to 20 or 30 pints of liquid have been found in the dilated kidney. 
The interlobular divisions have disappeared, and each lobule forms a 
cystic cavity. 

There is nothing special to describe as regards symptoms, as in the 
majority of instances the lesion is only discovered post mortem. In 
unilateral cases the normal kidney compensates for the diseased organ, 
and no symptoms may be present. In bilateral cases the symptoms may 
be mistaken for those of chronic nephritis. Occasionally the condition is 
recognised by rectal exploration, and in very well-marked cases the 
enlarged kidney forms a tumour-like swelling in the flank, which, accord- 
ing to Caffaretti, is fluctuating, and on percussion yields a tympanitic 
sound. This observer also states that in such instances an exploratory 
puncture reveals the nature of the case, provided the lesion be recent; 
but if chronic, a flow of liquid does not occur, as the urine becomes con- 
centrated and thickened by mucus. Beyond the employment of an ex- 
ploratory puncture in cases where the swelling is present in the flank, 
treatment cannot be adopted. In bilateral cases death is certain to occur 
from complications. 


CYSTIC DISEASE OF THE KIDNEY. 


This condition has been observed in cattle by various authors. As 
already mentioned, it may be regarded as a sort of localised hydro- 
nephrosis. According to Hutyra and Marek, it may happen in chronic 
inflammatory processes in the kidney that some urinary tubules may 
be constricted by contraction of the newly-formed connective tissue 
which is undergoing atrophy, or their lumen may be obstructed by col- 
lections of epithelium or casts. The result is that the urinary canals 


742 SYSTEM OF VETERINARY MEDICINE 


attached to the Malpighian bodies become dilated owing to the constant 
secretion of urine and the obstruction to its outflow, and they become 
transformed into retention cysts. These small cysts may be numerous, 
and contiguous ones become confluent, until finally the entire kidney is © 
transformed into a collection of cysts of various sizes. Occasionally the 
lesion occurs as a congenital condition. The terms vesicular nephritis 
or nephritis fibro-vesiculosa have been applied by Kitt to the lesion. 
The cysts are semi-transparent, of a bluish-white colour, and their walls 
are very thin. The contents are clear, and resemble white wine. Some- 
times the fluid is blood-stained; its composition is generally similar to 
that of urine. 

Polycystic Kidney.—This condition has been observed in the foetus 
by Arloing and Hermenier, and in the calf by Pflug. The lesions are 
similar to those described as occurring in polycystic kidney in the horse. 
The enormous size of the affected organs and the large amount of fluid 
they may contain are remarkable. | 


RENAL CALCULI. 


Nephrolithiasis of the kidney is regarded by Leblanc as an affection 
of frequent occurrence in cattle. According to Moussu, it is more common 
in sheep than in cattle. The latter author regards high and excessive 
feeding as the chief etiological factor in connection with the disease, but 
as it sometimes occurs in animals that are in poor condition, he is of 
opinion that a special diathesis may exist in such cases. Certain infec- 
tions of the kidney may, as in the horse, lead to the formation of renal 
calculus. 

Renal calculi in cattle vary as regards shape and composition. Ver- 
heyn classifies them as follows: coralline, pearly, metallic, white, and grey. 
In many instances they are firm, and show prolongations corresponding 
to the renal calyces. They are composed of 74 per cent. of carbonate of 
calcium, and, in addition, contain carbonate of magnesia, organic material, 
and traces of iron. According to Verheyn, the grey calculi contain, 
besides the above, ammonio-magnesium phosphate, and phosphate and 
oxalate of lime. They may occur singly or in large numbers, and in 
some instances their weight is very considerable. 

According to Leblanc, it is very rare to find only one kidney affected. 
Various lesions are described as being associated with the presence of 
calculi. These include a depression of the renal surface over the 
seats of the calculi, and an alteration in colour of the parts to a dark 
red or yellowish tint. The tissues in the vicinity of the calculi are hard 


DISEASES OF THE KIDNEYS: CATTLE 743 


and sclerotic, and on section a cavity is found in which the concretions are 
lodged. The renal tissue at the periphery of the lesion is sclerotic and 
fibrous in structure. The uriniferous tubules in the vicinity are dilated, 
and the epithelium degenerated, while some of the tubules show cystic 
transformation. 

Symproms.—In the majority of cases no. special symptoms are ob- 
served, and the calculi are found as a surprise at the post-mortem. 
Occasionally uremic symptoms are in evidence, such as a protruding 
tongue, trembling of the facial muscles, and deep, slow respirations, 
followed by coma and death. Some observers recorded colicky pains, 
dysuria, paralysis, diminution or suppression of urine. A case is reported 
in which a calculus became lodged in the ureter, and rupture of this struc- 
ture resulted. According to. Moussu, nephritic colic is not observed in 
cattle. 

TREATMENT.—It is quite clear that therapeutical measures cannot be 
of any value, even if it were possible to diagnose the condition. 


TUMOURS OF THE KIDNEY. 


The following have been met with: adeno-carcinomata, fibromata, 
sarcomata, and colloid cancer. Hess recorded a case of renal carcinoma 
in a cow, in which the hypertrophied organs were detected by rectal 
examination, and were of very large dimensions. A case of melanosis of 
the kidney in a heifer was reported by Andrieu. Tuberculosis of the 
kidneys is comparatively frequent in cattle in the form of small tubercles 
or large cheesy foci disseminated chiefly in the cortical portion. As these 
foci enlarge, they may penetrate the renal pelvis, and the mucosa of the 
latter then becomes involved. 

Except in cases where the enlarged organs can be detected by rectal 
exploration, a diagnosis is impossible, and in any case the hypertrophy 
may depend on other causes. If tuberculosis be suspected, a bacterio- 
logical examination of the urine should be carried out. 


PARASITES OF THE KIDNEYS. 


These include Eustrongylus gigas and Echinococcr. For a description, 
see the section on Parasites. 


T44 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE BLADDER. 
CYSTITIS. 


As in the horse, an acute and a chronic form of this affection are recog- 
nised in cattle. ! 

Acute Form.—This occurs with comparative frequency in the cow, 
and is less often met with in the ox. According to Moussu, it is generally 
found as a complication of metritis, vaginitis, and injuries of the genital 
passages following parturition. It is also associated with bacillary pyelo- 
nephritis. The etiological factors mentioned in connection with cystitis 
in the horse may also cause the disease in cattle. The lesions are similar 
to those occurring in the horse. 

Symptoms.—Weakness in the hind-limbs, loss of appetite, frequent 
looking towards the flanks, arching of the back, constant attempts at 
micturition, but only small amounts of high-coloured urine are passed, 
and sometimes it is blood-stained. In some cases colicky pains may 
be observed, and trembling of the hind-quarters; the expression of the 
countenance is anxious, the visible mucous membranes are injected, 
and obstinate constipation may be present. In other instances para- 
plegia results after four or six days. Paralysis of the bladder may occur, 
with anuria, or small amounts of urine may be passed, accompanied by 
marked pain. Death may result from rupture of the bladder or from 
gangrene of the organ, with similar symptoms to those described as 
occurring in the horse when suffering from such complications. The 
prognosis is grave in consequence of the tendency to complications. 
Some observers state that the mortality is about 25 per cent. 

TREATMENT.—The indications for treatment are similar to those 
mentioned for cystitis in the horse. Moussu condemns irrigation of the 
bladder as being likely to induce further infection. Moreover, in the 
case of the male, owing to the S-shaped curve in the urethra, it would 
be necessary to perform urethrotomy in order to irrigate the bladder. 

Chronic Form.—This must be distinguished from a special enzodtic 
affection occurring in various parts of the Continent and in America, and 
known as “ chronic hemorrhagic cystitis,” or “ hematuria vesicalis,”’ or 
“chronic hematuria ”’ (see p. 745). : i 

In simple chronic cystitis, which, according to Leblanc, is often met 
with in the cow, the vesical walls are more or less considerably thickened, 
and pyuria is present. The thickening and rigidity of the walls of the 
ergan are very marked in some cases, and they are of a yellowish or 


DISEASES OF THE BLADDER: CATTLE 745 


greyish-white colour. The vesical mucosa shows large thickened folds, 
between which are found pus and urinary sediments; ecchymoses are 
also observed, and the membrane may be of a slate colour. Dilatation 
of the ureters is generally present. 

Symproms.—The disease commences insidiously, but when developed, 
incontinence of urine is observed. In some cases there are frequent 
attempts at micturition, but only a small amount of a whitish, purulent, 
turbid urine is passed, which on microscopical examination shows pus- 
cells and crystals of ammonio-magnesium phosphate. As the disease 
advances, inflammation of the vaginal mucosa, with thickening of the 
urethral walls (in the cow), is detected by a vaginal examination. Cases 
are recorded in which, by rectal examination, the bladder gave the sensa- 
tion of a hard tumour, and the neck of the organ was hypertrophied. 
The thickening of the walls may be so extensive that the cavity of the 
organ almost disappears, and the urine is constantly being discharged. 
The course of the disease is slow, and eventually complications ensue, the 
animal dying in a state of cachexia. 

TREATMENT.—The therapeutical measures advised for chronic 
cystitis in the horse are applicable to the disease in cattle. In the case 
of the male it is necessary to perform urethrotomy in order to carry out 

irrigation of the bladder. Caffaretti advises the administration of oil of 
turpentine (3x. to 3xii. daily). Moussu advises benzoate of sogla. 


CHRONIC HASMORRHAGIC CYSTITIS. — 


Synonyms.—Vesical hematuria; Chronic hematuria; Enzoodtic hema- 
turia. 

This is a special disease affecting cattle, occurring in various parts of 
the Continent, and also in British Columbia. Its leading characteristics 
are an intermittent hematuria and progressive emaciation, associated 
with lesions of the vesical mucosa, such as ulcerations and neoplasms of 
a hemorrhagic nature. On the Continent it occurs in stall-fed cattle, 
and especially in adult or aged animals. 

Various theories have been suggested with reference to the etiology 
of the affection, but up to the present time nothing definite is known in 
this direction. On the Continent investigations have been conducted 
by Anacker, Detroye, Galtier, Hink, Liénaux, and others. 

In British Columbia the disease has been studied from 1907 to 1909 
by Bowhill, and afterwards by Seymour Hadwen. According to the 
Report of the Veterinary Director-General, Department of Agriculture, 
Canada, for 1911, somewhat serious losses have from time to time been 
caused by the malady. 


746 SYSTEM OF VETERINARY MEDICINE 


According to Seymour Hadwen, who up to the present time is investi- 
gating the disease in British Columbia, the average age at which cattle 
become affected is six years. In the Report for 1912 it is stated that a 
number of experiments were being started, but nothing definite could be 
ascertained until these were concluded. In the 1911 Report,* to which 
we are indebted for the following information, we observe that the disease 
was confined entirely to bench lands having an elevation of from 100 to 
300 feet above sea-level. The soil of the bench or highland is, for the 
most part, a reddish sort of loam, while on prairie land it varies from a 
black loam to peat; and an interesting point is that affected highland 
cattle, when taken into the prairie, if not too seriously attacked, recover 
completely. The majority of cases develop in mid-winter, when the 
animals are fed on dry food, and second and third attacks appear to 
be more prevalent in the winter months. The disease takes several years 
to develop and show itself, but an occasional case develops rapidly. All 
the evidence points against the affection being contagious. The disease 
appears to occur especially in recently settled districts under backward 
agriculture. 

The lesions present in incipient cases are one or two small vegetations, 
generally near the neck of the bladder, which tend to bleed readily; 
accompanying these are a number of submucous hemorrhages. One 
lesion may heal or get blocked up with a clot, and another lesion becomes 
active; thus the persistence of the disease is accounted for. The large 
growths met with in further advanced cases are of a fibro-papillomatous 
nature. Sometimes, in cases of old-standing, lesions of the liver and 
kidney are observed. Pus organisms may be found in the renal lesions, 
probably derived from the bladder. The blood shows no change in the 
early stages, but later on poikilocytosis, punctate degeneration, and 
nucleated red cells are encountered; these are evidences of ansemia, due to 
repeated blood losses. The relative percentages of the leucocytes do 
not alter in the early stages. In the majority of cases the coagulability 
of the blood is lowered. The urine shows the presence of unaltered red 
blood-corpuscles. 

The symptoms observed in the early stages are hematuria and 
frequent urination, accompanied by some straining. In a number of 
instances all that can be seen is a drop or two of blood-red urine just as 
the act of urination ends. The first attack usually lasts for a few days, 
and no further phenomena may be observed for weeks or months; but 
in other instances one attack may follow another in rapid succession, and 


* Appendix No. 9 to Report of the Veterinary Director-General, Department 
of Agriculture, Canada. 


DISEASES OF THE BLADDER: CATTLE TAT 


death may occur in a few months. The course is rarely shorter than six 
months, but a number of cases are recorded in which the animals lived 
for three years and over. The next symptom observed is emaciation 
leading to anaemia, and is due to the increased loss of blood. In the late 
stages acute straining after urination is more marked, and if due to large 
growths in the bladder it will be fairly constant. But straining may 
also be due to the presence of blood-clots in the bladder. These clots 
may eventually fill the organ, and even cause rupture. It is believed 
that the urine possesses the property of preventing coagulation of the 
blood in the bladder; otherwise the disease would prove more rapid and 
fatal. Probably clots are only formed when the bladder is empty or 
when the hemorrhage is above the level of the urine, but when once a 
clot is formed, the urine has no power to dissolve it. The contents of the 
bladder may become invaded by bacteria, and septicemia may result; 
or the micro-organisms may spread to the kidneys and induce pyelo- 
nephritis. Dropsy may occur in the later stages, and in a few cases of 
long standing icterus has been observed. 

Seymour Hadwen states that he only investigated the disease in 
milch cows, and points out that in males the termination is more rapidly 
fatal, due to the fact that, owing to the formation of the male urino- 
genital system, large blood-clots cannot be expelled from the bladder 
with the same ease as in females. 

- With regard to treatment, the most useful drug so far is calcium 
lactate, in doses of 2 to 4 drachms daily for a week, and improvement is 
noted as early as the second day after treatment. If anemia is present, 
phosphate of iron in small doses is advised. Spontaneous recovery is 
rare, and some long remissions have been noted—viz, from a year to 
two and a half years. 

According to Hutyra and Marek, the lesions observed in the disease 
on the Continent are, in the early stages, dark red spots on the vesical 
mucosa, and in the advanced stage red, brown, and sometimes yellowish 
or grey varicosities as large as hemp-seeds, and occasionally between these, 
cellular proliferations of various sizes and resembling cauliflowers, are 
found. Ulcers may also be present, which may perforate the mucosa, 
and as complications nephritis or hydronephrosis may be observed. 
The bladder contains bloody urine and sometimes blood-clots. In far 
advanced cases evidences of general anzemia are present. 

Retention of urine may be caused by the formation of blood- alot 
which obstruct the urethra at its origin. A fatal termination may result 
from anemia or from rupture of the bladder. The affection is more fatal 
in males than in females. According to Anacker, the condition is greatly 


748 SYSTEM OF VETERINARY MEDICINE 


improved after parturition. The Continental experience, according to the 
above authors, is that permanent recoveries are the exception, and 
usually the animals must be destroyed. 

So far as we are aware, the disease has not been observed in the British 
Isles. 


VESICAL CALCULUS. 


This is seldom met with in the cow, as, in consequence of the urethra 
being dilatable, the calculi can be expelled with the urine. In the ox 
it is sometimes observed, but most authors agree that in this animal 
urethral calculi are of far more common occurrence. As causes of the 
affection, high feeding and catarrhal states of the urinary passages 
depending on microbial infection are amongst the recognised etiological] 
factors, such conditions tending to bring about a deposition of the 
urinary salts in the bladder. The chief constituent of vesical calculi jn 
cattle is carbonate of calcium. 

The symptoms are so obscure as to be frequently overlooked. When 
a calculus becomes lodged in the neck of the bladder, the animal makes 
frequent ineffectual attempts to micturate, and unless the obstruction 
regains the fundus, retention of urine, followed by rupture of the organ, 
will result. In other cases there may be simply an interruption in the 
passage of urine, or occasionally hematuria may be observed. 

The diagnosis is based on a rectal examination, as in the horse, and 
treatment is similar to that advised for vesical calculus in the equine, 
but with due regard to the anatomical peculiarities of the urethra in the 
bovine. For the techinque of the operation the reader is referred to 
‘* Diseases of Cattle,’ by Moussu and Dollar. 


RETENTION OF URINE. 


This may occur in cattle from similar causes to those mentioned as 
producing the condition in equines. The same procedure as regards 
treatment is indicated. Most authors state that it is impossible to employ 
the catheter in the ox, owing to the presence of the S-shaped curve in 
the urethra; hence it is advised to perform urethrotomy, so as to introduce 
the instrument directly into the bladder. This is also the view held by 
many practitioners. But Law states that the difficulty may be over- 
come by careful manipulation of the sheath, so as to cause protrusion — 
of the penis; the organ is then freely extended so as to efface the S-shaped 
curve in the urethra. A catheter of small calibre should be employed. 
Judging from experience, the procedure is a most difficult one in most 
instances, as even the securing of the penis in the ox is often a work of art. 


DISEASES OF THE BLADDER: CATTLE T49 


PARALYSIS OF THE BLADDER. 


This is of comparatively rare occurrence in the ox, except as the 
result of retention of urine. It occurs more frequently in the cow, and 
generally as a post-partum complication. It is met with in cases of 
milk fever that remain in the recumbent position for a long period; also 
in cases of paraplegia depending on various causes. 

Incontinence of urine may be present, or complete retention, or the 
only urine passed may be the overflow from the distended bladder. 

The treatment is similar to that advised for the same condition in 
equines. 


RUPTURE OF THE BLADDER. 


The etiological factors are similar to those causing the lesion in 
equines, the most common being obstruction of the urethra due to a 
calculus. If the urine is septic, acute peritonitis develops, with uremia 
from absorption of urine, and death occurs, according to Moussu, in six 
to ten days. The same author states that when the urine is aseptic a 
chronic exudative peritonitis results, due to the irritating action of the 
urine. The exuded liquid mingles with the urine, and marked ascites 
occurs. Cases have been observed to live for three to six weeks without 
any marked disturbance. 

- Moller states that death may take place in a few days after rupture 
of the bladder. After the lesion has occurred, the pain diminishes, and 
the animal may even begin to feed; but tympanites soon sets in, and 
death takes place with symptoms of peritonitis and uremia. 


TUMOURS OF THE BLADDER. 


According to Moller, cattle appear to suffer from new growths in the 
bladder more frequently than horses. Amongst the varieties of neoplasms 
recorded are carcinomata, tuberculous tumours near the openings of the 
ureters, papillomata, and myxomata. 

The symptoms observed were frequent micturition, sometimes hema- 
turia, with the passage of blood-clots, and dysuria if the tumour involves 
the neck of the bladder. Pyuria is present in some cases. The diagnosis 
is based on palpation of the bladder by a rectal examination, and in the 
cow by a vaginal and urethral exploration. 

The treatment, when such cases are operable, is purely surgical, and 
for the technique the reader is referred to Dollar’s work on “ Veterinary 
Surgery.” 


750 SYSTEM OF VETERINARY MEDICINE 


INVERSION OF THE BLADDER AND PROLAPSE OF THE BLADDER. 


These conditions are met with in cows, generally as a sequel to diffi- 
cult parturition. There are no special features as compared with 
analogous cases in the mare, and the treatment is similar. 


DISEASES OF THE URETHRA. 
URETHRAL CALCULI. 


According to Moller, the bull is more subject to urethral calculi than 
any other animal. The calculi are formed in the bladder, enter the 
urethra during micturition, and become lodged therein owing to the 
comparatively narrow lumen of the tube and to its peculiar anatomical 
formation. Even small calculi may cause urethral obstruction in the 
ox. The calculus is usually lodged in the first bend of the S-shaped 
curve, and less often near the end of the organ. Moussu, however, states 
that the obstruction frequently occurs at the ischial curve. The symp- 
toms observed are uneasiness, stamping with the hind-feet, slight colicky 
pains, frequent attempts at micturition, but only a few drops of urine 
are passed. The portion of urethra above the obstruction is distended, 
but, according to Méller, the calculus can seldom be directly felt. If 
relief is not afforded within twelve to twenty-four hours, rupture of the 
bladder occurs. 

The treatment is surgical, and consists of urethrotomy, for the tech- 
nique of which the reader is referred to Dollar’s work on “ Veterinary 
Surgery,” or to Moussu and Dollar’s work on the “ Diseases of Cattle.” 


PREPUTIAL CALCULI. 


These occur around the preputial opening in the form of long stalactite 
deposits, and are believed to depend on an excess of phosphates in the 
system, arising from feeding largely on turnips or other foods containing 
a large amount of phosphates. 


TUMOURS OF THE URETHRA. 


These are of rare occurrence, Judging by the few cases mentioned by 
authors. Vorberg recorded an instance in an ox in which up to twelve 
srowths resembling polypi closely packed together were found in the 
urethra. The effects of tumours of the urethra are similar to those 
occurring in equines. 


DISEASES OF THE URINARY ORGANS 
IN SHEEP 


By G. MAYALL, M.R.C.V.S. 


The Urine of the Sheep.—According to F. Smith, this has an alkaline 
reaction, a specific gravity of 1006 to 1015, and the amount excreted 
varies from 0°5 pint to 1:5 pints in twenty-four hours. The urine of the 
sheep is very rich in hippuric acid, and contains much more magnesia 
than lime. 

Congestion of the Kidneys.—Very little is known in connection with 
this subject. Acute renal congestion has been described by Weith in 
1847. The disease was said to be due to the ingestion of certain toxic 
plants, such as the leaves of Quercus tosa and swallow-wort. The symp- 
toms observed were stiffness in progression, colicky pains, frequent 
attempts at micturition, but in most instances the urine was passed in 
increased amounts. If the exciting cause of the affection was permitted 
to continue, the animals became feeble, suffered from vertigo, followed by 
a comatose condition, and finally succumbed. The treatment suggested 
was removal to good pasture, and the addition of small amounts of 
common salt to the food. Recovery took place in about fifteen days. 

Chronic renal congestion is met with as a secondary condition ‘in 
connection with various diseases. 

Acute Nephritis—According to Leblanc, this affection is almost 
unknown in the sheep. Cases have, however, been reported. Damann 
met with an instance in which nephritis was followed by uremic symp- 
toms, epileptiform convulsions, and a comatose state. Nephritis 
may occur as a secondary condition in cases of hemorrhagie septicemia 
and hemoglobinemia. Cases are recorded as resulting from injuries 
due to violence, also to long-continued errors in diet. 

Symptoms.—Abdominal pain, arching of the back, high fever, the 
presence of albumin in the urine, and later on of other abnormal con- 
stituents, such as blood or pus, and various forms of casts, etc. Diarrhoea 
may follow, and also uremic symptoms. 

_ TREATMENT.—Demulcents, such as linseed tea, to which a drachm 
of glycerine of belladonna has been added, are indicated. A dose of 
751 


752 SYSTEM OF VETERINARY MEDICINE 


sulphate of soda should be given as a purgative. Hnemata of warm 
water and hot compresses to the loins are also advised. The animal 
should be carefully housed and protected from cold. 

Chronic Nephritis——Very few references to this affection in sheep are 
found in veterinary literature. -Horn, quoted by Hutyra and Marek, 
found chronic nephritis in 0:32 per cent. of 7,000 slaughtered sheep. 

Purulent Nephritis—Horn found purulent nephritis in 0-1 per cent. 
of slaughtered sheep as a secondary affection. Ostertag met with the 
disease repeatedly in lambs, the infecting agent originating in the urinary 
passages (Hutyra and Marek). 

Hydronephrosis.—Cases of this affection in sheep have been met with 
by Vallée, and in the goat by Roll. Morot has recorded an instance in a 
kid one month old. 

Polycystic Kidney.—This condition has been observed in the ovine 
foetus by Morot, and several cases in lambs are recorded by Pflug and 
Gurlt. | 

Renal Caleuli—aAccording to Leblanc, this condition occurs with 
comparative frequency in sheep, especially in fat animals. The subject 
has been studied by Verheyn and Kitt, who describe the calculi as small, 
white, or greyish in colour, and either smooth or tomentous on the surface. 
In some instances ten or fifteen calculi may be found united together. 
Verheyn found them to be composed of silicic acid (42 per cent.), car- 
bonate of calcium, magnesia, organic matters, and traces of iron. 

Diagnosis must of necessity be attended with great difficulty, as no 
special symptoms are observed. 

Tumours of the Kidney.—These are rare in sheep. Rayer reported 
a case of carcinoma affecting both kidneys. In the cortical substance 
tumours of the size of a small nut had developed. He also recorded a 
case of a cystic tumour attached to the kidney, containing a caseous 
material. 

Parasites of the Kidney—Hchinococci occur more frequently in sheep 
than in cattle. For a description of the parasite, the reader is referred 
to the section on Parasites and Parasitic Diseases. 

Cystitis——This may occur as a sequel to difficult parturition, and is 
generally accompanied by vaginitis. The symptoms are similar to those 
met with in cattle. Treatment consists in withdrawing the urine if the 
bladder is distended. A laxative dose of Rochelle salts should be given. 
Linseed tea containing decoction of buchu or balsam of copaiba should 
be allowed. 

Cystic Calculi—The causes of this condition in sheep are feeding on 
over-nourishing foods, such as rye-grass, cotton-cake, and maize; also 


DISEASES OF THE URINARY ORGANS: SHEEP 753 


over-feeding on turnips. It is most frequently seen in subjects fed on 
the produce of chalky soils, and generally only male animals are affected. 
The symptoms resemble those met with in cattle, and treatment is 
conducted on similar lines. 

Urethral Calculi— These also are met with in male animals, and 
under similar conditions of feeding to those mentioned for cystic calculi. 
The symptoms resemble those occurring in urethral calculi in cattle. 
The animal is restless, shows frequent abortive straining to urinate, the 
penis is partly protruded, and shows dampness. The calculus is usually 
found close behind the opening of the urethra. The latter extends 
beyond the penis, is free, usually S-shaped, and is termed the “ vermi- 
form appendix.” By manipulation of the prepuce and penis the obstruc- 
tion can be located. Owing to the difficulty in passing the catheter in the 
ram and in performing urethrotomy, many authors advise amputation 
of the vermiform appendix. By this means the obstruction is removed, 
and the urine is passed freely. If, however, the calculus is situated 
farther back, urethrotomy must be performed. For the technique, the 
reader is referred to Méller’s “ Operative Veterinary Surgery,” and to 
“* Diseases of Cattle, Sheep, and Swine,” by Moussu and Dollar. 


VOL. II. 48 


DISEASES OF THE URINARY ORGANS IN 
THE PIG 


By G, MAYALL, M.R.C.V.S. 


The Urine of the Pig.— According to F. Smith, the pig’s urine resembles 
that of carnivora, but its composition depends on the character of the 
food. The specific gravity varies from 1003 to 1025, and the reaction 
may be either acid or alkaline. The amount excreted varies from 24 to 
14 pints in the twenty-four hours, and it contains uric acid, hippuric 
acid, xanthine, guanine, and much urea. The ash largely consists of 
phosphates and potassium salts, a moderate amount of magnesium, and 
very little sodium or calcium. 

Nephritis may arise as a secondary disease in infectious and toxic 
illnesses of swine. A distinct affection of the kidneys of a polybacterial 
nature has been noticed in them, and investigated by Degen. He con- 
siders that infection occurs here most probably by way of the blood- 
stream (K. Glasser). Chronic indurative nephritis occurs pretty fre- 
quently, and may lead to atrophy or hypertrophy of the kidney. 

Hydronephrosis (Renal Dropsy).—This is a rather common disease in 
swine. Lucks found forty-three out of 6,425 swine examined to be 
suffering from the affection. In twenty-nine the complaint was uni- 
lateral, and in fourteen bilateral. Thirty-two of the animals were of the 
female, and eleven of the male sex. Lauritsen also found about the 
same percentage of cases in swine at the Dresden slaughter-house. 

ErroLtogy.—According to Lucks, the condition is due to the fact that 
the openings of the ureters are placed rather low in the neck of the bladder, 
and that in the pig the attachment of the bladder is very loose. 

The bladder when partially filled falls lower down and presses its 
neck, together with the end of the ureter, against the anterior border of 
the pubes, and thus prevents the escape of urine (Hutyra and Marek). 

Symptoms.—The ailment is generally found in well-nourished animals, 
and may occasion no apparent disturbance of health. Sometimes a 
subnormal temperature, lack of appetite, great thirst, and profuse 
urination, may be noticed. Richter saw enormous enlargement of the 


abdomen in an affected pig. 
754 


DISEASES OF THE URINARY ORGANS: PIG TDD 


Morsip ANAToMy.—There may be slight dilatation of the pelvis of 
the kidney, and atrophy of the cortical layer, or the whole organ may 
appear filled with fluid. 

TREATMENT.—Useless, and not undertaken in swine. 

Cysts or Vesicles filled with fluid are occasionally encountered in the 
parenchyma of the kidneys of swine. In such cases the ureters have 
generally been injured during foetal life, or a chronic nephritis has caused 
a defect in them. 

Urinary Calculi.—These do not arise frequently in swine. They may 
be present in the pelvis of the kidney, the ureter, the bladder, or urethra. 
The cause is the presence of a large quantity of certain salts which have 
a tendency to deposit in the urine at body temperature. They may 
follow on an attack of chronic nephritis and catarrh of the urinary pas- 
sages. The first deposition occurs in a nucleus formed by epithelial 
cells, a flake of mucus, or a cast from the uriniferous tubules. By further 
deposition of salts, the stones may gradually grow to a considerable size. 
The chemical composition of the calculi is generally made up of ammonio- 
magnesium phosphate and calcium phosphate, or calcium carbonate or 
phosphate. 

Et1oLocy.—Feeding on large quantities of potatoes, or beet, or the 
use of much bran or brewer’s grains. 

Symproms.—Usually only pronounced when a stone lodges in the 
urethra, and prevents the escape of urine. The subject is then restless, 
and makes frequent attempts to urinate. The urine is passed in driblets, 
or complete anuria may be present. Colicky symptoms may be ob- 
served. 

Morpip ANAToMy.—An inflamed condition of the mucous membrane, 
or patchy necrosis in the vicinity where the stone is lodged. 

TREATMENT.—Pass the catheter, and try and ascertain the position 
of the stone. If small stones (gravel) are present, they may be passed 
in the urine or removed by manipulation. Urethrotomy may succeed 
in the removal of larger urethral stones. 

Cystitis—This may occur in the course of such infectious diseases as 
swine fever or erysipelas, but it also arises, especially in sows, as an 
independent affection. By extension of inflammation from the womb 
or vagina at the time of parturition, cystitis may develop. It may also 
follow a chill or be a descending process from nephritis. Urinary stasis 
and stricture may occasion the complaint. 

Symptoms. — Frequent and. painful urmation. In male animals 
erection of the penis is observed, and the urine is passed in driblets. 
There is much sediment in the urine, consisting of epithelial cells, pus- 


756 SYSTEM OF VETERINARY MEDICINE 


cells, and even red blood-corpuscles. Fever is present, appetite lessened, 
and defecation retarded. 

TREATMENT.—Nalicylic acid, grs. xv. to grs. xl., in solution three times 
daily. Injections of dilute boric acid into the bladder. Urotropin, well 
diluted, may be given three times daily. 

Parasites of the Kidney.—These include Cysticercus cellulose, Ecchino- 
cocct, Stephanurus dentatus, and the Sclerostoma pinguicola (kidney worm). 
For a description of these the reader is referred to the section on Para- 
sites, 


DISEASES OF THE URINARY ORGANS IN 
THE DOG AND CAT 


By E. WALLIS HOARH, F.R.C.V.S., anp G. L. INGRAM, M.R.C.V.S. 


INTRODUCTORY REMARKS. 


Wits reference to renal diseases in these animals, we may remark 
that from a clinical standpoint our knowledge is very limited, because 
in a large number of cases no characteristic symptoms are displayed. 
The frequency with which chronic interstitial nephritis occurs in aged 
dogs is demonstrated by post-mortem examinations. In many instances, 
when death has occurred as the result of other diseases, such as 
canine typhus, the lesions of a chronic renal affection are observed 
at the autopsy (see Canine Typhus, Vol. I.). These, in the majority of 
cases, have been in existence prior to the animal being attacked by the 
disease which proved fatal, but as no symptoms were observed, the 
presence of the renal affection was not suspected. In some instances 
symptoms suggestive of a renal disorder are in evidence during the early 
stages of canine typhus, such as marked thirst, frequent micturition, and 
a stiff gait in the hind-limbs. Again, there are instances in which a dog 
apparently in perfect health dies without any assignable cause, and the 
autopsy reveals chronic nephritis associated with cardiac lesions. It is 
not uncommon also to find aged dogs developing obscure symptoms, such 
as emaciation, a capricious appetite, evidences of dyspepsia associated 
with chronic eczema, cardiac palpitation, and a tendency to avoid exer- 
tion. In such instances the post-mortem examination often reveals 
chronic renal lesions. In man retinal hemorrhages are common in 
chronic interstitial nephritis, while diffuse retinitis or papillitis is less 
frequent, also troubles in vision may be the first symptom of the disease. 
According to Nicolas,* nothing is known with reference to retinal changes 
occurring in connection with chronic renal affections in animals. 

If we compare the description of diseases of the urinary organs in the 
dog given by Youatt and Blaine with those found in modern works, we 

* “Veterinary and Comparative Ophthalmology,” translated and edited by 


Gray, 1914. 
757 


758 SYSTEM OF VETERINARY MEDICINE 


are forced to the conclusion that, with few exceptions, very little advance- 
ment has taken place, and so far as the majority of British authors are 
concerned, they have followed more or less the views of the pioneers in 
canine pathology whom we have mentioned. In one direction only can 
any advancement be claimed, and that is in the diagnosis and surgical 
treatment of urinary calculi and affections of the bladder. This is to be 
attributed to aseptic surgery, improved surgical technique, and to the 
use of anesthetics. The older authorities no doubt recognised that such 
conditions could only be treated successfully by surgical operation, and, 
in fact, practised such, with favourable results in some instances; but, 
judging by the cases recorded, it is quite apparent that operative measures 
were delayed as much as possible, and as the result of such delay, 
death sometimes occurred in consequence of rupture of the bladder 
owing to retention of urine, or from other complications. In the 
present day operations for the removal of cystic and urethral calculi 
prove very successful, and, once the diagnosis of such conditions is 
arrived at, surgical methods are adopted. 

Urine of the Dog.—<According to F. Smith,* the nature of the 
diet has a marked effect on the amount of the constituents of the ure. 
The reaction is acid when the animal is on a flesh diet, the acidity being 
due to acid phosphate of soda, but on a vegetable diet it may be alkaline. 
The amount excreted varies with the size of the animal and the nature 
of the diet, and is estimated at 2? pint to 13 pints daily. The specific 
gravity is from 1016 to 1060, depending on the diet; the colour pale 
yellow to straw yellow. The amount of urea varies from 4 to 6 per cent. 
Uric acid (in combination with soda and potash) is excreted when the 
dog is on an animal diet, but it disappears if vegetable food be given. 
Amongst other constituents are hippuric acid in small quantities, indican, 
phosphoric acid, and a substance known as “ glycuronic acid.” FF. Smith 
also points out that glycuronic acid exists only in traces, but as it exerts 
a reducing action on salts of copper, one cannot regard urine which 
possesses a similar action as necessarily containing sugar. This is a 
matter of importance in connection with the examination of urine in 
cases of suspected glycosuria, and the copper tests (Fehling’s and Trom- 
mer’s) cannot always be relied on. After the administration of certain 
drugs, such as camphor, chloral, phenacetin, morphine, chloroform, etc., 
glycuronic acid is obtained in well-marked quantities in the urine. 


* “ Veterinary Physiology.” 


DISEASES OF THE KIDNEYS: DOG AND CAT 759 


DISEASES OF THE KIDNEYS. 


CONGESTION OF THE KIDNEYS. 


The information to be derived from the majority of works on 
canine medicine with reference to hyperemia of the kidneys is very 
limited. Some authors, including Blaine, Youatt, Mayhew, and 
Miller, make no mention of the affection. Leblanc* states that acute 
renal congestion may result from the administration of irritating 
diuretic agents, especially oil of turpentine. Amongst other etiological 
factors, he mentions extensive inflammations of the skin, generalised 
eczema, extensive burns, all of which interfere with the cutaneous func- 
tions. Injuries, falls, severe exertion, chills, etc., are believed to affect 
the renal circulation, and to bring about acute congestion of the kidneys. 

Symptoms.—In the recorded cases, the following symptoms were 
observed: Pain on palpation of the lumbar region, and the urine either 
normal in appearance or blood-stained, but passed in large amounts. 
In cases where the causal factor is slight in degree and early removed, the 
symptoms abate in a short time; but when severe or long continued, 
renal hemorrhage or acute nephritis may result. Rupture of the kidney 
has been observed by Scoffie,f followed by internal hemorrhage and 
death. 

The diagnosis of acute renal congestion is attended by great difficulty, 
and an examination of the urine must be carried out in order to differ- 
entiate the condition from nephritis. The indications for treatment are 
similar to those mentioned for the affection in equines. 

Passive Congestion of the Kidneys is a secondary condition occurring 
during the course of chronic cardiac and pulmonary affections, abdominal 
tumours, etc. There are no diagnostic symptoms, and the case may be 
mistaken for one of chronic nephritis. The urine may be scanty and high- 
coloured, and may contain albumin, hyaline casts, and sometimes blood. 
In cases of long standing, lesions of chronic nephritis develop. 


NEPHRITIS. 

Acute Nephritis—We possess very little definite knowledge on this 
subject. Youatt in his day deplored the lack of attention devoted to 
renal affections in the dog, but it cannot be said that any advancement 
in this direction has taken place since his time. Several authors describe 


* Cadéac, “* Pathologie Interne.”’ t Revue Vét., 1898. 


760 SYSTEM OF VETERINARY MEDICINE 


acute nephritis in a routine manner, but omit any reference to the fre- 
quency of the affection. Blaine* makes no mention of nephritis in the 
dog. Youatt (1845) describes it as “a serious and dangerous malady, 
the immediate causes being blows and contusions on the lumbar region, 
hard work long continued, the imprudent use of aphrodisiacs, the presence 
of renal calculi, and the retention of urine in the bladder. The lesions 
may be confined to the cortex or to the tubular substance. The kidneys 
are enlarged, and occasionally there may be no alteration of structure. 
The organs are also subject to atrophy, which may be general or partial.” 
No symptoms of the affection are given. Mayhew does not describe 
nephritis. Miller gives a fulldescription of the disease. Sewell men- 
tions nephritis, but does not remark as to its frequency. Leblanc states 
that acute nephritis is as rare in the canine species as chronic nephritis 
is frequent, and that no observations on the acute form of the disease 
can be found in the periodicals. He also remarks that it is only possible 
to give a clinical description from observations of experimentally pro- 
duced cases. A case of the disease is recorded in a three-year-old sheep- 
dog by Cadiot.{ We have never met with a case of acute nephritis in 
the dog, or perhaps it would be more correct to state that we have not 
succeeded in diagnosing the condition; nor have we ever recognised the 
lesions as described below at post-mortem examinations. 

Etiotogy.—According to Miller, the most common causes are cer- 
tain infectious diseases and toxic agents. The former include septic 
affections ; the latter comprise substances, such as oil of turpentine, can- 
tharides, carbolic acid, mercury, etc. The three latter agents can be 
absorbed by the skin when applied in the form of ointments, and may 
produce acute nephritis by this route. Traumatic influences on the 
lumbar region are also regarded as etiological factors. Acute nephritis 
can be associated with some cases of canine distemper. 

Morspip Anatomy.—According to Kitt, the capsule of the kidney is 
thickened, and is not readily detached. The glomeruli are seriously 
damaged, the uriniferous tubules are enlarged in an irregular manner, 
and the interstitial tissue is infiltrated. In the case recorded by Cadiot, 
the kidneys were enlarged and blackish in colour. On section, the 
colour was deep red, and marbled with a few whitish points, which 
indicated the presence of small abscesses distributed through the cor- 
tical and medullary substance. The renal pelvis contained a little puru- 
lent urine. On microscopical examination, the glomeruli and the walls 
of the tubules were inflamed. The glomeruli were surrounded by a 


* “*Canine Pathology,” 1841. + “‘ Dogs’ Medical Dictionary.” 
t “Clinical Veterinary Medicine and Surgery,’ Cadiot and Dollar. 


DISEASES OF THE KIDNEYS: DOG AND CAT 761 


granular material exuded between the tufts and Bowman’s capsules. 
The tubules were obstructed by cylinders, and their epithelial cells were 
granular. The pericapsular and the intratubular connective tissue was 
infiltrated with migratory cells. Streptococci were found in the lesions. 

Symptoms.—According to Miiller, there are mild types of nephritis 
which are not recognised, as the presence of the disease can only be 
detected by an examination of the urine. In the severe cases the animal 
has a stiff gait in walking, the lumbar region is very sensitive to palpa- 
tion, the urine is scanty, dark in colour, and albuminous; in some cases 
it may contain blood. In toxic nephritis the urine is scanty, turbid, 
contains a large amount of albumin, and numerous tube casts, epithelial 
casts, and blood-corpuscles, and dysuria is a marked symptom. Other 
observers state that nausea and vomiting are present, especially in the 
early stages; later on constipation, succeeded by diarrhcea, occurs. When 
uremia sets in, vomiting, a weak and thready pulse, a subnormal tem- 
perature, exhaustion, convulsions, and coma, are observed. In the case 
observed by Cadiot the dog showed dulness and loss of appetite for some 
days; also stiffness in progression, especially in the hind-limbs. The 
abdomen was tender to palpation, especially towards the spine. The 
urine was slightly reddish. It contained albumin, cylindrical casts, 
leucocytes, a few red blood-corpuscles, and some epithelial cells. The 
case rapidly became serious, the animal became feeble, with a weak 
pulse, fever, etc. He also showed lameness in the right hind-leg. On 
the ninth day of illness he became extremely weak, the urine was very 
red in colour, persistent vomiting occurred, and death resulted in a short 
time. 

The diagnosis is based on an examination of the urine. 

TREATMENT.—The animal should be put on a milk diet. A purga- 
tive should be administered, so as to secure elimination by the intestines. 
Some authors advise the employment of hot baths. A cataplasm com- 
posed of kaolin and glycerine, heated to a proper temperature, should be 
applied to the lumbar region. Mild diuretics, such as citrate of potash, ° 
may be prescribed when the urine is scanty. Diuretin is advised by 
some authors. When uremic symptoms develop, bromide of potassium 
and chloral hydrate are indicated. When there are evidences of cardiac 
weakness, digitalis or strophanthus should be prescribed. In nephritis 
due to toxic causes, alkalies with hyoscyamus prove useful. 

Chronic Nephritis—We have already remarked that chronic renal 
affections are of frequent occurrence in aged dogs, and that practically 
no symptoms may be manifested. Hutyra and Marek have observed 
cases in dogs only a few weeks old. According to Porcher, there are very 


762 SYSTEM OF VETERINARY MEDICINE 


few dogs approaching middle age that do not show atrophic alterations 
in the kidneys. 

Etrotogy.—Very little is known with reference to the causation of 
the affection. Although occasionally the chronic form may occur as a 
sequel to an acute attack, in the large majority of instances chronic 
indurative nephritis occurs as an independent affection from the start. 
According to Hutyra and Marek, an indurative nephritis is sometimes 
found simultaneously with valvular cardiac disease, probably not as a 
consequence of the heart lesion, but depending on the same etiological 
factors. . 

As in the post-mortem appearances of chronic indurated kidneys both 
organs are as a rule attacked, it is probable that the cause is a general 
one, and may probably be looked for in malhygiene. Dogs kept as 
house pets in flats or town houses, where they have not free access to a 
garden, have frequently to be satisfied with a morning and evening walk. 
Being “ house trained’ from puppyhood, they are thus obliged to pass 
all their urine on two or three occasions during the twenty-four hours— 
a most unhygienic and unnatural condition for the canine species. The 
same applies to cats, and though in London and other large cities these 
animals are better able to care for themselves in this respect than is the 
dog, it is remarkable that more cases of renal disease are not met with 
as a result of this prolonged retention of urine. It seems probable, 
however, that to this mismanagement on the part of owners the chronic 
indurative nephritis of the dog and the frequent collections of sabulous 
material in the urethra of male cats may be in great part ascribed. 

Morsip Anatomy.—By far the most common type of chronic renal 
disease in the dog is chronic indurative nephritis. Miiller states that 
chronic parenchymatous nephritis may also be met with, but that the 
indurative form is most frequently found at autopsies. The subject has 
been specially studied by Mathis, Cadiot, and Porcher. According to 
their observations, the kidneys are either normal in volume or slightly 
smaller than normal; the consistence is firmer, and the surface is irregular. 
The capsule is easily detached, except in the depressions on the surface 
of the organ, where it adheres firmly to the cortical substance. On 
section, the kidney is anemic, the cortex is a greyish-brown colour, and 
the medullary portion is white. At the boundary line of the cortex and 
medullary portion large vessels are found surrounded by an abnormal 
amount of connective tissue. In the substance of the cortex small cysts 
are sometimes found containing a clear limpid fluid. On microscopical 
examination, the vessels are seen to be surrounded by a considerable 
amount of fibrous tissue. Various alterations are observed in the tubules. 


DISEASES OF THE KIDNEYS: DOG AND CAT 763 


At the points where small cysts occur, the tubules are dilated, owing to 
obstruction by a band of connective tissue. The epithelium of the con- 
voluted tubules are swollen, granular, and sometimes detached. The 
glomeruli are surrounded by an extensive zone of connective tissue, and 
are compressed, finally undergoing atrophy. 

In the majority of cases which we have observed the kidneys were 
considerably atrophied, very irregular on the surface, the capsule firmly 
adherent, and the renal tissue very resistant to the knife. In some 
nstances all macroscopical appearances of renal structure had dis- 
appeared. We observed in one case in an Irish terrier that both 
kidneys weighed only one ounce. 

On a few occasions we have observed lesions similar to those described 
as the small white kidney (see p. 693), but we have never met with ex- 
amples of the large white kidney in the dog. It is said, however, to 
occur in the dog and in the cat. 

In addition to renal lesions, hypertrophy of the left ventricle is 
generally present. Ascites and hydrothorax may be observed in rare 
cases. 

We have observed in some old and very fat dogs the presence of a 
tumour-like swelling in the lumbar region, which is readily noticed by 
the owners. On post-mortem the swelling is found to be due to large 
deposits of fat over each kidney, and lesions of chronic indurative nephritis 
are present in some Cases. 

Symproms.—We have already remarked that the symptoms of this 
affection are generally obscure, or the previous history may show nothing 
abnormal. In the majority of the cases that we observed the presence 
of the disease was not suspected. Occasionally dulness, a capricious 
appetite, loss of condition, polyuria, and increased cardiac impulse are 
present. In one case (already alluded to) the symptoms presented were 
persistent vomiting, prostration, weakness in the hind-limbs, and a weak 
cardiac impulse. On palpation of the abdominal region a strong pulsation 
was readily detected. The dog suffered from a few attacks of gastric 
catarrh on previous occasions, but recovered spontaneously. The 
present illness lasted for two days and was attributed by the owner to 
the ingestion of meat containing poison. The animal died in about 
twelve hours after being admitted to the infirmary. 

Gray has observed polyuria, excessive thirst, a ravenous appetite, 
wasting, anemic visible mucous membranes, and occasional vomiting 
in cases of chronic interstitial nephritis. In some cases the post-mortem 
shows a subacute type of the lesion, and the subjects may be young 
animals, 


764. SYSTEM OF VETERINARY MEDICINE 


Gray has found that very commonly an examination of the urine in 
chronic nephritis may not reveal the presence of any abnormal constituents, 
such as albumin, casts, blood-corpuscles, etc. 

Senile Kidney.—This term is applied by Leblanc and Porcher to a 
form of renal lesion very frequently met with in old dogs. Externally 
_ the kidneys are of a dark reddish colour, and on section they are pale or 
greyish-white. They are usually diminished in volume, and show well- 
marked depressions on their surface. The capsule is thickened and 
firmly adherent. The connective tissue is largely increased, and sclerotic 
changes are best marked in the cortex. On microscopical examination 
the small vessels show endarteritis and periarteritis, and the arterioles 
are obstructed. The glomeruli are atrophied, and Bowman’s capsules 
are dilated in some cases. Cysts may be observed, and are formed by 
dilatation of a uriniferous tubule, owing to obstruction of its lumen at 
a certain point, or in rare instances to distension of Bowman’s capsule. 

The etiology of senile kidney is not definitely determined. 

TREATMENT.—The therapeutical measures will be almost entirely 
confined to treating the symptoms, and, considering that symptoms are 
not observed in the majority of cases, it is clear that any rules for treat- 
ment cannot be laid down. The disease is a progressive and insidious 
one, and we are not aware of any agents that can prevent a’ fatal termina- 
tion. 

Chronic Nephritis in the Cat.—Several cases of this disease in the cat 
are recorded. We have observed ascites and emaciation in a Persian cat 
three years old, and on post-mortem found chronic interstitial nephritis. 
The kidneys were much reduced in size, the capsule firmly adherent, and 
the surface of the organs very irregular. On section there was well- 
marked atrophy of the renal substance, and the organs were very resis- 
tant to the knife. 

McFadyean has recorded* an instance of peculiar and unique struc- 
tural alteration in the Malpighian bodies of a cat’s kidney. The animal 
was affected with ascites, and on post-mortem the kidneys presented 
macroscopic evidence of nephritis ; on microscopical examination a low 
power showed “the presence of irregularly distributed patches of sub- 
acute interstitial nephritis. In sections suitably stained, Bowman’s 
capsule was seen to be incompletely filled by the glomerulus, a greater 
or smaller part of its cavity being occupied by a nucleated mass, sharply: 
marked off from the glomerulus by a difference of tint. In the case of 
Malpighian bodies cut through the neck of Bowman’s capsule, the 
abnormal cellular plug partially filling the cavity of the latter was seen 


* Journal of Comparative Pathology and Therapeutics, September, 1891. 


DISEASES OF THE KIDNEYS: DOG AND CAT 165 


to be directly continuous with the epithelium of the uriniferous tubule... . 
Bowman’s capsule was occupied in its upper two-thirds by the shrunken 
glomerulus. ... It seemed as if the epithelial cells that normally line 
the neck of Bowman’s capsule had proliferated and thrust the newly- 
formed cells into the capsule, thus causing compression and atrophy of 
the glomerulus. The great majority of the Malpighian bodies showed 
a similar abnormality.” 


PURULENT NEPHRITIS AND RENAL ABSCESS. 


According to Leblanc, this affection is rarely met with in the dog. 
Miiller describes the condition, but does not remark as to its frequency. 
He states that it may be associated with suppurative processes in the 
urinary passages or the renal pelvis, and under certain conditions 
with ulcerative endocarditis. The pathological alterations he describes 
are similar to those occurring in purulent nephritis of equines (see 
p. 703). Perinephritic abscess, according to this author, may become 
so extensive as to form a tumour-like body in the lumbar region, 
in which fluctuation may be present. Except in cases where the 
abscess opens into the renal pelvis, and causes pyuria, the symptoms 
are not in any way characteristic. The lesion may be tubercular. 

Perinephritic abscess, if fluctuating, is diagnosed by the employment 
of the trocar and cannula. 

Nothing can be done in the way of treatment for purulent nephritis 
or renal abscess. It has been suggested to perform nephrotomy, but an 
important matter to decide before attempting this operation is the con- 
dition of the other kidney. According to Hutyra and Marek, from ex- 
periments made with the cystoscope in the clinic at Budapest, it is not 
possible to carry out catheterisation of the ureters of the dog, owing to 
the anatomical relations of the ureteral openings in this animal, but the 
procedure has been adopted in the horse successfully. It is only by this 
means that the functional activity of the kidney can be determined. 

One of us (Hoare) met with a case of renal abscess in a Great Dane 
bitch that occurred as a sequel to a long-continued attack of septic 
metritis following parturition. The symptoms observed were recurring 
attacks of rigors associated with high fever, gradual emaciation, and a 
capricious appetite. After about four months the emaciation was 
extreme, the left hind-limb became swollen and showed loss of power, and 
small clots of blood were passed with the urine. The animal was destroyed 
by chloroform, and the autopsy revealed the left kidney greatly enlarged 
and resembling a tumour. It weighed 104 ounces, and in the cortex was 


766 SYSTEM OF VETERINARY MEDICINE 


a large abscess containing a quantity of pale emerald-green-coloured 
sticky pus. The right kidney was hypertrophied, and weighed 9 ounces 
2drachms. Bacteriological examination of the pus showed the presence 
of a small bacillus, which the pathologist considered was possibly one of 
the colon group, but its identity could not be established. 


PYELITIS. 


This may occur in the dog, and depends on similar causes to 
those inducing the condition in equines. It is usually associated with 
other affections, such as purulent nephritis, cystitis, nephrolithiasis, etc. 
A differential diagnosis is almost impossible, hence the great majority of 
authors do not describe it as a disease per se. 


AMYLOID DISEASE OF THE KIDNEY. 


Cases of this affection have been observed in the dog by Rabe, 
Rivolta, Kitt, and Dorflnger, and in the cat by Mathis. It is 
generally associated with a similar affection of the liver and spleen. 
There are no characteristic symptoms. Ascites and dropsical effusions 
were present in many of the recorded cases; also albuminuria, 
vomiting, coma, and collapse. 


FATTY DEGENERATION OF THE KIDNEYS. 


This is recognised as an important and common renal lesion in the 
dog and cat. The subject was studied in 1861 by Vulpian, who found 
that fatty degeneration of the renal epithelium in cats was very 
common. Rayer, Goubaux, Trasbot, Cagny, and McFadyean, have also 
reported cases in cats and studied the lesions. 

The etiology is not definitely determined. Vulpian attributed the 
condition to lack of sufficient exercise, as it was found especially in cats 
largely confined in houses. Other observers were of opinion that in such 
animals micturition is likely to be delayed for long intervals, and the 
Tetention of urine may be a contributory cause of fatty degeneration, 
but this theory is at best a doubtful one. Burlach found the lesion more 
frequently in aged cats suffering from a cardiac affection. According to 
Mathis, the lesion is only an exaggerated condition of a physiological 
state of the kidneys in cats, as normally fat is deposited in the protoplasm 
of the renal epithelium in these animals. 

Morsip AnatomMy.—The kidneys are of normal size; the capsule is 
detached with facility. They are anemic, and either light yellowish or 


DISEASES OF THE KIDNEYS: DOG AND CAT 767 


sometimes of a straw colour. On section the medullary region is pale, 
and the vascular zone red, and the renal tissue gives an unctuous feel on 
palpation. According to Mathis, on microscopical examination a large 
proportion of the epithelium, especially that of the convoluted tubules, 
is invaded by fat globules, and the protoplasm has disappeared. The 
tubules may be obstructed by collections of fatty matters, which may 
even extend to Bowman’s capsules, and cause pressure on the glomeruli. 
The effect of these lesions is to interfere with the secretory function of the 
kidneys, and to bring about albuminuria. 

Symproms.—In some instances no symptoms are observed; in others, 
phenomena similar to those met with in chronic nephritis are present. 
Trasbot has observed scanty urine followed by albuminuria, and the 
presence of epithelial and granular casts. Crystals of cholesterin have 
been found in the urine. Ascites, codema of the limbs, thirst, feebleness, 
emaciation, polyuria, marked albuminuria, and lipuria, are the symp- 
toms recorded by Cagny and Mathis. The course of the disease is slow, 
and death may be preceded by convulsions. According to Leblanc, out 
of forty cats examined at a furriery, twenty-eight showed fatty degenera- 
tion of the kidneys. 

Diaenosis.—T his is based on an examination of the urine. The 
presence of fatty materials and of epithelium undergoing fatty changes, 
in addition to the usual abnormal elements found in cases of chronic 
nephritis, suggest the existence of fatty degeneration. 

TREATMENT.—T herapeutical measures can have no effect on the 
disease. 


HYDRONEPHROSIS. 


Nearly all authors agree that hydronephrosis is a rare affection 
in the dog. It has been observed by Roll, Almy, Siedamgrotzky, and 
Miiller, and is also described by C. French. It may result from 
any condition that prevents the urine from reaching the bladder. The 
obstruction must be persistent and prolonged. According to Roll, 
the most common cause is hypertrophy of the prostate gland, in 
which case both kidneys are involved, anuria occurs, and death takes 
place from uremia. Almy recorded a case due to an obstruction in the 
left ureter, which was altered to a cord-like structure. The animal was 
emaciated and feeble. On palpation of the abdomen, a large fluctuating 
tumour was detected. An exploratory laparotomy was performed, and 
hydronephrosis of the left kidney was found. The fluid was removed by 
puncturing the organ. The disease recurred, and death took place. On 
post-mortem the left kidney was found to be simply a large sac, with 


768 SYSTEM OF VETERINARY MEDICINE 


walls of a fibrous consistency, and containing a foetid brownish-yellow 
liquid. In a case described by Siedamgrotzky the kidney was converted 
into a large cyst, with walls formed of connective tissue. The contents 
consisted of a slimy, brownish fluid containing numerous cholesterin 
crystals. 

TREATMENT is unsatisfactory. Nephrectomy is suggested, but there 
is always the danger that the other kidney may develop disease. For 
details of the operation, the reader is referred to Hobday’s manual 
on ‘“‘ Surgical Diseases of the Dog and Cat.” 


FLOATING KIDNEY. 


This is a very rare condition. A case is recorded by Hébrant and 
Antoine* in a hound. The symptoms observed were a progressive loss 
of aptitude for rapid movement, and a marked tendency to become fat, 
associated with increase in the volume of the abdomen. On palpation 
of the abdominal region, a kidney-shaped tumour slightly painful to 
pressure, was detected, floating amongst the intestines. This tumour 
could be moved backwards and forwards, and showed no evidence of ad- 
hesions with the viscera, but it seemed attached to the lumbar region 
as it could not be drawn towards the linea alba. An exploratory lapar- 
otomy showed that the tumour was in reality the left kidney, which had 
become displaced, its ordinary means of attachment being elongated 
and forming a pedicle about 10 centimetres in length. The causes 
suggested were falls, violent exertion, etc. The treatment advised was 
the surgical fixation of the organ in its normal position, but in consequence 
of the difficulties and the uncertainty of the results, this was not 
attempted. 

In the cat a case of floating kidney was described by W. Williams. 
The right kidney was situated subcutaneously between the two last ribs. 
It was mistaken for a tumour and removed by operation. The animal 
made a perfect recovery. 


RENAL CALCULI. 


Although described by some authors as not of common occurrence in 
the dog, renal calculi have been met with not infrequently by canine 
practitioners. Owing to this fact, and also remembering that a 
diagnosis of the condition is seldom possible, and that autopsies are 


* Ann. de Méd, Vé., janvier, 1913. 
t “‘ Principles and Practice of Veterinary Medicine.”’ 


DISEASES OF THE KIDNEYS: DOG AND CAT 769 


not carried out as systematically as is desirable, we are inclined to agree 
with the remark made by Youatt—viz., “urinary calculi are more 
common than is generally imagined.” According to Blaine, the condi- 
tion is not of frequent occurrence in the dog. He mentions a case in 
which nearly the entire renal pelvis was occupied by a calculus, and the 
symptoms observed were pain, emaciation, and the presence of blood 
and mucus in the urine. Youatt quotes an instance of renal calculus 
recorded by Latour (1827). The following symptoms were noted: 
Difficulty in micturition occasionally, and the animal walked slowly and 
with evident pain. A sudden exacerbation came on, the dog was much 
agitated, barked, and rolled himself on the ground almost every minute. He 
made frequent attempts to micturate, but the urine was passed only in 
drops. When forced to walk, the fore and hind limbs seemed to mingle 
together, the loins were bent into a perfect curve, and the flanks were drawn 
in. The appetite was in abeyance, and pain was evinced during defeca- 
tion. Demulcent foods were allowed, warm baths and enemata pre- 
scribed, and apparent recovery ensued in eight days. In eight months 
afterwards the symptoms returned with greater intensity. The animal 
became paralysed in the hind-limbs, he howled continuously, and emacia- 
tion was rapid. As there was no relief from treatment, he was destroyed. 
At the autopsy one kidney was three or four times its normal size, and 
in the renal pelvis a calculus was found which weighed 126 grains. It 
was composed of uric acid, 58 grains; ammonia (sic), 58 grains; and 
calcium phosphate, 10 grains. The bladder was enlarged, owing to 
thickening and induration of its parietes, and its mucosa was covered by 
ecchymoses. 

According to Miiller, renal calculi are irregular, and either colourless, 
or yellowish or yellowish-brown in colour. They are found in the renal 
pelvis, and vary in size from a mustard-seed to a pea. In rare cases they 
are very large, and fill up the renal pelvis or greatly distend it, and con- 
form to the shape of this structure. On section, they are found to be in 
layers, and consist of uric acid, triple phosphate, and phosphoric acid. 
Gray has met with regular calculi which reached the size of a pigeon’s 
or a fowl’s egg, and also those of irregular form which were very large. 
Large calculi distend the renal pelvis, the kidney 1s enlarged, but is under- 
going atrophic inflammatory changes. 

Hutyra and Marek state that the renal calculi of carnivora contain am- 
monium-magnesium phosphate and small quantities of calcium phosphate 
or carbonate, and usually also uric acid and its salts. ‘“‘ Cystin calculi are 
much less frequent, and are always small, soft, and of a greasy lustre.” 

According to Woodruff, the commonest calculus in the dog is that 

VOL. II. 49 


770 SYSTEM OF VETERINARY MEDICINE 


composed of triple phosphate. Uric acid calculi are much less common, 
those composed of calcium oxalate are rare, while organic calculi made 
up of cystin, xanthin, tyrosin, etc., are very rare. 

Symproms.—In the majority of cases the symptoms are obscure. 
We have already related the symptoms as observed in a case by Latour 
(see p. 769). 

Hobday * states that as a general rule renal calculi are not diagnosed 
until an autopsy is made. He records a case in a bulldog only four years 
old which died from pneumonia, and the autopsy revealed calculi in both 
kidneys, although the animal showed no signs whatever of renal disease 
during life. C. French} observes that renal calculi may exist without 
producing any appreciable symptoms, and that they are often found at 
autopsies when calculi are present in other parts of the urinary tract. 
According to this author, they are usually small, and probably originate 
in the uriniferous tubules, and then pass to the renal pelvis. Occasionally 
they may, by causing irritation and abrasions of the mucosa of the renal 
pelvis, lead to hemorrhage and hematuria, especially after exertion. 
Frequent micturition may also be observed. 

Woodruff draws attention to the employment of radiography in the 
diagnosis of renal calculi, and points out that the purely inorganic stones 
give a dense shadow, while those composed of uric acid, etc., are with 
difficulty seen. 

Gray has found that in the case of an attenuated dog suffering from 
renal calculus the affected kidney may be found by palpation, enlarged 
and very resistant; and if, in addition, there has been a previous history 
of urethral obstruction, occasional hematuria, especially after exercise, 
rheumatic symptoms, wasting of the muscles of one or both quarters, 
and no evidence of the presence of calculi in the bladder, then nephro- 
lithiasis, may be diagnosed. 

TREATMENT.—In cases where the condition can be diagnosed, the 
surgical treatment may be considered. For details of the surgical means 
at our disposal, and the technique of same, the reader is referred to 
Hobday’s ‘‘ Surgical Diseases of the Dog and Cat.” But in old dogs it 
is more desirable to adopt palliative measures, such as the administration 
of urotropin or the urinary sedatives mentioned on p. 773. 

Renal Calculi in the Cat.—According to Leblanc, this condition is very 
rare in the cat, and Roell is the only author who has reported a case in 
thisanimal. The calculus resembled the concretions composed of cystin, 
which are occasionally met with in the dog. 


* “Surgical Diseases of the Dog and Cat.” + “Surgical Diseases of the Dog.” 


DISEASES OF THE KIDNEYS: DOG AND CAT 171 


TUMOURS OF THE KIDNEY. 


Some authors state that tumours of the kidney are rather fre- 
quent in the dog. Cases of carcinomata, epitheliomata, and sarco- 
mata, have been recorded, also tuberculosis. Papillomata have been 
met with in the renal pelvis and ureter by Briickmuller and Siedam- 
grotzky. These were in the form of villous proliferations, which 
impeded the outflow of urine, and resulted in dilatation of the 
renal pelvis and atrophy of the substance of the kidney. Briickmuller 
has observed small lipomata formed of fat cells imbedded in connective 
tissue, and situated in the medullary substance. Cadiot records a case 
of carcinoma of the kidney in a spaniel aged eight years. The animal 
was feeble and emaciated, and a large moderately firm subcutaneous 
swelling was observed on the left side of the lumbar region, and another 
hard, rounded, large swelling on the left side of the inferior abdominal 
region. The urine was darker than normal, and contained albumin. 
The autopsy revealed generalised carcinomata. The left kidney was 
transformed into an ovoid, bosselated, fluctuating tumour, which con- 
tained a large amount of a red fluid. Tumours of the kidney, in the large 
majority of cases, are found as a surprise at autopsies. 

In the cat, tuberculosis of the kidney is common. According to Gray,* 
the condition can often be diagnosed by palpation of the abdomen. In 
this animal the kidneys are floating, and can be felt by a bimanual 
examination, and, when found much enlarged, in nineteen cases out of 
twenty they are tuberculous. 

We have observed several cases of tuberculosis of the kidney, unilateral 
and bilateral, in the cat, but have not seen any case in which the lesions 
appeared to be primary in that organ. They have been, in our experi- 
ence, secondary to infection of the abdominal mesenteric glands; and 
although the kidneys are so easily examined by palpation in the cat, it 
is necessary to bear in mind, when making a clinical examination, the 
possiblity of the mesenteric glands being the seat of sarcomatous or 
tubercular enlargements. We have seen these tubercular lesions accom- 
panied by marked ascites in more than one instance. Paracentesis should 
therefore be followed by careful palpation of the abdomen. 


* “Tuberculosis in the Dog, Cat, and Bird,” by H. Gray, M.R.C.V.S., Veterinary 
Record, April 26, 1913. 


172 SYSTEM OF VETERINARY MEDICINE 


PARASITES IN THE KIDNEYS. 


These include Eustrongylus gigas, and, in rare instances, Cysticercus 
cellulose and Tenia serrata. For information on these, the reader is 
referred to the section on Parasites. Renal coccidiosis has also been 


observed in the dog (see Coccidiosis of the Dog, Vol. 1.). 


DISEASES OF THE BLADDER 


CYSTITIS. 


Acute Cystitis—According to Blaine, this affection is not very com- 
mon in dogs, but cases are occasionally met with. He describes an 
epidemic of cystitis that occurred in the year 1810, and in every case 
observed, the bladder was much inflamed, and in many instances this 
was the only lesion present. The symptoms recorded were great rest- 
lessness, panting, and a frequent pulse. In some instances the urine was 
passed in drops at frequent intervals; in others there was retention of 
urine. Hematuria was present in some cases. The abdomen was 
swollen and tender, especially in the pubic region. 

Youatt describes the same epidemic, and mentions that in the year 
of its occurrence there was a great drought throughout the country. 
This author gives the following clinical description of ordinary cases of 
cystitis, and states that the affection is of frequent occurrence in the dog. 
The animal is agitated, shows trembling of the hind-limbs, and frequent 
attempts at micturition, but only small amounts of urine are passed, 
which may be either clear or contain much mucus and sediment, also 
blood. The urine is passed in jets, and much pain accompanies the act. 
At times it may suddenly be passed in a large amount. Colicky pains 
may be observed, the animal looks towards his flanks, marked tenderness 
is evinced when the lumbar region is palpated, and thirst is present. 

Er1oLogy.—According to Hobday,* the condition may arise from 
various causes, which give rise to irritation of the mucous membrane of 
the bladder. These include tumours, especially papillomata and carcino- 
mata, the entrance of septic organisms, either from metritis or from the 
employment of a septic catheter, overdoses of certain drugs, such as 


* Ibid. 


DISEASES OF THE BLADDER: DOG AND CAT 773 


cantharides, and the presence of cystic calculi. According to Leblanc, 
acute cystitis in the majority of instances occurs in connection with 
nephritis. This author has also observed it in association with extensive 
disease of the skin, in which instance well-marked renal lesions were 
complicated with a hemorrhagic cystitis. Trasbot states that acute 
cystitis frequently follows prolonged retention of urine, and also chills. 
Miiller is of opinion that retention of urine due to urethral calculi and to 
hypertrophy of the prostate is the most frequent cause of cystitis. The 
retained urine becomes highly ammoniacal, and thus acts as an irritant 
to the vesical mucosa. 

In Gray’s experience the majority of cases of acute cystitis, both in 
the dog and cat, are due to retention of urine, depending on urethral 
calculi. Occasionally the affection may depend on suppurative prosta- 
titis, or vesical calculi. 

SymMptoms.—tThe clinical picture given by Youatt (see p. 772) may 
be taken as fairly typical of the disease. In addition, the morbid altera- 
tions in the urine observed are a neutral or alkaline reaction, the presence 
of epithelial débris, white blood-corpuscles, mucus, albumin, pus-cells, 
and crystals of ammonium-magnesium phosphate. Davis* stated that 
he had observed persistent vomiting as one of the marked symptoms 
in acute cystitis. 

Course.—In mild cases recovery may take place in a few days, but 
in the acute forms, after some days, micturition may be completely sup- 
pressed, and death then occurs from uremia. Miiller states that the 
affection frequently terminates in chronic cystitis. Gangrene of the 
organ, succeeded by rupture and peritonitis, is also recorded as a termina- 
tion of the disease, 

DIFFERENTIAL Diaanosis.—This is based on the presence of a dis- 
tended bladder, and on an examination of the urine, taken in conjunction 
with the symptoms noted above. 

Proenosis.—Owing to the conditions under which acute cystitis 
develops, the prognosis is always grave. 

TREATMENT.—Friedberger and Fréhner advise the internal adminis- 
tration of one of the following agents—viz., boric acid, salicylic acid, 
benzoic acid, chlorate of potash, naphthalin, resorcin, and creolin. 
Trasbot recommends bromide of potash and bromide of camphor. Miiller 
advises chlorate of potash and decoction of uva ursi. Hobday recom- 
mends urotropin, buchu, creolin, creosote, carbolic acid, hyposulphite of 
soda, as urinary disinfectants. He has also found urotropin and hyo- 
scyamus, and bicarbonate of potash, useful as sedatives to the bladder. 


* Report of Discussion, National Veterinary Association, 1913. 


174 SYSTEM OF VETERINARY MEDICINE 


All authors agree that irrigation of the bladder is the most important 
therapeutical measure in cystitis. In carrying out this procedure, Miller 
introduces a catheter into the bladder, and by means of a small rubber 
tube the instrument is connected with a funnel. The antiseptic solution 
is then poured into the latter (the dog being fixed in the dorsal position), 
and reaches the bladder. The organ is then emptied by removing the 
funnel, and placing the tube in a dependent position. This process can 
be repeated several times without removing the catheter. It is advised 
to wash out the bladder first with pure tepid water, and then to employ 
a 2 per cent. solution of boric acid, also used tepid. Some authors em- 
ploy a 4 or 5 per cent. solution of boric acid, and advise that irrigation 
be carried out by first performing a perineal urethrotomy; but Miiller 
states that with a little practice the method indicated above can easily be 
employed. In the bitch a short metallic catheter is used, and the irriga- 
tion is a very simple matter. Hobday advises the use of a double- 
channel catheter whenever possible. Experiments have demonstrated 
that certain agents can be readily absorbed by the vesical mucosa, 
especially cocaine and carbolic acid, and Leblanc points out the danger 
in employing solutions containing such drugs for bladder irrigation. 

The diet in cystitis must receive attention, Milk, barley water, linseed 
tea, and such-like demulcents, should be allowed. Meat and meat 
juices should be interdicted. 

In the human subject cystitis often yields to vaccine treatment after 
irrigation and other surgical methods have failed. In the case of valuable 
animals, where the owner is able to follow the arguments in favour of 
such treatment, the urine should be submitted to a bacteriologist for 
examination as to the possibility of a vaccine proving beneficial. The 
difficulty of rendering catheters, solutions, and the prepuce of the animal 
sterile is another argument in favour of vaccine treatment as preferable 
to surgical. 

Chronic Cystitis—In this form of the disease the symptoms may for 
an indefinite period be so mild as to be overlooked. It is generally a 
sequel to an acute attack. In advanced cases incontinence of urine may 
be observed, and pain may be evinced on palpation of the abdomen. 
The urine may be passed in drops involuntarily while the dog is moving 
about or asleep. . 

The treatment advised by Miiller consists in the administration of 
alkaline salts with balsam of copaiba, balsam of Peru, oil of juniper, etc. 
Irrigation of the bladder should also be carried out, as in the acute 
form. 


DISEASES OF THE BLADDER: DOG AND CAT T75 


PARALYSIS OF THE BLADDER. 


This is not an uncommon condition, especially in old dogs. It 
may depend on various causes, such as extreme distension of the 
organ, owing to the animal retaining the urine for a long period, 
also any obstruction in the urinary passages which prevents the flow 
of urine, such as hypertrophy of the prostate, urethral calculi, hernia 
of the bladder, certain affections of the nervous system, etc. The 
most common cause, both in the cat and dog, is retention of urine 
depending on urethral calculi. The paralysis may involve the detrusor 
vesicee or the sphincter vesice, or both conditions may occur simul- 
taneously. When the sphincter is involved, the urine is passed con- 
stantly or at short intervals, and the bladder is generally found empty. 
On the other hand, when the detrusor vesice is paralysed, the muscular 
coat of the organ loses its power of contraction, and distension occurs; 
while the pressure exerted on the sphincter overcomes the latter, and 
the urine escapes in small amounts. Under such conditions, the disten- 
sion of the bladder can be detected by abdominal palpation. When 
both muscles are involved, the involuntary discharge of urine is observed 
or it may dribble away constantly. 

In the dog and cat it is not uncommon to find distension of the bladder 
with no marked symptoms present, hence the necessity of examining the 
condition of the bladder by palpation of the abdomen when no urine is 
passed, especially in cases of paraplegia, etc. Catarrh of the bladder is 
not an uncommon sequel to paralysis of the organ, and depends on 
decomposition occurring in the retained urine. 

TREATMENT.—When the bladder is distended, the employment of the 
catheter is indicated. Irrigation of the organ with cold water is advised 
by some authors. The administration of nerve tonics, such as strychnine, 
is also recommended. According to Miiller, the prognosis is unfavourable 
in the majority of cases. : 

PREVENTION.—It is of importance to allow dogs facilities for urina- 
tion, a8 some animals, when confined in house or kennel, will refuse to 
micturate unless they are brought out of doors. This refers also to cases 
under treatment in veterinary infirmaries. 


SPASM OF THE BLADDER. 


This is described by Miller as a condition in which, owing to 
extreme irritability of the bladder, a marked contraction of the 
muscular coat of the organ occurs. The urine is passed in small 


776 SYSTEM OF VETERINARY MEDICINE 


amounts, or only in drops, and the act is accompanied by straining 
(dysuria). Evidences of uremia may be observed in some cases. On 
passing the catheter pain is evinced, and the bladder is found to be 
empty. When spasm of the neck of the bladder is present, the bladder 
is distended, and on passing the catheter the urine is expelled in a 
forcible stream as soon as the instrument overcomes the contracted 
sphincter. . , 

The hypodermic injection of morphine is advised in the treatment of 
this condition, | 


HAMORRHAGE OF THE BLADDER. 


This is sometimes observed in the dog, and may be due to external 
injuries, to lesions produced by vesical calculi, to a very acute cystitis, 
and to the presence of neoplasms in the bladder. The symptoms observed 
are the admixture of blood in the urine, and if the latter be permitted 
to stand after removal from the bladder, a sediment is formed composed 
of blood-corpuscles and fibrinous coagula. In severe cases a fatal ter- 
mination due to internal hemorrhage results. Instances are met with 
in which a large blood-clet occupies the interior of the bladder. Obscure 
cases also occur in which retention with hematuria are observed, and 
spontaneous recovery may ensue after the use of the catheter. Treat- 
ment consists in the administration of adrenalin internally. Irrigation 
of the bladder with solutions of boric acid is advised in order to prevent 
decomposition of the blood in the organ. 


RUPTURE OF THE BLADDER. 


This is said to occur under a variety of conditions, such as over- 
distension of the bladder from any cause, or as the result of external 
injuries ; also it may occur while irrigation of the bladder is being carried 
out, and in cases of hemorrhagic cystitis. Gray, however, has not ob- 
served the lesion as the result of retention of urine, and is of opinion that 
rupture is more often due to the sudden intra-vesical distension caused 
by irrigating the bladder in cases of cystitis. Hobday describes an 
instance in which, during the performance of an odphorectomy in a 
bitch, the bladder (which was enormously distended) was accidentally 
incised, and a quantity of urine made its escape into the peritoneal | 
cavity. This was swabbed up as completely as possible, and the wound 
in the bladder was brought together with three sutures. The odphorec- 
tomy was completed, and an uneventful recovery ensued. Youatt 
recorded a case in which rupture occurred as a sequel to a very acute 


DISEASES OF THE BLADDER: DOG AND CAT 777 


cystitis, and quotes one that was under the care of Simonds, in which 
the lesion was associated with chronic hypertrophy of the prostate. 
According to C. French, rupture of the bladder may occur as the result 
of a calculus becoming lodged in the neck of the organ. The lesion may 
also follow torsion of the bladder. Cases are recorded in which neoplasms 
occupying the neck of the organ, or situated in neighbouring structures, 
have interfered with the flow of urine, and led to rupture. The above 
author, however, points out that rupture does not as a rule follow a 
gradual obstruction, as in such instances a compensatory hypertrophy 
of the vesical walls takes place. Rupture of the bladder has also been 
observed in connection with wounds and punctures of the abdominal 
wall in the pubic region, and is not uncommon as the result of kicks, or 
when an animal has been run over by a vehicle, especially when the 
bladder is distended with urine. 

Symproms.—According to Hobday, when the lesion occurs during the 
manipulation and pressure exerted on the distended bladder, with a view 
to overcome the obstruction caused by an urethral calculus, the operator 
finds that the rupture makes a distinct “ popping” sound, and the organ 
suddenly collapses in the hand. When rupture occurs during the pro- 
cedure of irrigating the bladder in cases of acute cystitis, a similar sound 
is heard, and in both instances the patient may suddenly collapse and 
make attempts to vomit. C. French remarks in connection with the 
diagnosis of the condition that if a catheter be passed, urine and blood 
may be drawn off; and if fluid be injected, the bladder will show by 
palpation a gradual distension, succeeded by collapse of the organ and 
the return of only a small amount of the fluid. He has also found that 
at the autopsy the urine as a rule does not remain long in the peritoneal 
cavity, but is quickly absorbed, and that death occurs from uremia. In 
a vigorous dog the fatal termination may be delayed for forty-eight hours, 
and in cases where the lesion occurs in connection with a wound, so that 
drainage is present, life may be prolonged even beyond the period mentioned. | 

TREATMENT.—This is essentially surgical. Hobday has found that, 
in the case of a large jagged rent, such as occurs when the accident 
results during irrigation of the bladder, it is almost impossible to suture 
with any chance of permanent success. We haye already quoted a case 
to show that the escape of normal urine into the abdominal cavity is not 
necessarily followed by peritonitis or death, provided aseptic surgical 
measures are quickly adopted. C. French states that the chances of 
success are good if operation is carried out within from six to twelve 
hours. For the technique of the operation the reader is referred to 
Hobday’s work already mentioned. 


778 SYSTEM OF VETERINARY MEDICINE 


CYSTIC CALCULI. 


A single large calculus may be present, which in some instances may 
occupy a considerable extent of the bladder, or there may be a large number 
of small calculi in the organ. In one case Hobday has observed the 
presence of eighty-four calculi. According to this author, the condition 
is most commonly met with in old, or at all events adult, animals, but 
even young.ones are not exempt. It is said to occur with equal frequency 
in the cat, especially in the castrated male; but Gray states that cystic 
calculi are rare in this animal as compared with collections of sabulous 
matter composed of triple phosphates in the bladder. More cases are 
met with in the bitch than in the dog, and in the former the calculi are 
of larger size. C. French remarks that the smaller breeds of dogs are 
more subject to urinary calculi than the larger varieties. 

As regards the composition of the calculi, and the commonest forms 
met with, some difference of opinion exists amongst authors. Thus, 
Woodruff* states that in the dog the commonest calculi are composed of 
triple phosphate (ammonium magnesium phosphate), while uric acid 
calculi are much less common, and those composed of calcium oxalate 
and ammonium urate are rare. On the other hand, C. French remarks 
that calculi composed of uric acid and urates (ammonium urate) are 
those most commonly met with. They are usually small, hard, and 
smooth, and of a yellow, brown, or reddish colour. According to this 
author, the calculi composed of triple phosphate are probably often 
secondary to the uric acid variety, the latter acting as a nucleus, and 
becoming surrounded by phosphates in the presence of alkaline urine. 
When the urine again becomes acid, a layer of urates may be added to 
the calculus. This variety has a rough surface. The calcium oxalate 
variety 1s less frequently met with. It is hard, variable in shape, brown 
or yellow in colour, and often has an irregular mulberry surface. The 
cystin calculus, which is very rare, is soft, waxy, and of a brownish-yellow 
colour. 

When a large number of calculi are present, they are small and round, 
and occasionally a few are found imbedded in the vesical mucosa. It is 
not uncommon to find calculi in the bladder, urethra, ureter and kidney 
at the same time. Owing to the friction produced when one calculus is 
continually rubbing against another, facets are formed, which give the 
concretions an irregular shape. 

When crystalline deposits form, and persist in the bladder as small, 


* “Urinary Caleuli in the Horse and Dog,’ Veterinary News, December 16, 
1911. 


DISEASES OF THE BLADDER: DOG AND CAT 179 


gritty particles, the condition is termed “ gravel.’ When some of these 
particles become agglutinated by vesical mucus, albumin, degenerated 
epithelium, or blood-clots, a nucleus is formed, around which a calculus 
may develop. 

Symptoms.—According to C. French, uric acid calculi are not so 
likely to cause symptoms as those composed of the triple phosphates. 
Hobday states that the symptoms which first draw the owner’s attention 
to the animal are a continual restlessness, and constant attempts at 
micturition, but only a few drops of urine are passed. The urine may 
be turbid, or may contain blood; but the presence of the latter depends 
on whether the vesical mucosa has become abraded or otherwise, and 
hence is not a diagnostic symptom. Moreover, hematuria may occur 
under other conditions, as well as in cystic calculi. Unless relief be 
afforded, the animal shows pain, fever, a capricious appetite, and emacia- 
tion. In the case of a large calculus, its presence can be detected by 
abdominal palpation and by rectal examination carried out by the 
fingers; also by the use of the catheter, as when the instrument strikes 
against the calculus, a distinct metallic “click”’ is felt. When a cal- 
culus lodges in the neck of the bladder, symptoms similar to those oc- 
curring in a case of urethral calculus are observed (see p. 783). Sewell* 
states that a round calculus is more likely to prevent the flow of urine, 
as, when otherwise shaped, the fluid may find its way past the obstruc- 
tion. 

In a case that we observed in a mastiff dog the bladder contained a 
number of small calculi, and the urethra was partially obstructed at three 
different points by similar concretions. The symptoms were frequent 
painful micturition, small amounts of urine were passed in jets; then a 
sudden cessation of the act, straining, and the passage of pure blood. 
In a case recorded by Davis,} a cystic calculus weighing 5 drachms was 
removed by him from a small Pekingese bitch by prepubic lithotomy. 
The symptoms observed were difficulty in’ micturition and emaciation; 
the bladder distended with the calculus could be distinctly felt through 
the abdominal wall, and it could be pushed from one side of the organ 
to the other. Gray, in discussing the above case, remarked that such 
calculi were always larger in the bitch than in the dog, and that he had 
seen cases in the former in which the calculus was larger than a turkey’s 
egg without any symptoms being observed, and the condition was only 
discovered post mortem. 

Dunlop-Martin{ recorded a case of cystic calculi in a toy Pomeranian 

* “ Dogs’ Medical Dictionary.” 


{ Central Veterinary Society, Veterinary Record, April 26, 1913. 
{ Veterinary Journal, November, 1912. 


780 SYSTEM OF VETERINARY MEDICINE 


bitch four years old. Blood was observed in the urine in May, 1911. 
This disappeared, and in September, 1911, the animal gave birth to one 
puppy. In March, 1912, she again gave birth to one puppy. In July 
of the same year the hematuria reappeared. No treatment was adopted 
for nine days, and then the owner administered an empirical remedy. 
Total suppression of urine followed, and death resulted. The owner 
regarded the animal as healthy, and only observed, in addition to the 
two attacks of hematuria, that the bitch always passed urine frequently 
and in small quantities. The autopsy showed marked thickening of the 
vesical walls, and the presence of three large pyramidical calculi, which 
consisted mainly of triple phosphates. 

The above cases show that the symptoms of this condition may in 
some instances be little marked, and how easily it may be overlooked. 

In the bitch vesical calculi are sometimes passed with the urine. 
We have seen a Clumber bitch showing all the signs of a urethral obstruc- 
tion—distended bladder, straining, excitement, and cries of pain from 
time to time. On examination per vaginam it was found possible to 
dislodge a small, smooth calculus. A rapid escape of urine followed, and 
there was no recurrence for about three months, when a similar attack 
was described by the owner, who stated that the bitch had passed another 
stone, and for some months afterwards no further trouble was experi- 
enced. The case was then lost sight of. In many instances incontinence 
of urine is observed. 

TREATMENT.—This is essentially surgical, and for details of the various 
operative procedures the reader is referred to Hobday’s “‘ Surgical Diseases 
of the Dog and Cat,” or to “ Surgical Diseases of the Dog,” by C. French, 
D.V.S. Gray is of opinion that in the majority of cases in old dogs 
palliative measures are preferable to surgical interference. 


TUMOURS OF THE BLADDER. 


These include innocent and malignant varieties. Myomata, myxo- 
mata, primary and secondary sarcomata and carcinomata, papillo- 
mata, and fibromata, have been recorded. C. French states that 
tumours in this region are very rare. According to Hobday, the 
neoplasms most commonly met with are papillomata, sarcomata, and 
carcinomata. They may occur in the vicinity of the bladder, but 
external to it, and show adhesions to surrounding structures, or may 
be found growing from the vesical mucosa. In the latter instance, 
after they have been in existence for some time, they assume a villous or 
fungoid character, and tend to bleed readily. The same author records 


DISKASES OF THE BLADDER: DOG AND CAT 781 


a case of pedunculated tumour of the bladder in a male Yorkshire terrier. 
On microscopical examination the neoplasm proved to be a mucoid 
polypus. 

Symptoms.—Frequent micturition, accompanied by pain, is observed, 
the symptoms becoming gradually more marked. According to Hobday, 
the only symptom noticed in the early stages is hematuria, the urine 
being blood-stained. C. French states that several cases have been 
recorded in which hematuria was absent. In the case of malignant 
tumours, cachexia, emaciation, and loss of appetite, are well marked. 
In the later stages the urine may be feetid or purulent. If the neoplasm 
be extensive, the abdomen is enlarged. As regards diagnosis, a rectal 
examination, or, in the female, a vaginal examination, may disclose the 
presence of an uneven growth in the bladder. Hobday advises the use 
of a sound or catheter, by means of which the tumour can be detected 
as a soft spongy body resisting the progress of the instrument inside the 
bladder; but he points out that if the neoplasm be of small size this 
diagnostic measure will fail. 

TREATMENT.—It is generally admitted that surgical measures offer 
but a remote chance of success in most instances. An exploratory supra- 
pubic lithotomy is indicated in order to ascertain if the case is operable 
or otherwise. For details of the operative procedure the reader is 
referred to the works on canine surgery already alluded to. 


HERNIA OF THE BLADDER. 


In this condition, the bladder passes backwards through the pelvis, 
and becomes involved in a perineal hernia. Hobday records several 
cases, and points out the dangers attendant on the condition— 
viz., “that retention of urine may occur, owing to the bladder 
becoming distended, and the animal being unable to exercise sufficient 
pressure on the vesical walls to overcome the resistance offered by the 
‘kink’ in the neck of the organ. In severe cases, owing to the 
altered position of the bladder, it cannot be acted on by the abdominal 
muscles.”’ 

TREATMENT.—In urgent cases the urine must be removed by punc- 
turing the bladder by means of a fine trocar and cannula. Operative 
treatment is then indicated. For details of the technique of both of the 
above measures the reader is referred to the works on canine surgery 
already mentioned. 


782 SYSTEM OF VETERINARY MEDICINE 


EVERSION OF THE BLADDER. 


This is also termed “prolapse of the bladder.” Hobday states 
that it is occasionally met with in the bitch, the organ becoming 
everted through the relaxed and enlarged urethral opening. Reduction 
is to be carried out on similar lines to those mentioned for the treatment 
of this condition in the mare. 


TORSION OF THE BLADDER. 


Two cases of this condition were observed by Siedamgrotzky. In 
one instance it was caused by the presence of a subserous hematoma 
near the neck of the bladder, in another an omental sarcoma was 
found adherent to the neck of the organ. A case was recorded 
by Stroud,* and another by Griveaux.t The symptoms observed 
were retention of urine, enlargement of the abdomen, and, by pal- 
pation and rectal examination the distended bladder could be detected. 
In addition to the above phenomena, Stroud observed a weakness of the 
hind-quarters, and a marked swelling of the perineal region; and Griveaux 
found an obstruction to the passage of the catheter in front of the neck 
of the bladder. In both instances death occurred in a short space of 
time. 

Probably an exploratory laparotomy would be necessary in order to 
diagnose the condition, and to adopt surgical measures for its relief. 


PARASITES OF THE BLADDER. 


Cases are recorded in which the EHustrongylus gigas has been met 
with in the bladder of the dog. 


DISEASES OF THE URETHRA 
URETHRAL CALCULI. 


Obstruction in the urethra due to calculi is a condition frequently 
met with in the dog, chiefly in the male. The calculi gain entrance to 
the urethra from the bladder. They may be rounded or uneven on their 


* “Veterinary News,” 1906. 
+ Journal de-Médecine Vétérinaire et de Zootéchnie (Lyon), 1906, p. 393. 


DISEASES OF THE URETHRA: DOG AND CAT 783 


surface. In some instances the obstruction may be due to a single 
calculus; in others a number may be present at varied distances in the 
urethra. In the bitch the condition is of less frequent occurrence, 
owing to the large calibre, shortness, and dilatable character of the urethra ; 
but, when present in the female, they may be of much larger size than 
in the case of the male animal. Gray* recorded a case in which he dis- 
covered eight calculi in the urethra of an aged female terrier. C. French 
has met with instances in which several small calculi were cemented 
together by mucus, forming an impaction in the urethra. He has also 
observed cases in which small calculi became embedded in the urethral 
mucosa. The condition occurs more commonly in adult or aged animals, 
but cases may be met with at any age. Siedamgrotzky records an 
instance in which a puppy aged three months died suddenly, showing 
inflammatory cedema of the prepuce. The autopsy revealed the presence 
of cylindrical calculi in the curved portion of the urethra. This structure 
was perforated, and infiltration of urine occurred. 

The seat of obstruction is, in the majority of instances, that portion 
of the canal which passes through the os penis, or immediately before it 
enters the bone. Occasionally a calculus may be found just anterior to 
the prostatic portion of the urethra. As already remarked, it is not 
uncommon to find calculi in the bladder and urethra at the same time. 

Hobday removed eleven calculi at one urethrotomy operation on a 
St. Bernard doy. The owner of the animal had allowed the case to 
progress so far that the extremity of the penis was gangrenous. The 
same author on two occasions counted more than fifty small calculi in 
the urethra and bladder. 

In the cat urethral calculi are of much rarer occurrence than in the 
dog, and when met with, occur more frequently in the castrated male. 
The obstruction is more often in the form of sabulous material, which 
may be lodged at the extreme end of the penis—a matter of importance 
as regards treatment. 

Symproms.—The phenomena usually observed are uneasiness and 
frequent persistent attempts at micturition, but only a few drops of 
urine, which may be blood-stained, are passed. The animal may remain 
in the attitude for micturition for a long period, and the expression of 
countenance is anxious. In the majority of instances in the male the 
animal assumes the attitude of the bitch during micturition. A straddling 
gait and arching of the loins in a downward direction (not a convexity 
as in tenesmus) may be observed in some cases. When a number of 
calculi occur in the bladder and urethra at the same time, pure blood 


* Journal of Comparative Pathology and Therapeutics, vol. x., p. 88. 


784 SYSTEM OF VETERINARY MEDICINE 


may be passed after several attempts at micturition. In some cases the 
urethra behind the og penis may be distended by urine. According to 
C. French, hydronephrosis may occur occasionally in cases of urethral 
calculi. Occasionally the obstruction is suddenly removed in a spon- 
taneous manner, and urination occurs. When the obstruction con- 
tinues for more than twenty-four hours, the distended bladder can be 
detected by abdominal palpation as a large pyriform body, or feels like 
a cricket-ball, situated anteriorly to the pubic border. At this stage 
the urine may show little alteration in appearance, but after twenty- 
four to thirty-six hours’ retention it becomes dark-coloured, strongly 
ammoniacal, and finally coffee-coloured and fetid (Hobday). Unless 
relief be afforded, the animal will succumb to uremia, and occasionally 
rupture of the bladder is said to occur; but Gray has never observed the 
latter lesion in this affection. 

In the cat, Hobday has observed that the penis is protruded to its 
fullest extent, and the extremity of the organ moves in a jerky manner 
with the efforts at micturition. | 

DIFFERENTIAL Diacnosis.—On attempting to pass a catheter or 
sound, the progress of the instrument is checked at the point in the 
urethra where the calculus or obstruction is lodged. 

TREATMENT.—In consequence of the importance of urethral obstruc- 
tion in the dog and cat, we deem it advisable to consider the treatment of 
the affection rather fully. More especially is this the case with reference 
to the affection in the cat, in which, owing to the condition being over- 
looked and proper treatment not being adopted, many valuable animals 
are lost. It is advisable here to give some brief details with reference to 
the technique of passing the catheter in the male cat. To the canine 
and feline specialist no doubt this is a simple matter, but to the general 
practitioner who has not devoted any attention to the subject such 
details are of importance. The form of catheter best suited to the cat 
is described on p. 786. 

It is advisable to have three different-sized catheters, as the lumen 
of the urethra varies in calibre according to the size or age of the cat. 
The animal is placed on the left side, the assistant holding the two 
fore-legs with his left hand, and the right hind-leg with his right hand, 
the left (or under) hind-leg being left free. The operator presses the penis 
out of the sheath with his left hand, and with his right hand he passes the 
catheter gently into the urethra in a perpendicular direction, until it 
reaches the floor of the pelvis, when it meets with some resistance. The 
catheter is then brought gently in a backward direction until it is on a 
straight line with the floor of the pelvis, and is carefully passed into the 


DISEASES OF THE URETHRA: DOG AND CAT 785 


bladder and the stilette is withdrawn, permitting the urine to flow through 
the instrument. 

Mr. Henry Gray, who has devoted special attention to the subject 
we are discussing, has kindly favoured us with the following remarks on 
treatment: 

“The principle of treating urethral impaction is to remove the ob- 
struction so that the urme may pass through the natural channel and 
thus allow the bladder to empty itself of its contents. 

‘The use of the trocar and cannula in relieving the bladder, either 
through the rectum or external abdominal walls, as advised by some 
writers, is irrational, and generally, if not always, followed by failure to save 
the animal’s life. The simpler, more rational, more skilful, and com- 
paratively safer method is to cut down on the obstruction and remove 
it. The operation can be performed painlessly by injecting a few drops 
of a 4 per cent. solution of cocaine containing adrenalin (1 in 10,000) 
in and under the skin where the incision is to be made. It is needless 
to say that a bold incision in the line of direction of the urethra should 
be made. The calculus can then be pressed out of the opening by a 
probe. If more than one stone is present below the incision, these may 
be pushed up through the opening by passing the probe up the urethral 
meatus. In the case of sabulous material, this can be scooped out of the 
urethral canal by means of a director, or washed out by forcing water up 
the urethral orifice by means of a syringe. After this has been done the 
catheter should be passed towards the bladder to make sure there is no 
further obstruction between the incision and the bladder. Although the 
obstruction may be removed, there sometimes arise instances in which 
the obstruction recurs from fresh calculi descending from the bladder 
after the operation. When this occurs the calculi mostly become fixed 
at the upper end of the wound before it has cicatrised, and under such 
circumstances manipulation and the skilful use of the probe are sufficient 
means to bring about their extrusion. If one does not succeed in this 
manner, cutting on to the calculi will be necessary. Two or three longi- 
tudinal incisions in the urethra at separated points are not harmful. 
Sutures are not necessary, and their non-use may be beneficial in a case 
where fresh calculi descend from the bladder and become fixed in the 
wound. The dog’s tongue in these cases is the safest and surest dressing 
to apply to this kind of wound. Of the numerous cases that I have operated 
upon in this manner, I have never observed a bad result. No fear of 
stricture, gangrene, sloughing, or percolation of urine into the areolar 
tissue need be entertained. In textbooks of veterinary surgery it is 
very often stated that urethrotomy in the dog is a dangerous operation. 

VOL, Il. 50 


786 SYSTEM OF VETERINARY MEDICINE 


But the authors advise sutures, which I consider give rise to the trouble 
anticipated. | 

‘In the case of the cat no cutting operation is necessary, as the 
obstruction may be extruded by pressing the end of the penis between 
the thumb and index-finger; or, when located higher up, the sabulous 
material may be pushed into the bladder. What is necessary here is 
the passage of a fine straight metal catheter about 5 or 6 inches in length, 
as introduced into veterinary surgery by me, and manufactured by Messrs. 
Allen and Hanburys. In lieu of this special catheter, the smallest 
human metal catheter straightened out has proved useful in my hands in 
the case of the large cat; in fact, I have been able, not only to pass the 
smallest, but the two sizes above it, of the human catheter in the larger 
cats. Gum-elastic catheters are useless for the cat. In the absence of 
any small catheters, the operator may pass a fine probe up the urethra 
and cut down upon it in the perineal region, and through the opening thus 
made he can pass a catheter—even.a gum elastic one of a larger calibre— 
into the bladder. However, as remarked above, no cutting is necessary 
where suitable metal catheters for this purpose are at hand. 

‘* After the removal of the obstruction it may be necessary, in cases 
when the urine is bloody, and especially where it is ammoniacal, to wash 
out the bladder with a warm solution of boracic acid contaiming a few 
drops of atropine and cocaine solutions, and even adrenalin. This can 
be accomplished by attaching a rubber douche or a syringe to the catheter. 
This treatment may allay the irritability of the bladder, and convert a 
threatened severe attack of cystitis into a simple one. Care should be 
taken that not too much of the fluid injected is left in the bladder, as 
the belladonna or cocaine may set up cerebral excitement. Again, in 
washing out the bladder, too much force or too great a quantity of fluid 
should not be used, as the sudden distension of the organ too forcibly, 
and with too much fluid, has been known to bring about rupture of it both 
in the cat and in the dog. 

“The animal’s food should be of the vegetable kind and milk, but 
no other animal food ought to be given at least for a fewdays. (It should 
be remembered that animals living on flesh, those living upon their own sub- 
stance during disease orstarvation, or young animals living on their mother’s 
milk, have acid urine.) Doses of sodium or potassium bicarbonate (5 to 
10 grains), may be administered to lessen the natural acidity of the urine. 

“The question arises sometimes, when calculi are left in the bladder, 
What treatment should be adopted ? The writer considers it advisable, 
if they cause no urgent symptoms, to leave them alone, and to operate 
only when an operation is urgent and absolutely necessary. He knows 


DISEASES OF THE URETHRA: DOG AND CAT 787 


of numerous cases on which he has operated for urethral obstruction 
that have carried calculi in the bladder, and also in the kidneys, for years 
after without any serious symptoms being manifested. If any symptoms 
of vesical or nephritic irritation should exhibit themselves, a few doses 
of the following mixture will generally put matters right: 


RK Sod. bicarb. LETS Als 


Inf. tritici rep. conc. vel inf. buchu conc. .. 3i.ss. 

Tr. hyoscyami ... A, x war veorte 

Syr. simpl. sie a NS VAN) SK, 

Aq. camph. ste as ad 3vi. 
F. M. 


Sig.—A tea, dessert, or a tablespoonful three or four 
times a day, according to the size of the animal. 


‘ Lithium citrate, urotropin, or borovertin may be given to ward off 
a threatened attack or to render the urine aseptic. 
‘* Barley-water, linseed tea, decoction of mixed grain, and other 


mucilaginous liquids, may prove of service in soothing the irritable urinary 
passages.” 


STRICTURE OF THE URETHRA. 


This condition may occur as a sequel to operative measures for 
the removal of calculi, also as the result of accidental wounds. It has 
been observed in both male and female animals. OC. French describes 
rare cases in which small exostoses on the os penis encroached on the 
urethra, and produced a form of stricture. 

The symptoms observed are dysuria, or retention of urine, accom- 
panied by much distress. The diagnosis is based on the evidences 
obtained by passing the catheter. Treatment is carried out by passing the 
instrument twice or three times daily, and permitting it to remain in siti 
for about ten minutes, so as to overcome the stricture. Great care is 
essential in carrying out the procedure, and the catheter should be well 
lubricated. In order to prevent stricture occurring as the result of 
urethrotomy, Hobday advises that the catheter should be passed at least 
once a week or once a fortnight for some months, so as to keep the urethra 
patent. A small-sized catheter should be applied at first, and then the 
calibre should be gradually increased. Where these measures fail, an 
artificial urethral opening in the perineal region often renders the animal 
quite comfortable for years. Gray, however, has not observed stricture as 
the result of urethrotomy. 


URETHRITIS. 
See “‘ Surgical Diseases and Surgery of the Dog,” by C. French. 


788 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE PROSTATE GLAND. 


See the work by C. French, already mentioned, also Hobday’s 
“‘ Surgical Diseases of the Dog and Cat.” 


PROLAPSE OF THE URETHRA. 


This condition is rare. It has been observed by Hobday in the 
bitch. The mucous membrane of the urethra becomes much relaxed, 
and protrudes below the urethral orifice into the vagina. The above 
author records a case in a small French bull bitch in which 14 inches 
of the urethra was prolapsed. The treatment advised is to return 
the prolapsed portion by means of a catheter of proper calibre, and 
to inject a solution of alum or tannic acid and opium two or three 
times daily for a week or ten days. 


PARASITES OF THE URETHRA. 


According to C. French, the EH. gigas may gain entrance to the 
urethra from the kidney. It becomes arrested in the urethra, where 
this structure passes along the groove in the os penis. It then 
perforates the urethral wall, and lodges in the surrounding connec- 
tive tissue posterior to the os penis, and a swelling rapidly forms at 
this point. Leblanc met with three cases, and Lacoste observed an 
instance in which the parasite was expelled from the urethra with the 
urine, acute pain being manifested by the patient. 


IMPERFORATE URETHRA. 


This is a congenital condition, which may occur in the newly- 
born puppy or kitten. Hobday* recorded a case in a female kitten 
six weeks old. The urethral orifice was entirely absent, the opening 
being replaced by a very thin skin, which the urine appeared to 
filter slowly through, and gain the vaginal passage. The bladder was 
found distended on palpation of the abdomen. An incision was made 
on the thin skin referred to, and the urine flowed out witha rush. The 
edges of the wound were cauterised with nitrate of silver to prevent 
union, and an excellent recovery resulted. 

In the case of more severe malformation the indications for Teen 
will depend on the conditions present. 


* Journal of Comparative Pathology and Therapeutics, vol. ix., p. 155. 


DISEASES OF THE URINARY ORGANS 
IN BIRDS 


By E. WALLIS HOARE, F.R.C.V.S. 


Acute Nephritis.—This affection has been observed in birds by Larcher, 
Semmer, Zurn, Siedamgrotzky, Rivolta, and Delprato. It is said to 
occur frequently in chickens, and to bring about arrest of growth, loss 
of condition and interference with appetite. The lesions observed were 
marked increase in size of the kidneys, the renal tissue was firm in con- 
sistence, and the organs were of a greyish-yellow colour. The micro- 
scopical examination revealed marked hypertrophy of the interstitial 
connective tissue, the uriniferous tubules were partly destroyed, and 
their epithelium in many parts was affected by fatty degeneration. 
There was a complete absence of urate of soda, which substance, accord- 
ing to Leblanc, is rarely absent from the kidney of fowl. Bacteriological 
examination showed the presence of cocci, diplococci, and bacilli. Sem- 
mer was of opinion that the affection was caused by certain toxic fungi 
or moulds contained in the food, which produce a special toxin capable 
of inducing the renal lesions. 

Chronic Indurative Nephritis.—This condition is said by Hutyra and 
Marek to occur in birds, and to possibly develop upon a gouty basis. 
No description of the disease is given. 

Renal Calculi.—Cases of renal calculi in birds are described by Larcher. 
Lucet recorded a case of uremia in a fowl following the deposition of 
urinary sediments in the kidneys. The organs showed the presence of 
numerous small white spots, which extended deeply into the renal tissue. 
On microscopical examination the renal tissue was found to be infiltrated 
by a product which proved to be uric acid. 


789 


DISEASES OF THE RESPIRATORY ORGANS 
IN THE HORSE 


By E. WALLIS HOARE, F.R.C.V.S., anp Mayor E. E. MARTIN, A.V.C., 
F.R.C.V.S. 


INTRODUCTORY REMARKS. 


RESPIRATORY diseases are of great importance in veterinary practice. 
Not only have we to consider the high mortality which is not uncommon 
in some epizoétic outbreaks characterised by serious lesions in the lungs 
and pleure, but also we must point out the unfortunate sequele which 
so frequently follow respiratory disorders, rendering the animals so 
affected unfit for fast work, and hence considerably reduced in market 
value. Under modern and rational systems of treatment, the mortality 
from respiratory diseases has been reduced to a marked extent. But as 
regards sequels, such as whistling and roaring, we must confess our 
inability to suggest prophylactic measures; while the surgical treatment 
of such conditions can, in our present state of knowledge, only be directed 
towards influencing their effects. 

It is generally admitted that respiratory affections are of more com- 
mon occurrence in early life than digestive disorders. Still, in ordinary 
practice we find, during the prevalence of influenza outbreaks, a large 
number of cases of pneumonia and pleurisy even in adult horses. There 
seems little doubt but that young horses are more susceptible to the 
micro-organisms on which respiratory diseases depend. It is a well- 
known fact that many cases of pneumonia and pleurisy met with in 
large stables occur in young horses which have been recently purchased. 
Of course, there are predisposing causes to be taken into consideration, 
such as the altered surroundings, and the character of the work, plus 
the exposure to infection. The vitiated atmosphere of many town 
stables no doubt tends to lower the vital resistance of young horses | 
accustomed to an open-air life in the country, and thus renders them 
liable to infection. 

Marked progress has been made in recent years with reference to the 
prophylaxis and treatment of respiratory affections. This advance must 

790 


DISEASES OF THE RESPIRATORY ORGANS: HORSE 791 


be attributed to a recognition of the infectious nature of such disorders. 
Knowing that these diseases depend on the entrance and development 
of micro-organisms in the system, we secure isolation of the affected 
animals, and also recognise that heroic therapeutical measures are not 
only useless but actually inimical to the patients. The pioneers of the 
rational treatment of respiratory affections arrived at their conclusions 
by comparing the results of various therapeutical measures. They 
learned by experience that bleeding, blistering, purging, constant drugging, 
and the forcible administration of nourishment, were altogether contra- 
indicated. The altered views were not universally accepted for a long 
period, as there were many practitioners who clung pertinaciously to the 
belief that they could influence these diseases, and even arrest the course 
thereof, by adopting active treatment. Increased knowledge has in 
reality demonstrated the limits of our therapeutical skill, and pointed 
out that the vis medicatrix nature should be both respected and given 
due credit in the treatment and results of respiratory diseases. It can 
truly be said that one of the most important factors in bringing about 
the greatly reduced mortality in such affections is the recognition of the 
fact that the constant administration of fluid medicines in the form of 
drenches was responsible for a large proportion of the fatal cases, owing 
to portions of the medicament entering the trachea and bronchioles, 
and thus inducing septic broncho-pneumonia. 

Other important factors are the improved surroundings of the patients, 
attention to hygiene, dietetics, careful nursing, and prompt cessation 
from work on the appearance of the early symptoms. Attendants of 
horses are now commencing to recognise that it is essential to cease 
working the animals under their charge, even when the only symptoms 
present are those of common nasal catarrh. The “simple cold,” if 
neglected, may be the forerunner of a serious respiratory affection, 
especially if the subject of it be exposed to chills and fatigue. The 
importance of isolating ordinary cases of nasal catarrh, whenever this is 
possible, cannot be overestimated. 

There are a number of general symptoms common to many respiratory 
disorders, and a physical examination of the chest is necessary in order 
to arrive at a correct diagnosis. Thus, a nasal discharge, cough, ac- 
celerated respirations, dyspnoea, fever, interference with appetite, etc., 
may be observed in a variety of respiratory affections, but there are 
peculiarities in connection with some of these symptoms which, taken 
in conjunction with a careful physical examination of the chest, lead 
us to differentiate the common disorders of the respiratory system. In 
the present day more attention is paid to the care and supervision of 


792 SYSTEM OF VETERINARY MEDICINE 


horses in large establishments, and as a result serious respiratory affec- 
tions are of far less: common occurrence than formerly, when the animals 
were forced to work until decided symptoms of illness appeared. Un- 
fortunately, such careful supervision is not yet as generally practised as 
is desirable, nor can we always succeed in convincing the owners and 
attendants of horses that preventive measures and early treatment prove 
most important details in connection with economical stable manage- 
ment. | 

In many instances the first symptoms which lead the attendant to 
seek professional advice are interference with appetite, dulness, inapti- 
tude for work, cough, a nasal discharge, and accelerated breathing. But 
so marked is the ignorance sometimes observed that our services are not 
requisitioned until symptoms of pneumonia and pleurisy are well in 
evidence. 

The general symptoms mentioned merit consideration, as they present 
certain important modifications according to the affections with which 
they are associated. 

Accelerated Respirations and Dyspnoea.—Exercise or exertion causes 
quickened respirations, which return to the normal during quiescence. 
Accelerated respirations vary in degree, and when assuming the char- 
acter of difficult or laboured they constitute the condition known as 
“dyspnoea.” Accelerated respirations, however, are not always charac- 
teristic of respiratory affections. They are also observed in various acute 
inflammatory affections of other organs, such as laminitis, irritative fever, 
etc. Dyspnoea occurring in respiratory affections may depend on various 
conditions, as follows: 

1. Obstruction to the entrance of air to the lungs, such as takes place 
in acute laryngitis and acute bronchitis. 

2. Lessened area for respiration in the lung itself, as in cases of 
pneumonia. : 

3. Interference with the expansion of the lungs, caused by the presence 
of pleural effusion in the cavity of the chest. 

4. Pleurisy, which renders the respiratory act painful, and causes 
shallow, quick respirations. 

5. Engorgement of the lungs with venous blood, such as occurs in 
cases of acute pulmonary congestion. | 

6. Pulmonary emphysema (broken wind), in which the alveoli lose 
their elasticity, or a number of them become confluent, so that expiration 
is performed with difficulty. 

Types of Respiration—1. Abdominal Breathing.—In this condition the 
movements of the thoracic walls are limited as much as possible. The 


DISEASES OF THE RESPIRATORY ORGANS: HORSE = 793 


ribs are fixed to a certain extent, and a hollow line is observed extending 
along the lower borders of the false ribs from the sternum to the anterior 
spine of the ilium. The abdominal muscles then act as auxiliaries, and 
compensate for the limited action of the special muscles of respiration. 
The respirations are quick and incomplete. This type of breathing is 
observed in cases of pleurisy and also in pleural effusion. 

2. Thoracic Breathing is characterised by the abdominal muscles 
being as far as possible in a state of quiescence, while extra movements 
of the thoracic walls compensate for the deficiency. It is observed in 
cases of peritonitis, ascites, intestinal tympany, etc. 

3. Irregular Breathing—In this type the inspiratory movement 1s 
performed rapidly, while expiration is accompanied by a spasmodic 
double action, especially of the abdominal muscles. It is observed in 
cases of “‘ broken wind.” 

4, A snoring or roaring sound, accompanying especially inspiration, is 
met with in cases of acute laryngitis, nasal or pharyngeal polypi, the 
presence of pus in the facial sinuses, or in the guttural pouch, etc. 

Cough.—This is a very common symptom in respiratory affections, 
but it may be absent in some cases of pneumonia. 

Several varieties of cough are met with, as follows: 

The Dry Cough occurs during the first stages of catarrhal affections. 
In cases of pleurisy the cough is dry, short, suppressed, and painful, 
owing to the forced expiratory movement causing pain. 

The Motst Cough is met with in the secondary stages of catarrhal 
affections. It indicates the presence of an increased secretion of 
- mucus. 

The Chronic Cough varies in type. In “ broken wind”? it is short, 
shallow, dry, suppressed, and usually single. At times, however, it may 
occur in paroxysms. In roaring, the cough is deep and. hollow, being 
‘‘ half roar and half cough.” 

The Paroxysmal Cough is observed in cases of acute laryngitis, or in 
instances where fluids gain entrance to the trachea and bronchi owing to 
careless drenching. 

Nasal Discharge.—T his varies in character and ote In some cases 
of pneumonia it is rusty-coloured, and trickles from the nostrils in a fine 
stream, but in others it may be absent. A nasal discharge is not always 
an indication of a. respiratory disorder, as it may occur in a chronic form 
(nasal gleet) as the result of diseased bones or molar teeth. The varieties 
of nasal discharge will be described in connection with the diseases with 
which they are associated. For special information on chronic nasal 
discharge, see p. 803. 


794 SYSTEM OF VETERINARY MEDICINE 


Physical Examination of the Chest.—With regard to this subject, we 
may remark that the student must first be familiar with the character of 
the respiratory sounds in health before he can appreciate the alterations 
produced by disease. In both instances he must educate himself by a 
practical study of the subject, as it cannot be acquired by reading descrip- 
tions in textbooks. The time spent in the study of the normal animal 
will be amply compensated for by the greater facility with which abnormal 
conditions can be detected, and these remarks apply equally to the 
clinical study of other systems of the body. ‘Space will not permit of a 
full consideration of the physical examination of the chest, and in the 
following pages only an outline can be given. For fuller information on 
the subject, the reader is referred to the work entitled “ Clinical Diag- 
nosis,” by Malkmus. 

It is generally admitted that, in consequence of anatomical peculiarities, 
the horse, as compared with the dog, presents difficulties in the way of a 
proper physical examination of the chest, and similar remarks apply to 
the ox. The thoracic walls are comparatively thick, the anterior third 
of the chest is covered laterally by.the massive shoulders, while the con- 
tiguity of the large intestines tends to produce sounds which must be 
carefully distinguished from those originating from the lungs. 

For the following remarks on the normal respiratory murmur we are 
indebted to that valuable work, “ Veterinary Physiology,” by F. Smith: 

“The air-sounds both of inspiration and expiration should be heard 
all over the chest, the inspiratory murmur being louder and better 
marked than the expiratory; in fact, in many perfectly healthy chests 
the expiratory murmur can scarcely be heard. The normal murmur, 
whether inspiratory or expiratory, is soft in character; there is no harsh- 
ness. ... The respiratory murmur, also known as the vesicular mur- 
mur, is caused by the friction of the air entering the alveoli. In those 
portions of the lung lying close to the bronchi and larger tubes there is, 
in addition to the vesicular murmur, a sound produced by the trachea 
and glottis. This is not distinct from the vesicular sound, but is added 
to it, the result being that the respiratory murmur over the tubes is 
louder than elsewhere. The expiratory sound is weaker and shorter than 
the inspiratory—that is to say, the sound is not continued to the end of 
expiration, but dies away before that is reached. ... The ordinary 
murmur is best heard where the chest wallis thin. Ifthe ribs be covered — 
with fat or any great thickness of muscle, the sound may be entirely lost. 
It is also important to note that there are some chests perfectly healthy 
where, for no apparent reason, the respiratory murmur is obscure or even 
undetectable.” 


DISEASES OF THE RESPIRATORY ORGANS: HORSE 795 


Physical Signs obtained by Percussion—NorMAL PERCUSSION SOUNDS. 
—These are best marked over those parts least covered by soft tissues, 
and where the bronchial sounds are most distinct. 

On the Left Side—In the upper third, from behind the shoulder to 
the twelfth or thirteenth rib, the sound is clear, but after this there is a 
gradual lessening of sound. 

In the middle third the resonance is most marked from the sixth to 
the twelfth ribs, and diminishes to the fifteenth rib. 

In the lower third, over the fifth, sixth, and seventh ribs, the sound 
is very slight or may be absent. This is due to the space being occupied 
by the heart. From the seventh to the thirteenth ribs a slight resonance 
may be detected. 

On the Right Side.—In the upper third, from the shoulder to the thir- 
teenth rib, the percussion sound resembles that of the left side. Posterior 
to this, if percussion be executed with force, increased resonance is ob- 
served, probably due to the proximity of the double colon. 

In the middle third the resonance is similar to that obtained on the 
left side, but posterior to the fifteenth rib it becomes dull, owing to the 
proximity of the liver. 

In the lower third, as far as the seventh rib, the resonance corre- 
sponds to the left side. Posterior to this it is dull, because of the prox- 
imity of the liver. 

ABNORMAL PERcussIon Sounps—Increased Resonance.—T his may be 
general or partial. It is general in cases of extensive pulmonary emphy- 
sema (broken wind), also in pneumothorax. 

Partial increase of sound is observed when portions of the lung become 
hepatised in cases of pneumonia, or compressed by false membranes or 
pleural effusion in cases of pleurisy. The unaffected portions then, owing 
to extra functional activity, take in a greater amount of air than normally, 
hence the resonance over these areas is increased. 

Diminished Resonance, when general, may depend on pulmonary 
congestion, pulmonary cedema, the presence of a false membrane over 
the costal pleura or enveloping the lung itself, and interfering with the 
normal distension of the organ. 

Loss of Resonance is not general except in those cases of “‘ massive ”’ 
pheumonia sometimes met with, when a ‘“‘ wooden ”’ dulness is elicited 
by percussion. Absence of resonance may be due to hepatisation of the 
pulmonary tissue, or to pleural effusion. It is best marked in the latter . 
condition, and commences in the inferior part of the chest. 

Enlargement of the liver or spleen causes dulness over the portions 
of the thorax with which these organs are in proximity. 


796 SYSTEM OF VETERINARY MEDICINE 


Physical Signs obtained by Auscultation.—It is of importance to direct 
attention first to the normal respiratory sounds in connection with the 
auscultation of the chest. These include—(1) Tubal or bronchial sounds; 
(2) vesicular or respiratory murmur. 

Tubal or Bronchial—These are blowing and harsh in character. 
They begin and end abruptly, are about the same duration in inspira- 
tion and expiration, and are separated by a short but distinct pause. 
They depend on the air passing through the larger bronchi, and are 
detected by auscultating the breast over the lower end of the trachea, or 
the upper third of the chest immediately behind the shoulder. 

Vesicular or Respiratory Murmur.—This has already been described 
(see p. 794). It is best heard over the middle third of the chest, just 
behind the shoulder. 

Auscultation of the Chest—Lrerr Sipp—Upper Third.—Respiratory 
sounds loud and somewhat harsh, in consequence of being chiefly bronchial. 
The vesicular sounds are heard from the thirteenth rib, becoming fainter 
to the seventeenth rib. 

Middle Third —Vesicular sounds heard from fourth to sixth ribs, but 
are better marked to the ninth rib, and gradually diminish to the six- 
teenth rib. 

Lower Third.—Respiratory sounds replaced by the cardiac sounds 
over the fourth to the sixth ribs. Vesicular sounds heard over the seventh 
and eighth ribs, and are lost over the tenth rib. 

Rieut Sipe—U pper and Middle Third.—Similar to those on the left side. 

Lower Third.—Vesicular sounds clearly heard over fourth to seventh 
ribs, and diminish to the tenth rib. 

Abdominal Sounds.—These are of a gurgling character, and have no 
relation to the rhythmical respiratory action. They may be heard over 
_ the middle and lower third, and especially over the posterior part of the 
chest. 

Abnormal Respiratory Sounds.—T hese include modifications of normal 
sounds, and the presence of adventitious sounds. With regard to the 
former, the most important are—(1) Modifications in the bronchial 
sounds; (2) modifications in the vesicular murmur. 

1. MopIFICATIONS IN THE BRONCHIAL SounDs.—Bronchial breathing 
is heard over those parts of the chest where normally only the vesicular 
murmur is audible, in cases where the lung-tissue has ceased to contain air, 
such as consolidation in pneumonia; also in collapse or compression of the 
lung in cases of pleuritic effusion. In these instances the bronchial tubes — 
are surrounded by solid tissue, hence the sounds are well conducted, while 
any sounds which originate in the parenchyma are suppressed. 


DISEASES OF THE RESPIRATORY ORGANS: HORSE 797 


The bronchial sounds may be altered in character, and the modifica- 
tions are described as tubular, blowing, and cavernous. 

Tubular.—This is higher in pitch than the normal bronchial sound, 
and is heard to perfection over a hepatised lobe in pneumonia, and 
appears to be immediately beneath the part examined. 

Blowing breathing is less concentrated. The sounds appear to be 
produced at a distance and in a wider tube. 

Cavernous breathing is generally heard over cavities in the lung, such 
as occur in tuberculosis and circumscribed gangrene, but is also produced 
when solid tissue exists between the root of the lung and the surface. 
The sound resembles that made by blowing into a wide-mouthed vessel. 
The inspiratory and expiratory sounds are of a hollow, whiffing character, 
and lower pitched than in tubular breathing. 

Amphoric Echo is a metallic sound similar to that produced by 
blowing into an empty bottle. It occurs in cases of large cavities in the 
lungs, and in pneumothorax, but is rarely met with. 

2. MoDIFICATIONS OF THE VESICULAR MurnmMuR.—This murmur may be 
exaggerated or harsh over portion of a normal lung when another portion 
of the organ is compressed or solidified, or when the other lung is affected 
by the lesions mentioned. It is diminished in cases where feebleness of 
the movements of the thorax exists, such as conditions of weakness and 
prostration. In instances where the inspiratory act is attended by pain, 
such as in the early stages of pleurisy and in peritonitis, etc., the chest 
is not fully dilated, the respirations are short and quick, and the respira- 
tory murmur is also diminished. Absence or suppression of the vesicular 
murmur occurs in various morbid conditions, such as hepatisation of the 
lung in pneumonia and pleuritic effusion. In the latter case the absence 
of sound is observed in the lower part of the chest, and its level corre- 
sponds with that of the fluid. 

Adventitious Sounds.—In the majority of diseases of the lungs and 
pleure, during some part of their course the respiratory murmur is 
accompanied by certain adventitious sounds. These are known as— 
(1) Rhonchi, (2) Rales, and (3) Friction Sounds. 

Ruoncul, oR Dry Sounps.—These are sometimes termed “ dry 
rales.” They are continuous sounds, and accompany inspiration and 
expiration. According to their pitch, they are classified as sonorous and 
sibilant. 

Sonorous Rhonchi are low-pitched and of a cooing or snoring char- 
acter. 

Sibilant Rhonchi are high-pitched and of a whistling character. 

Rhonchi are produced by the passage of air through bronchial tubes 


798 SYSTEM OF VETERINARY MEDICINE 


which are narrowed or constricted at some point. The constriction may 
depend on various alterations in the bronchial tubes, such as the presence 
of viscid mucus, tumefaction of the bronchial mucosa, or contraction of 
the tubes, as in asthma. 

2. RAues, or Moist Sounps.—These include crepitation and various 
forms of moist rales. 

Crepitation, Crepitant or Vesicular Rales.—T hese terms are applied to 
the crackling or very fine sharp sounds heard during inspiration only, 
and usually towards the termination of the act. They may be imitated 
by rubbing a lock of hair between the fingers close to the ear. Crepi- 
tant rales are heard in the first stage of pneumonia, and also over an 
cedematous or collapsed lung. They depend on the sudden expansion 
of alveolar walls which have become glued together by viscid secretion. 
In this condition air can still enter the air-cells. 

Mucous Rdles, also known as “simple bubbling rales,” are of various 
sizes. They are produced in bronchial tubes or in cavities in the lung 
by the passage of air through serum, mucus, blood, etc., and are modified 
by coughing, thus differing from the crepitant rales. 

Subcrepitant Rdles are small in size, and are met with in capillary 
bronchitis. 

Submucous Rdles are medium in size. 

3. Friction Sounps.—These are detected in the early stages of 
pleurisy, and depend on dryness of the pleural surfaces and the deposi- 
tion of layers of lymph thereon. They vary from a slight grating sound 
to a crackling or creaking sound, and occur as a rule only with each 
inspiration, being best heard at the lowest part of the chest. They 
disappear when effusion takes place, but may reappear during the stage 
of absorption. They are never distinct in the horse, and are frequently 
overlooked. 

There are other adventitious sounds described as occurring in con- 
nection with pleurisy, such as “ metallic tinkling” and “ gurgling or 
splashing ” sounds, but they are seldom detected in the horse, and are 
of little clinical importance. 

With reference to the methods employed for auscultation, some prac- 
titioners prefer to depend on the unaided ear, others find the use of the 
stethoscope or phonendoscope more reliable. Whichever method be 
adopted by the student, it is necessary that he should be well acquainted | 
with the character of the respiratory sounds in normal animals before 
he commences to study the subject clinically. It is only by this means 
that he can detect abnormal conditions, and also prevent errors arising 
from imagining the presence of adventitious sounds. Generally speaking, 


DISEASES OF THE NASAL CAVITIES: HORSE 799 


the employment of the instruments mentioned gives more accurate 
results, but, like all instruments of precision, a long apprenticeship is 
necessary in order to become familiar with their use and to draw correct 
deductions. One of the greatest difficulties to overcome, especially in 
the case of nervous animals, is to render them quiescent during the ex- 
amination, and to prevent movement of the skin, as otherwise sounds _ 
are conveyed to the ear of the observer which may easily be mistaken 
for evidences of disease. Constant practice in the use of such instru- 
ments, however, will enable tolerably correct deductions to be drawn, 
although we can never expect in the larger animals to bring stethoscopy 
to the high degree of perfection which is attained in the case of the 
human subject. We may here draw attention to the necessity for a 
careful examination of the chest even in cases where symptoms sugges- 
tive of a pulmonary disease are not presented. As we shall point out 
when dealing with pneumonia, the usual symptoms of this affection may 
be absent, and a physical examination of the chest will alone give an 
indication of its existence. 

Palpation.—In some cases of pleurisy, in the early stages the friction 
produced between the pleuree may be manifested by vibration of the 
walls of the chest, which is perceptible to the touch. 

Firm pressure applied to the intercostal spaces over the, affected 
region in the early stages of pleurisy causes pain and even grunting; but 
it must be remembered that in nervous horses this manipulation is often 
resented, although the animals are perfectly healthy. 


DISEASES OF THE NASAL CAVITIES 
ACUTE NASAL CATARRH. 


Synonyms.—Coryza; Rhinitis. 

This in popular language is known as a “cold,” and is an affection 
of very frequent occurrence in the horse. The nasal mucous membrane 
becomes the seat of an acute catarrhal inflammation, which varies in 
degree and extent. It may occur as an independent affection, or it may 
precede or accompany other inflammatory conditions of the respiratory 
organs. 

Coryza is met with either in a mild form in which the catarrh is 
limited to the nasal mucosa, or as a severe attack in which the inflamma-_ 


¢ 


800 SYSTEM OF VETERINARY MEDICINE 


tion may extend to the pharynx or to the air-sinuses of the head, and is 
accompanied by febrile symptoms. 

Ertotoey.—Exposure to chills, sudden changes of surroundings, and 
rapid variations of weather, are usually regarded as mene factors in 
the etiology of coryza. 

But it is highly probable that the disease is of an infectious nature, 
depending, according to some authorities, on the presence of strepto- 
cocci. Any circumstances, such as chills, etc., tend to lower the vitality 
of the system, and thus permit micro-organisms to develop and exert 
their morbid actions. On clinical grounds, the infectious nature of the 
disease is established, as it is well known that if one case of coryza 
occurs in a stable, other horses therein are liable to become affected. 
Young horses from the country brought into town stables and put to 
hard work very frequently develop coryza. The affection is also com- 
mon in young horses taken up from grass for the purpose of being trained. 
Here we have the influences of ill-ventilated close stables, the subjection 
to exertion, and probable exposure to chills and also to infection, acting 
together. 

Coryza is also frequent in horses that have recently been in show- 
yards, and in those which have travelled a long distance by rail or boat, 
especially during inclement weather. Horses purchased at fairs and 
brought into dealers’ stables are very subject to the affection. No 
doubt infection in this instance also plays an important part. Coryza 
as a symptom is met with in strangles, pharyngitis, laryngitis, and in the 
catarrhal form of influenza. 

Symptoms.—In the mild form, the nasal mucous membrane is at 
first dry and congested, and a clear watery discharge soon appears from 
both nostrils. Later on, the discharge becomes more profuse, and is 
turbid in character, owing to increased mucous secretion and desquama- 
tion of epithelial cells. In a few days it assumes a purulent character. 
The animal snorts frequently. No constitutional disturbance is present. 

In the severe form, a slight degree of fever is present and partial loss 
of appetite. Lachrymation may also be observed, due to obstruction of 
the opening of the duct in the nostril by the inflamed mucosa. The 
inflammatory action may extend to the frontal sinuses, or through the 
lachrymal ducts to the conjunctive. The animal then shows a heavy 
appearance of the head, and symptoms of conjunctivitis. A varying’ 
degree of pharyngitis and laryngitis may be present, due to extension 
of the inflammation to the pharynx and larynx. This is evidenced by 
cough, difficulty in swallowing, and tenderness on palpation of the 
pharyngeal region. 


DISEASES OF THE NASAL CAVITIES: HORSE 801 


Coursrt.—This varies according to the severity of the attack. In 
mild cases, the nasal discharge becomes gradually lessened, and recovery 
takes place in from seven to ten days. 

Proenosis.—This is favourable, but in cases that are kept at work 
and exposed to chills, etc., other respiratory affections may develop. 
It must be remembered that nasal catarrh facilitates the entrance into 
the system of the micro-organisms of diseases such as influenza and 
pneumonia. 

Diaenosis.—Mild cases of the affection present little difficulty in 
diagnosis. In the severe forms, however, it may be difficult to decide 
whether the symptoms presented may not be precursory evidences of a 
more serious affection, such as strangles, and a guarded opinion should 
be given. It should be remembered that acute nasal catarrh may pre- 
cede or accompany other affections, and also that the presence of a nasal 
discharge may be a symptom of other affections than coryza. Careful 
attention should be paid to the history of the case, to the character of 
the nasal discharge, to its source, and to the other symptoms presented. 

In every instance it is advisable to isolate cases of coryza, so as to 
avoid any possible danger of infection. 

TREATMENT.—In the mild form, all the treatment necessary is prompt 
cessation from work, properly ventilated surroundings, freedom from 
draughts, suitable clothing in cold weather, light, easily digested diet, 
and the administration of simple salines, such as potassium nitrate and 
magnesium sulphate in the food or drinking-water.. Inhalations of 
steam medicated with terebene or oil of eucalyptus reduce the irrita- 
bility of the nasal mucous membrane, and assist in clearing the nasal 
passages. : 

In the severe form, accompanied by pharyngitis and laryngitis, a 
stimulating liniment may be applied to the pharyngeal region, and an 
electuary composed of extract of belladonna, potassium chlorate, and 
honey, may be administered on the back of the tongue. The febrile 
symptoms rarely require any special treatment beyond the simple salines 
already mentioned. A useful addition to the diet is hay tea and linseed 
gruel. We consider that the moderate dose of aloes advised by some 
authors in the treatment of this affection is not only unnecessary, but 
also may prove harmful, as such an agent may in this condition cause 
superpurgation, besides being productive of nausea. ‘There is no neces- 
sity for an elaborate course of treatment, as the affection tends to recover 
spontaneously. | 


VOL It. 51 


802 SYSTEM OF VETERINARY MEDICINE 


CHRONIC NASAL CATARRH. 


This may occur in a primary form as a sequel to an acute nasal catarrh, 
or it may develop as a secondary affection in connection with certain 
diseased conditions, in which instances it is in reality a symptom. 

Et1oLocy.—As a primary affection, chronic nasal catarrh may occur 
as a sequel to the acute form resulting from an intense and diffuse in- 
flammation of the nasal mucous membrane, or from repeated attacks of 
ordinary coryza. 

The affection varies in degree. In some cases it consists simply of 
a muco-purulent discharge from both nostrils, which may be intermittent, 
and yields in a variable time to local and general treatment. In others, 
the diseased condition is more persistent and the discharge more profuse, 
so that the affection is termed nasal gleet or ozewna. 

It is important to remember that nasal gleet may occur as an affec- 
tion of the nasal mucous membrane, in the absence of disease of the air- 
sinuses of the head or other allied disorders. As a secondary affection, 
in which form it is more common than as a primary one, chronic nasal 
catarrh may occur as a sequel to influenza, also in connection with diseases 
of the maxillary and frontal sinuses, or from a diseased molar tooth 
causing suppurative periostitis of the alveolar cavity; also in necrosis of 
the turbinated bones, or from tumours, foreign bodies, or parasites in the 
nasal cavities. It may also occur as a symptom of chronic debilitated 
conditions of the system, associated with anemia, and may be one of the 
symptoms of glanders. Cases are on record in which chronic nasal 
catarrh resulted from a physic ball, which was coughed up during ad- 
ministration, and lodged in the posterior nares. 

Symproms.—T he character of the nasal discharge varies according to 
the extent, intensity, and duration of the disease. In the primary form 
and in the milder cases the discharge may be intermittent and rather 
fluid, while in the more chronic instances it becomes of a white colour, 
thicker in consistency, and more continuous. Usually in the primary 
form the discharge issues from both nostrils, while in the secondary cases 
it may appear from one nostril only. It may be fcetid, especially in 
disease of the air-sinuses, and generally so in cases depending on the 
presence of a diseased molar tooth. In the secondary forms, an enlarge- 
ment of the submaxillary lymphatic gland on the affected side is not 
uncommon, 

Occasionally in cases of long standing ulcers may be found on the 
nasal septum. These are termed by some authors “erosion ulcers.” 


DISEASES OF THE NASAL CAVITIES: HORSE 803 


They vary in size, and are superficial, with sharp edges, and heal without 
a cicatrix resulting. 

The nasal mucous membrane may be either pale or cyanotic in ap- 
pearance, and in long-continued cases it may become thickened and 
show the presence of dilated veins. 

DIFFERENTIAL Dracnosis.—Considerable difficulty is experienced in 
deciding whether the affection depends on chronic disease of the nasal 
mucosa, or is secondary—.e., accompanying other affections. In many 
instances it will be found advisable to apply the Mallein test in order to 
exclude the possibility of the presence of glanders. A careful examina- 
tion of the mouth should be made, so as to detect the presence of a diseased 
molar tooth. An exploratory opening into the air-smuses may be neces- 
sary to complete the diagnosis (see p. 810). 

TREATMENT.—In the primary form of the disease both local and 
constitutional treatment are necessary. Inhalations of steam medicated 
with terebene or oil of eucalyptus may be tried. Nasal injections of 
astringent solutions, such as sulpho-carbolate of zinc, prove more useful 
in some cases, but the risk of the fluid entering the trachea and bronchi 
must be considered. 

If the nasal discharge be foetid, injections of weak solutions of car- 
bolic acid, cyllin, lysol, or iodine, are indicated. Strong solutions should 
be avoided, and care is necessary to prevent injury to the mucous mem- 
brane during the process of injection, and also to avoid the entry of the 
fluid into the trachea and bronchi. 

Constitutional treatment consists in the administration of tonics, 
preferably sulphate of iron with arsenious acid, 1 drachm of the former 
with 5 grains of the latter being given in the food twice daily. A nourish- 
ing diet and hygienic surroundings are important attributes to treat- 
ment. 


CHRONIC NASAL DISCHARGES. 


Chronic nasal discharges are by no means uncommon in the horse, 
and they may arise from so many causes that we consider it is useful to 
enumerate the most common of these, with a few remarks on the dif- 
ferential diagnosis of each. The differential diagnosis is dealt with more 
fully in the section dealing with the particular disease ; the present section 
is intended more as a reference table giving the outstanding features in 
each case. | 

It will be noted that only the causes of chronic nasal discharges are 
dealt with here. To save repetition, it may be said that in almost all 
such discharges, unless the cause is pretty evident, it is advisable to 


804 SYSTEM OF VETERINARY MEDICINE 


carry out the Mallein test. For this reason we have not included glanders, 
as this disease would be at once disclosed by this test. 

1. Chronic Catarrh of the Mucous Membrane of the Nasal Cavities. — 
Discharge usually bilateral, yellow or yellowish-white, and fairly thick. 
No striking difference in the amount of discharge according to the posi- 
tion of the head, but it is usually more profuse in the mornings. Non- 
foetid. Sometimes a cough and some snorting. Slight enlargement of 
submaxillary lymphatic glands on both sides. 

2. Chronic Catarrh of the Mucous Membrane of the Air-Cavities.— 
Discharge generally unilateral, yellow, and often clotted. Frequently 
comes in quantity when head is held low. Usually foetid. Snorting and 
cough usually absent. Enlargement of submaxillary gland on the 
affected side. Exploratory puncture by gimlet will reveal the source of 
the trouble. Percussion may reveal dulness, and in very severe cases 
there may be softening and bulging of the bone. 

3. New Growths in the Atr-Cavities—Symptoms usually similar to 
the previous, but on trephining the affected sinus it will be found more 
or less blocked by the new growth, and profuse hemorrhage may 
occur. 

4. Discharge due to Diseased Molars.—As the alveoli of most of the 
upper molars extend into the air-sinuses, any disease of the roots of these 
teeth will first induce a purulent condition of these sinuses before any 
nasal discharge is shown. The symptoms in many cases are indistin- 
guishable from discharge arising from a chronic catarrh of these sinuses, 
and the only diagnostic evidence will be that of the diseased tooth, which 
is found on examination of the mouth. Sometimes difficulty and pain 
in mastication are seen. In some cases particles of food find their way 
into the sinuses, and may be found in the nasal discharge. The dis- 
charge is usually fcetid, but not invariably so. There will be enlarge- 
ment of the glands of the affected side. 

5. Discharges arising from the Growth of .Tumours in the Posterior 
Nares.—A tumour usually excites an abnormal amount of secretion, 
which it may partially obstruct. The discharge is unilateral, and may 
be yellowish, mucoid, or purulent. Sometimes it is brownish, and may 
become fcetid. There is usually a good deal of snorting, and the passage 
of air will be more or less diminished, and sometimes quite blocked. A 
sound passed up the nostril is a useful aid to diagnosis. Usually enlarge- 
ment of gland on the affected side. 

6. Disease of the Turbinated Bones.—The discharge is purulent and 
foetid. It may come more profusely if the head be elevated. Very 
occasionally there may be some obstruction to the passage of air. It is 


DISEASES OF THE NASAL CAVITIES: HORSE 805 


usually unilateral, and there will be enlargement of the gland on the 
affected side. : | 

7. Foreign Bodies lodged in the Posterior Nares, such as a physic ball 
which has been coughed up. The symptoms will vary, but will be 
rather similar to those caused by tumours. 

8. Disease of the Guttural Pouches.—The discharge is purulent, and 
may be foetid. It is intermittent, and usually much increased when the 
head is depressed. There is generally a swelling in the parotid region, 
which, if pressed on gently, increases the flow of the discharge. The 
latter is generally unilateral, and the gland of that side will be enlarged. 
There may be a cough, and sometimes there is interference with respira- 
tion. It must be remembered that both pouches may be diseased, in 
which case the discharge may come from both nostrils. 

9. Abscess in the Lungs.—An open abscess in the lung may be an 
unsuspected cause of a nasal discharge. In this case the discharge will 
be bilateral (although frequently seen more on one side than the other), 
purulent, and foetid. It varies very much in quantity, and it is noticed 
that the breath stinks even when no discharge is present. There 1s 
generally some cough, which may be violent at times. There is usually 
no enlargement of the submaxillary lymphatic glands. Constitutional 
symptoms may be present or not. Generally speaking, when the nasal 
discharge is most free—i.e., when the abscess is discharging freely—the 
constitutional symptoms will be least marked. An interesting case of 
this kind was published in the Veterinary Record of August 16, 1913. In 
this case the discharge was present over twelve months, and there was 
no tendency on the part of the abscess to heal. 


CROUPOUS RHINITIS. 


Synonym.—Nasal croup. 

This form of intense inflammation of the nasal mucous membrane, 
usually accompanied by the formation of pseudo-membranes, is described 
by Continental authors as occurring in horses, and assuming at times an 
enzootic character. It is regarded in some cases as arising from violent 
irritation of the nasal mucosa from the inhalation of smoke during an 
outbreak of fire in buildings, but several observers believe that it depends 
on infection, the nature of which is yet unknown. Hutyra and Marek 
observed it in a case of streptococcic mastitis in a mare, and also in 
connection with purpura hemorrhagica and strangles. The lesions con- 
sist in the deposit of grey or reddish-grey pseudo-membranes on the 
mucosa, which are gradually removed by suppuration, leaving an ex- 


806 SYSTEM OF VETERINARY MEDICINE 


coriated surface, and resulting in the presence of a viscid nasal discharge. 
So far as we are aware, the disease has not been observed in Great Britain. 
The course is usually favourable, provided no complications are present, 
and the treatment advised is similar to that employed for acute coryza. 
Irrigation of the nasal passages with a 1 or 2 per cent. solution of car- 
bonate of soda is said to hasten the shedding of the false membranes. 


EPISTAXIS (HAXMORRHAGE FROM THE NOSE). 


This must be regarded in many instances as a symptom, as it occurs 
under a variety of conditions. It varies in degree from a trivial discharge 
of blood to a profuse hemorrhage. The term is usually applied to a 
hemorrhage from the vessels of the nose, or from those of the accessory 
nasal cavities. 

EtioLoay—l. Traumatic Causes——Injuries or contusions of the 
nasal region, or of the air-sinuses of the head, or fractures of bones in 
this vicinity. 

2. Eaucessive Congestion of the Nasal Mucosa, such as may occur in 
plethoric animals. 

3. Violent Exertion, such as racing, or a quick run with hounds. 

4. New Growths in the Nasal Cavities, such as adeno-fibromata, car- 
cinomata, etc. The hemorrhage results from rupture of small vessels, 
owing to the friable nature of their walls. 

5. Epistaxis may have its origin in the lungs—e.g., rupture of a pul- 
monary blood vessel—or it may occur in very acute pulmonary congestion. 

6. Epistaxis may be met with in certain diseases—e.g., purpura 
hemorrhagica. It may also occur in glanders, being evidenced by a 
hemorrhagic nasal discharge. Occasionally it is one of the symptoms 
accompanying acute cerebral congestion. 

7. Rare causes include the presence of angiomata, laceration of the 
pharyngeal artery, or of the internal carotid or internal maxillary artery. 

8. Cases occur in which the etiology is obscure. 

Symptoms.—The hemorrhage may be slight, occurring in drops or in 
a small stream, or, when depending on traumatic causes, it may be pro- 
fuse. Usually the hemorrhage proceeds from one nostril, occasionally it 
appears from both. It may be continuous or intermittent. The blood 
is usually arterial in character, and the clots which form around the 
nostrils are expelled by the act of snorting, which frequently occurs. 

When the hemorrhage proceeds from the lungs, it is profuse, frothy 
in character, bright. red, and accompanied by coughing, and there may 
be marked respiratory distress (see Hemoptysis, p. 859). 


DISEASES OF THE NASAL CAVITIES: HORSE 807 


Draenosis is difficult in cases where blood from the nasal passages 
enters the pharynx, trachea, and bronchi, as cough is then induced, and 
the blood expelled may be foamy in character. 

TREATMENT.—In slight cases the haemorrhage generally ceases spon- 
ta.ieously. When the flow of blood is persistent and profuse, astringent 
nasal injections may be carefully carried out, such as a solution of alum 
(3ss. to Oi. of water). Hazeline is also useful for this purpose, and solu- 
tion of peroxide of hydrogen has also proved of value. Solutions of 
adrenalin may be tried either locally or subcutaneously. Ergotin given 
by subcutaneous injection is also advised. The horse’s head should be 
kept in an elevated position, but care should be taken to release the head 
should the animal cough, otherwise the blood may enter the trachea or 
bronchi, and produce serious consequences. 

Plugging the affected nasal cavity with a pellet of tow soaked in an 
astringent solution is advised by some authorities, but we have always 
found that after this procedure the hemorrhage is diverted to the other 
nasal cavity, and obviously it is not possible to plug both, as suffocation 
would result. To obviate this, it is advised that in serious cases, when 
both nasal cavities require plugging, a small rubber tube should be placed 
in the centre of each of the pellets of tow, so as to permit of respiration 
being carried on, or tracheotomy may be performed as an alternative. 

When the hemorrhage proceeds from injuries to the nasal cavity or 
to the air-sinuses of the head, with fracture of the overlying bones, tre- 
phining may be necessary, and the bleeding can then be controlled by 
the application of pledgets of tow soaked in compound tincture of benzoin. 
In such cases, the operation should be carried out with the animal in the 
standing posture, so as to avoid the danger of blood being drawn into 
the bronchi. This can be accomplished by the use of local anesthesia. 
For the treatment of hemoptysis, see p. 861. 


NEW GROWTHS IN THE NASAL CAVITY. 


Nasal Polypi.—These belong to the class of fibromyxomata. They 
may be attached to the mucous membrane either by a pedicle or by a 
broad base, and vary in size, in some instances forming a mass which 
fills the nasal chamber of one side, so as to obstruct the passage of air. 
They may exert pressure on the surrounding bones and septum, and 
cause displacement of the turbinated bones on the affected side. Occa- 
sionally by their growth they may perforate the hard palate, or may 
extend to the pharynx, and in some instances their surface shows ulcera- 
tion and sloughing, giving rise to a foetid nasal discharge. 


808 SYSTEM OF VETERINARY MEDICINE 


Symptoms.—Frequent snorting and the presence of a chronic nasal 
catarrh on the affected side are observed, and the discharge may be 
purulent, hemorrhagic, or fetid. Respiration is accompanied by a 
snoring, wheezing sound, and on the affected side the passage of air will 
be found obstructed to a more or less extent, depending on the size of 
the polypus. This defect can be detected by placing the hand in front of 
the affected nostril, or by closing the nostril on the sound side dyspneea 
will be produced when the obstruction is complete in the affected nasal 
chamber. The polypus may be rendered visible by careful examination 
of the nasal chamber in a good light, or it may be detected by digital 
examination. 

When situated beyond reach of vision or manipulation, the diagnosis 
must be based on the dulness elicited by percussion of the nasal and 
frontal bones, and on the interference with the passage of air through 
the affected nostril. The use of a fine gum-elastic bougie passed care- 
fully up the obstructed nasal cavity will also assist in the differential 
diagnosis. 

TREATMENT.—This 1s essentially surgical, and for details of the 
operation necessary the reader is petomred to works on veterinary 
surgery. 

Fibromata may occur in the form of flat proliferations of the nasal 
_ mucosa, and give rise to chronic nasal catarrh and narrowing of the nasal 
cavity on the affected side. 

Carcinomata and Sarcomata are occasionally met with, and may 
produce symptoms similar to those of nasal polypi. They may per- 
forate into the mouth and pharynx. The nasal discharge is usually 
foetid, and hemorrhage from the nostril is frequent. The submaxillary 
lymphatic gland on the affected side is often swollen. We have met 
with a case of carcinoma where the tumour, small in size, was situated 
inside the nostril at the junction of the skin and mucous membrane. 
Frequent slight attacks of hemorrhage occurred, and after removal] of 
the growth recurrence did not take place. This, however, is exceptional, 
as in most cases of these malignant growths operative measures fail to 
prevent a recurrence. 

Angiomata.—These may affect the nasal septum or the mucous mem- 
brane covering the turbinated bones. They originate from dilatation of 
the vessels, and also from new growth of the vascular tissue. They are- 
not sharply defined, and their centre is of a bluish-red colour. The 
results of the lesion are a tendency to hemorrhage during exertion, 
ulceration, and a hemorrhagic nasal discharge. When the ulcers heal. 
a scar or cicatrix remains. 


DISEASES OF THE AIR-SINUSES: HORSE 809 


In order to differentiate the condition from glanders, the Mallein test 
must be carried out. Other new growths are occasionally met with in 
the nasal cavities, and for a description of these the reader is referred to 
works on veterinary pathology and surgery. 


DISEASES OF THE AIR-SINUSES OF THE,HEAD. 


A catarrhal inflammation, followed by the formation of pus in the 
sinuses, is of comparatively common occurrence in the horse. The superior 
maxillary sinus is more usually the seat of the disease, the inferior max- 
illary and the frontal being next in order, while the sphenoidal sinus is 
rarely affected. As a rule the affection is unilateral, so that the chronic 
nasal discharge occurs from one nostril. 

Kt1oLtocgy.—The most common cause is extension of an intense in- 
flammation from the nasal cavity to the smus. Another cause is a diseased 
molar tooth, the inflammatory process extending from the alveolus to the 
sinus. Amongst other etiological factors may be mentioned depressed 
fractures of the superior maxillary or frontal bones, and occasionally the 
presence of foreign bodies or new growths in the sinuses, such as car- 
cinomata. In some instances glanders may extend to this region. 

The inflammatory thickening of the mucous membrane partially 
obstructs the communication between the sinus and the nasal cavity. 
so that pus accumulates in the former, as only a small portion escapes 
by way of the nostril. The accumulated pus becomes thicker in con- 
sistency, and may undergo decomposition, giving rise to a foetid nasal 
discharge. Again, the pus may form between the mucous membrane 
and the overlying bone, so that the latter becomes thinned, and bulges 
over the region of the sinus. 

In cases depending on a diseased molar tooth, aes of food may 
enter the sinus by way of the alveolus. Occasionally, from the irritating 
effects of the discharge, erosions or ulcers may form on the nasal mucosa. 

Symptoms.—The most prominent symptom is the presence of a nasal 
discharge, which is usually unilateral, and varies in character and amount. 
The colour may be yellowish-white or white, and it may be feetid or 
without odour. Usually it is persistent, but at times it may be inter- 
mittent. It is more profuse when the head is depressed. 

Percussion applied over the affected sinus reveals dulness and tender- 
ness. If, however, there be only a moderate amount of pus present, 
evidences of dulness may be absent. The eye on the affected side may 
show dulness and a watery discharge. In cases of old standing we may 


810 SYSTEM OF VETERINARY MEDICINE 


observe bulging of the bones over the affected sinus, also swelling or 
induration of the submaxillary lymphatic glands of this side. 

CoursE.—This is chronic, and the disease may continue for an un- 
limited period. In rare instances the inflammation may extend to the 
brain and the meninges, purulent meningitis resulting. 

DIFFERENTIAL D1aGNnosis.—In many instances it is advisab'e to 
apply the Mallein test, so as to determine the existence or otherwise of 
glanders. An exploratory opening into the sinuses by means of a gimlet 
may be necessary in order to detect the presence of pus. A careful 
examination of the molar teeth should always be made, as a diseased 
molar is often the cause of the disease. 

TREATMENT.—The only radical treatment is to trephine the affected 
sinus, so as to give free exit to the pus, and to permit thorough irriga- 
tion. For details of the operation, consult works on veterinary surgery. 
When a diseased molar tooth is present, it must be extracted, and a 
communication established between the sinus and the alveolus. Con- 
stitutional treatment is usually indicated, such as a course of iron com- 
bined with arsenic. Attention to the hygienic surroundings of the 
animal is imperative. 


DISEASES OF THE TURBINATED BONES. 


This may result from long-continued nasal catarrh, from disease of 
a molar tooth, and from fracture of the nasal bones. Occasionally it 
may follow an attack of strangles or purpura hemorrhagica. The in- 
flammation is of a suppurative character, and necrosis may result. The 
anterior turbinated bone is more frequently affected than the posterior. 

The symptoms observed are a chronic purulent foetid nasal discharge, 
and obstruction to the passage of air through the affected side, due to 
bulging of the diseased bone into the meatus. Owing to the pus gravi- 
tating to a sac at the lower end of the bone, the nasal discharge may be 
more marked when the horse’s head is raised. The disease may extend 
to the nasal bones, causing them to appear prominent. The ethmoid 
bone and the nasal septum may also become involved. Respiration 
may be accompanied by a marked snoring sound. : 

TREATMENT.—This is essentially of a surgical nature, consisting of 
trephining of the nasal fossa, removal of the diseased parts of the bone, 
and thorough irrigation of the affected region. See works on veterinary 
surgery. 


DISEASES OF THE GUTTURAL POUCHES 811 


MYXOID DEGENERATION OF FACIAL AND TURBINATED BONES. 


This affection is described by Continental authors as occurring in 
foals, but the cases we observed were in yearlings. The symptoms are 
as follows: A muco-purulent nasal discharge, a loud snoring sound accom- 
panying respiration, marked deformity of the frontal and superior 
maxillary bone of one side, consisting of a bulging or protrusion. These 
bones become very thin at the most prominent part, and on employing 
the trephine the instrument sinks through, and a large amount of yellow- 
coloured mucoid material containing fibrin-like coagula flows from the 
opening. The frontal sinus is greatly enlarged, and in some cases its 
walls are changed into a friable tissue. Enlargement of the turbinated 
bones and complete occlusion of the nasal passages are observed in long- 
standing cases. 

TREATMENT.—Harly surgical measures are indicated, and consist of 
trephining the affected sinuses, and irrigation with antiseptic solutions 
when the animal is on his feet. In long-standing cases treatment is not 
likely to prove successful. 


DISEASES OF THE GUTTURAL POUCHES. 


CHRONIC CATARRH OF THE GUTTURAL POUCHES (COLLECTIONS 
OF PUS IN THE GUTTURAL POUCHES). 


This is by no means a common affection. It is usually unilateral, 
and results as a sequel to catarrh of the pharyngeal cavity, such as occurs 
in pharyngitis and strangles. The catarrhal inflammation extends up 
the Eustachian tubes from the pharynx to the guttural pouches (the 
opening of these tubes into the pharynx is at the anterior extremity of 
the guttural pouches, and close to the posterior nares). The nasal dis- 
charge which results is chiefly observed when the horse’s head is depressed, 
as the escape of the pus is thus favoured. If at any time the discharge 
does not escape readily from the guttural pouch, the purulent contents 
tend to become inspissated. In some instances the contents undergo 
decomposition, gases are generated, and tympanites of the guttural 
pouch results (see p. 813). Occasionally, in cases of long standing, the 
contents-‘may be transformed into one or several caseous or firm masses 
of various sizes. These are sometimes termed ‘“‘ chondroids ”’ (see p. 812). 
Hutyra and Marek found in exceptional cases that the guttural pouch 


812 SYSTEM OF VETERINARY MEDICINE 


was filled with a serous fluid. Occasionally, also, food may enter the 
guttural pouch by way of the Eustachian tube. 

Symptoms.—The nasal discharge is usually unilateral and inter- 
mittent, an increased flow occurring when the head is depressed. The 
discharge may be purulent, muco-purulent, or foetid in some cases. The 
submaxillary lymphatic gland is enlarged on the affected side. A 
swelling may appear in the region of the parotid gland. This may 
fluctuate in some cases, and if pressure be applied thereto, an increase 
in the nasal discharge is induced. 

When tympanites of the guttural pouch is present, the swelling is 
elastic to the touch, and tympanitic if percussed: 

Amongst other symptoms which may be present are a cough and a 
roaring sound accompanying respiration. In extreme cases, with much 
distension, dyspnoea and difficulty in swallowing may result, and occa- 
sionally an opening may occur at the inferior border of the parotid gland, 
from which the discharge issues. The pressure on the larynx may be so 
extreme as to cause stenosis of this organ, and attacks of dyspneea, 
especially if the pouch becomes tympanitic. 

Occasionally ulceration occurs in the pouch, and the contents may 
escape through the pharynx and nostril. 

Paralysis of the pharynx, unilateral epistaxis due to ulceration, and 
aspiration pneumonia depending on difficulty in deglutition, have been 
observed as complications. 

CoursE.—This is chronic, and the disease may sii for an in- 
definite period. 

DIFFERENTIAL Diacnosis.—The diagnosis will present considerable _ 
difficulty when there is an absence of swelling in the parotid region. In 
order to exclude the possibility of glanders being present, the Mallein 
‘test should be applied. To differentiate the affection from an accumula- 
tion of pus in the air-sinuses, an exploratory opening into the latter may 
be necessary. From post-pharyngeal abscess the affection is differen- 
tiated by an examination of the pharynx. In the former instance a 
distinct fluctuating swelling will be found by manual examination of this 
region through the mouth. 

TREATMENT.—This is purely surgical, and the technique will be found 
in works on veterinary surgery. 


CHONDROIDS OF THE GUTTURAL POUCH. 


Hepburn* reported a case of this interesting condition in a Clydesdale 
gelding. The animal suffered from a persistent nasal discharge which 


* Meeting of the North of Scotland Veterinary Medical Society, vide Veterinary 
Record, November 1, 1913. 


DISEASES OF THE GUTTURAL POUCHES 813 


followed an attack of influenza. The symptoms, in addition to a slight 
bilateral muco-purulent nasal discharge, more particularly from the left 
side, were unthrifty condition, slight pain and swelling detected by pal- 
pation of the left parotid region, and an occasional cough. A diagnosis 
of chronic catarrh of the guttural pouch, with formation and retention 
of pus therein, was given. 

After two months, an intermittent discharge from the left nostril was 
observed; the swelling had disappeared. On careful examination, a 
slight sound was detected during inspiration, more marked during feed- 
ing. After drinking water, a few clots of muco-purulent material came 
down the left nostril. On opening the pouch, a quantity of chondroids 
weighing about 30 ounces was discovered, and removed by frequent 
irrigation. The animal made a complete recovery. The point of clinical 
interest in the case was the inability to detect some traces of the large 
amount of material, especially as repeated examinations were made in 
the endeavour to ascertain the presence of some substance in the pouch. 


TYMPANITES OF THE GUTTURAL POUCH. 


This may occur from the development of gases owing to decomposition 
of the contents of the pouch in chronic catarrh of the structure. Accord- 
ing to Friedberger and Frohner, tympanites of the pouch may be met 
with as a primary affection in foals, owing to anomalies of construction 
in the Eustachian tube, which permit an abnorma! amount of air to 
enter and to accumulate in the pouch. According to Thomassen, this 
anomaly consists in the presence of folds of mucosa, which close like 
valves. Gerlach and Dieckerhoff state that the affection probably depends 
on paralysis of the muscles of the Eustachian tube, so that active dilata- 
tion ceases, and air accumulates in the pouch. As already mentioned, 
the condition may be associated with chronic catarrh of the pouch (see 
p. 811). , 

Symproms.—A swelling of a puffy elastic character is observed in the 
parotid region. It is tympanitic to percussion, and may be unilateral 
or bilateral. If subjected to pressure, a decrease in size may be pro- 
duced, accompanied by a distinct sound, and in severe cases a roaring 
sound may result from palpation. Dyspnoea is present, and in some 
cases dysphagia is observed. 

TREATMENT.—This is a surgical procedure, and for the technique of 
opening the guttural pouch the reader is referred to works on veterinary 
surgery. 


814 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE LARYNX. 
ACUTE LARYNGITIS. 


Synonyms.—Inflammation of the mucous membrane of the larynx; 
Catarrhal laryngitis. 

This may occur as an independent affection, or it may be associated 
with pharyngitis. It may also accompany other diseases, such as influ- 
enza, strangles, tuberculosis, etc. The term “sore throat ”’ is sometimes 
applied to laryngitis, but it would be more correct to limit its application 
to pharyngitis. However, acute laryngitis is very frequently associated 
with pharyngitis, and it is not easy to differentiate the two affections. 
On the other hand, acute pharyngitis may occur as a separate and dis- 
tinct affection without the larynx being involved, and a differential 
diagnosis can sometimes be made (see p. 39). Acute laryngitis shows 
various degrees of intensity, and it assumes a very serious character 
when the rima glottidis and epiglottis are involved. 

EtrioLocy.—The effects of chills, exposure to cold and wet, sudden 
changes of surroundings, the influence of ill-ventilated insanitary stables, 
etc., are generally regarded as causes of acute laryngitis. It is highly 
probable, however, that the affection is microbial in character, and that 
the above-mentioned causes act by lowering the vital resistance, and thus 
permit micro-organisms to exert their effects. The disease may also 
follow an attack of acute nasal catarrh, or may accompany pharyngitis. 

Some outbreaks of influenza are characterised by the appearance of 
acute laryngitis as the chief lesion present. It is also a prominent con- 
dition in cases of strangles. The disease may also arise from the inhala- 
tion of irritating fumes, such as smoke resulting from the occurrence of 
fires in stables. 

Morsip Anatomy.—The laryngeal mucous membrane is swollen, and 
may show ecchymoses. The exudation may be muco-purulent in char- 
acter, and in very severe cases the epithelium may be removed, and 
superficial erosions result. When the epiglottis and glottis (or, more 
correctly, the structures which form the glottis) are involved by cedema, 
the mucous and submucous coats are infiltrated and thickened by : 
exudation. The process may extend to the connective tissue on the 
external aspect of the larynx, causing an extensive swelling in this region. 

Symproms.—In ordinary cases, the symptoms usually observed are 
cough, difficulty in swallowing, tenderness evinced on manipulation of 


DISEASES OF THE LARYNX: HORSE 815 


the region of the larynx, the presence of a muco-purulent nasal discharge, 
and extension of the head on the neck to a degree varying with the 
severity of the case. The cough in the earlier stages of the disease is 
of a dry, hard character, and is apt to occur in paroxysms, especially 
when attempts are made to swallow solids or liquids. Later on, it assumes 
a softer character. In severe cases a wheezing or roaring sound accom- 
panies respiration, due to extensive swelling of the laryngeal mucous 
membrane, the head is protruded to a marked extent, the external 
region of the larynx is swollen, there is marked dysphagia, fluids are 
returned by the nostrils, and attempts to swallow produce violent 
fits of coughing. These latter symptoms depend on the occurrence 
of pharyngitis as a complication, probably also the passage of food 
or fluid over the inflamed epiglottis causes irritation, and assists in the 
process. 

When cedema of the glottis is present we observe, in addition to the 
above symptoms, marked difficulty in respiration an anxious expression 
of countenance, and, unless relief be obtained, asphyxia is liable to occur. 
In some cases spasm of the larynx may appear, which is evidenced by 
sudden attacks of dyspneea of an intermittent character, with dilated 
nostrils and lividity of the visible mucous membranes (see p. 818). A 
varying degree of fever accompanies the severe form of laryngitis. _ 

Course.—In ordinary cases the symptoms may continue from a 
week to ten days, the improvement being gradual. The difficulty in 
swallowing and the cough disappear. 

In severe cases sequel are not uncommon, such as chronic laryngitis, 
whistling, and roaring. A common sequel is a hard cough, which often 
persists for a long period in spite of treatment. 

Proenosis.—In severe cases prognosis must be guarded, as cedema 
of the glottis may supervene and prove dangerous to life. The owner 
of the animal should be informed of the necessity of carefully watching 
the patient, so that professional aid may be forthcoming when serious 
symptoms arise. 

DiFFERENTIAL Diacnosis.—It is not always easy to differentiate 
laryngitis from pharyngitis. Most of the severe cases of the former are 
associated with the latter affection. For the distinguishing features of 
pharyngitis, see p. 39. 

As acute laryngitis is a frequent symptom of strangles and influenza, 
considerable difficulty is experienced in deciding in the early stages 
whether we are dealing with a disease of the larynx per se or otherwise. 

It is not uncommon to find the disease known as “ strangles ” to occur 
without the formation of an abscess, the prominent symptoms being 


816 SYSTEM OF VETERINARY MEDICINE 


those of acute laryngitis, or the abscess may not develop until the acute 
stage has passed. Hence the importance of a guarded diagnosis and 
isolation of the case, so as to prevent strangles spreading to other horses 
in the same stable. In influenza the febrile symptoms are usually more 
marked and the debility greater, but in view of the difficulty of a dif- 
ferential diagnosis, the most advisable course to adopt is to isolate all 
cases of acute laryngitis. | 

TREATMENT.—Attention to hygiene and dietetic details is necessary. 
The animal should be removed from work as early as possible. The diet 
should be of a soft nature and easy of digestion, such as bran mashes, 
linseed tea, oatmeal gruel, hay tea, etc. In mild cases, inhalations of 
steam medicated with terebene or oil of eucalyptus, the administration 
of potassium chlorate in the drinking-water, and the application of a 
stimulating liniment to the external region of the throat, comprise all 
the treatment that is necessary. 

In severe cases, presenting dysphagia and difficulty in respiration, 
experience has proved that the application of a cantharides blister to the 
region of the throat is the most advisable treatment. This relieves the 
difficulty in swallowing, the cough, and the respiratory distress. We 
have found that, in addition to the blister, the application of a thick 
layer of kaolin and glycerine heated to the proper temperature assists 
in relieving the symptoms. 

An electuary composed of belladonna, potassium chlorate, camphor, 
etc., with honey as a basis, should be administered on the back of the 
tongue three times daily. On no account should drenches be adminis- 
tered, as in consequence of the violent fits of coughing induced by the 
process some of the fluid is hkely to enter the bronchi and set up broncho- 
pneumonia. When evidences of marked respiratory distress are present, 
tracheotomy should be performed. The indications for this operation 
should not be overlooked, more especially in cases that are a long dis- 
tance from the practitioner. In such it is preferable to perform the 
operation early when respiratory distress is present, so as to avoid the 
risk of asphyxia occurring from sudden cedema of the glottis. 


CHRONIC LARYNGITIS. 


This may occur as a sequel to an acute attack of laryngitis. A sub- ' 
acute form is also met with. Both forms are not uncommon as sequels 
to strangles and influenza. As rare causes of chronic laryngitis we may 
mention the presence of various tumours in the larynx, polypi, etc., also 
clanderous and tuberculous lesions. 


DISEASES OF THE LARYNX: HORSE 817 


Symproms.—A persistent cough, which is of a dry, hard character, 
and occurs in paroxysms, is observed. It may be accompanied by a 
nasal discharge, often of a whitish colour, increased by exercise, and 
during feeding. In some cases improvement may be observed for a 
few days, followed by a renewal of the symptoms. In the subacute 
cases temporary “whistling”? may be noticed when the horse is 
galloped. 

The Course of chronic laryngitis is variable. Some cases recover 
after an indefinite period, others terminate in permanent “ whistling” 
or roaring. Chronic cough and pulmonary emphysema may also occur 
as sequels. 

TREATMENT.—The affection is often very resistant to treatment. A 
cantharides blister should be applied to the region of the larynx. Medi- 
cated inhalations of steam sometimes prove useful. The internal ad- 
ministration of arsenic, sulphate of iron, and potassium iodide, often 
gives good results. In cases characterised by severe paroxysms of 
coughing, a mixture of heroin in glycerine may be given in the food or 
as an eélectuary. Tar-water, substituted for the ordinary drinking-water, 
is also useful. 


CROUPOUS LARYNGITIS (CROUP). 


This is described by some authors as occurring in the horse, but others 
state that it is a very rare affection in this animal. We have never met 
with a case of the disease, or at least we have never recognised one as 
such. It is said to occur as the result of inhalation of smoke during 
conflagrations in stables, and also as an infectious malady of undeter- 
mined etiology. According to Hutyra and Marek, it may be observed 
as a secondary condition in cases of purpura hemorrhagica. 

The characteristic lesions are situated in the larynx and trachea, and 
consist of the formation of false membranes of varying thickness, which 
may form complete casts of the larynx and trachea. The underlying 
mucous membrane is swollen, congested, and may show purulent infiltra- 
tion. , 

The symptoms resemble those of a very acute laryngitis, but are 
specially characterised by their sudden mode of appearance, marked 
constitutional disturbance, high fever, great respiratory distress, and the 
presence of various abnormal sounds accompanying respiration. In 
favourable cases the false membranes may be detached in from three to 
four days, and are either coughed up in portions through the nostrils, or 
swallowed. In severe cases death may occur in a few days from asphyxia. 
Spasm of the laryngeal muscles has also been observed. 

VOL, IL. | 52 


818 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—Similar treatment to that advised for acute’ laryngitis. 
may be adopted. The local application of a solution of nitrate of silver 
(10 grains to 31.) is recommended, but is difficult to apply. Tracheotomy 
should be performed early, should symptoms of dyspnoea occur. 


GEDEMA OF THE LARYNX. 


SynonymM.—Cidema of the glottis. 

This is an cedematous condition of the laryngeal mucous membrane. 
The submucous connective tissue is affected by an oedematous swelling, 
due to an extensive serous exudation. In some cases a suppurative in- 
flammation results. The effect of the lesion is to cause partial or com- 
plete closure of the glottis. 

Errotogy.—It may occur during the course of a very acute attack 
of laryngitis or severe pharyngitis, also in cases of purpura hemorrhagica, 
anthrax, etc. A hyperemic cedematous condition of the larynx depend- 
ing on cardiac, pulmonary, and renal affections, is also recognised. In- 
juries to the soft palate and pharynx, such as wounds inflicted by ad- 
ministering a bolus by means of a pointed stick or the administration of 
irritating drugs not sufficiently diluted, may also be causes of oedema of 
the larynx. The usual seat of the lesion is the upper region of the larynx, 
as here the mucous membrane is more loosely attached than in the lower 
parts of the organ. 

Symptoms.—The prominent symptoms appear rather suddenly, con- 
sisting of extreme dyspnea, stertorous breathing, anxious expression of 
countenance, swelling in the region of the throat, and, if BEES relief is 

not given, death occurs from asphyxia. 

In cases depending on hypereemic cedema the course of the disease is 
slower. 

TREATMENT.—This has already been referred to under the heading 
of Acute Laryngitis. Usually the operation of tracheotomy is indicated. 


SPASM OF THE LARYNX. 


This is a condition described by Cadéac as occurring in the horse. 
The laryngeal muscles are affected by tonic spasms, and these latter are 
believed to depend on irritation of the terminations of the superior 
laryngeal nerve. | 

According to this author, the irritation may depend on various factors, 
as follows: Pedunculated tumours situated at the base of the tongue or 
in the inferior region of the pharynx may, during deglutition or inspira- 
tion, project into the opening of the glottis, irritate the terminal] filaments 


DISEASES OF THE LARYNX: HORSE 819 


of the superior laryngeal nerve, and bring about a reflex spasmodic con- 
striction of the larynx. 

According to some authors, in unilateral paralysis of the larynx 
attacks of suffocation may occur depending on spasmodic contraction of 
the unaffected muscles. The mechanism of this is complex. Laryngeal 
hemiplegia induces dyspnoea, as deoxygenated blood acts as a stimulant 
to the respiratory centre. Again, particles of mucus retained in the 
larynx may in a reflex manner cause irritation of the motor filaments of 
the superior laryngeal nerve. 

Amongst other causes recognised are the inhalation of smoke from 
burning buildings, and lathyrism (poisoning by the Lathyrus sativus). 

Symproms.—These appear suddenly. The head is extended, the 
nostrils dilated, the mouth open, the respiratory movements cease, the 
countenance is anxious, trembling of the muscles is observed, the animal 
falls, clonic convulsions occur, and death may result from asphyxia in 
afew minutes. Cases are recorded in which several attacks have occurred 
separated by intervals of one or a few days. Delwart met with an 
instance in which attacks appeared each time the horse was trotted. 

TREATMENT.—Tracheotomy is indicated to prevent asphyxia. In 
order to arrive at a correct diagnosis, laryngotomy must be performed; 
and if a pedunculated tumour cause the condition, it must be extirpated. 


NEOPLASMS OF THE LARYNX. 


These are of comparatively rare occurrence. Cysts may occasionally 
develop on the anterior surface of the epiglottis, and more rarely under 
the cricoid cartilage. Fibromata, lipomata, carcinomata, melanomata, 
lympho-sarcomata, are regarded as very rare. Hepburn reported a case 
of a tuberculous laryngeal tumour in a five-year-old Clydesdale mare.* 
The lesion was associated with tuberculosis of the lungs and intestines. 

Symptoms.—These will depend on the seat and on the form of the 
neoplasm. A pedunculated tumour,causes attacks of dyspnoea, as it is 
likely to be aspirated at intervals between the vocal cords, and to become 
displaced therefrom by a fit of coughing. Tumours on the epiglottis 
interfere with respiration and deglutition, and induce attacks of coughing, 
especially when the animal is drinking. Dyspnoea and a roaring sound 
accompany some forms of laryngeal tumours. 

Diagnosis is attended with considerable difficulty. In some cases it 
may be possible to detect the tumour by an internal examination of the 
larynx. The history of the case may prove of assistance. In some 
instances an exploratory laryngotomy is necessary. 


* Vide Veterinary Record, November 1, 1913. 


820 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—T his is essentially surgical, and the technique will be 
found in works on veterinary surgery. 


WHISTLING. 


This may be defined as a sound of a “‘ whistling” character of various 
degrees of intensity, depending on an abnormal condition of the larynx 
or nasal cavities, and emitted when the horse is submitted to exertion. 
Some authors describe “‘ whistling” and “ roaring’ together, as if the 
terms signified modifications of one affection. With this view we cannot 
agree, for although we admit that many whistlers ultimately develop into 
roarers, still we also know from experience that quite as many “ whistlers ”’ 
remain in this condition, do not become roarers, and prove useful all 
their lives. Again, we know that a horse may develop roaring in a short 
space of time without ever having shown any previous evidences of 
whistling. 

Although we meet with many instances in which whistling may be 
of such a character and intensity that it is not an easy matter to draw 
the border-line between it and roaring, still from a practical point of view 
it is necessary and desirable to make a distinction between the two con- 
ditions. A whistler of moderate degree is capable of practical utility, 
whether as a hunter or for harness work; while a roarer may be unfit for 
either work, in consequence of the marked distress evinced on exertion, 
and the disagreeable character of the sound. No doubt there are many 
roarers affected to a moderate extent which are capable of doing harness 
work, but in the large majority of cases the affection tends to become 
ageravated, especially if the animal is attacked by laryngitis or influ- 
enza. 

The subject of whistling is a most important one to the practitioner 
with reference to the examination of horses as to soundness and in con- 
nection with questions of jurisprudence, hence it is necessary to discuss 
the matter fully. 

Whistling varies in character, pitch, and degree. In some cases the 
sound is very faint, is only emitted after severe exertion, and requires 
considerable training of the ear on the part of the examiner to detect it. 
In other cases the sound is of a shrill character—a veritable whistle— 
which is readily heard even when the animal is put to only a moderate 
degree of exertion. In roaring, the sound is of a deeper note, far more 
easily detected, and requires less exertion to cause its production. It is 
heard at some distance from the animal, and severe cases, when 


galloped, show marked distress. 


DISEASES OF THE LARYNX: HORSE 821 


As a rule whistling is heard during inspiration only, but in some cases 
of marked intensity it may be heard during expiration also. 

As regards the etiology of whistling, it is believed to depend on a 
permanent thickening of the laryngeal mucous membrane, resulting from 
an attack of acute laryngitis, but this view is not corroborated by post- 
mortem evidence. The affection is most commonly met with as a sequel 
to strangles or to influenza, more especially when laryngitis is one of the 
prominent features of the latter disease. 

As roaring may occur under similar conditions, it is not possible to 
explain why whistling should be a sequel in one case and roaring in the 
other. Moreover, we are well aware that whistling, like roaring, may 
develop in the absence of any history of an acute respiratory affection. 

Most authorities believe that the affection is of an hereditary nature, 
and certainly in those instances which are followed by roaring, in the 
absence of any appreciable cause, this theory seems a probable one. But 
if whistling depends on a thickening of the laryngeal mucous membrane, 
occurring as the result of an acute laryngitis, the calibre of the larynx 
being thus diminished, and causing the abnormal sound, the hereditary 
theory is not at all easy of explanation. 

Temporary Whistling, also known as “soft” or “ moist”? whistling, 
depends on a temporary tumefaction of the laryngeal mucous membrane, 
with exudation of mucus, and occurs during recovery from acute laryn- 
gitis. In such cases the whistling is a temporary affection, and may 
disappear when the laryngeal mucosa returns to a normal condition. 
As we shall point out farther on, we have no means of deciding, when 

examining a horse’s wind, whether whistling of this nature is likely to 
disappear or to become more pronounced and permanent. 

. In some cases the sound emitted is of a peculiar “‘ wheezing ’ 
acter, and appears as if proceeding from some narrowing or obstruction 
of the nasal passages. As occasional causes, Williams mentions diminu- 
tion of the calibre of the trachea, due to thickening of the mucous 
membrane or to the presence of an immovable tumour. 

In connection with the examination of horses as to soundness, the 
subject of whistling must be considered with reference to the manner in 
which the defect proves a cause of unsoundness, and also to the means 
by which its presence can be detected. 

It is generally admitted that slight whistling does not interfere with 
the utility of a horse. The difficulty, however, arises from the fact that 
a case of slight whistling may increase to such an extent as to interfere 
with the utility of the animal, more especially if at a future date he 
should suffer from an attack of laryngitis or influenza, as he is then hkely 


> char- 


822 SYSTEM OF VETERINARY MEDICINE 


to become a roarer. Hence it is that even a slight whistler must be 
regarded as unsound, and the defect seriously interferes with the market 
value of a horse. 

With reference to the detection of whistling, we may say that in well- 
marked cases there is little difficulty, as even moderate cantering will 
cause the animal to emit the characteristic sound. In slighter cases, 
more exertion is required on the part of the animal in order that the 
examiner may detect the whistling sound. In many instances a severe 
test is necessary. The animal should be galloped in a circle in one 
direction, and then in the reverse direction, and also in what is known 
as the figure-of-8 direction, so that the examiner may more readily detect 
any abnormality in the respirations. Many veterinary surgeons prefer to 
ride the horse themselves, believing that by this procedure they are better 
able to forman opinion. Others, however, state that they can detect the 
abnormality quite as readily by having the horse ridden around them. 

In some cases the defect is only evident while the animal is galloping, 
and disappears immediately when he is pulled up. In others it is heard 
most distinctly when he is brought to a stand-still, if the ear of the 
examiner is held close to the animal’s nostrils. Others, again, exhibit 
the defect best during a slow canter, and it may be difficult to discern 
the whistling when the pace is increased. We also meet with cases in 
which the abnormal sound is only heard when the animal is galloped in 
a ring or circle. 

It is thus apparent that in the examination of a horse’s wind, all the 
above circumstances must be taken into consideration, and the tests 
applied so that the abnormal sound, if present, may not be overlooked. 

In the case of an unbroken horse, the test must be carried out by 
having the animal galloped with a “lunging” rope in a ring. Under 
such circumstances it is often difficult to test the wind properly, as, 
unless the animal is trained to gallop in the ring, a sufficient degree of 
exertion is not readily induced. So frequent is the defect in Ireland that 
even two-year-old colts may be affected, and careful examination is 
necessary in order to detect it. 

Differences of opinion as to the soundness of a horse’s wind are of 
very frequent occurrence, and at times this is difficult to explain. Great 
discrimination is required to differentiate the harsh character of the 
respirations which is present in animals in too high condition, or when 
out of condition and grass-fed, from the abnormal sound known as 
‘ whistling.”’ No doubt experience in this matter is essential, just as it 
is In connection with other pomts in the examination of horses as to 
soundness. If the normal respiratory sounds in all horses were alike 


DISEASES OF THE LARYNX: HORSE 823 


when the animals were submitted to exertion, then, indeed, there would 
be little difficulty in forming an opinion. We know from experience 
that, especially in the case of young horses, it 1s absolutely essential to 
subject them to a proper degree of exertion before a definite or correct 
opinion can be given as to the soundness of the wind. The slightest 
whistling sound in such cases is a matter of importance, as the defect 
lessens the market value of the animal, or may increase and seriously 
interfere with his utility as he gets older. Of course, the possibility 
of the whistling being of a temporary nature must be considered. If 
there are evidences that the horse is suffering or has recently suffered 
from an attack of catarrh, the opinion must:be deferred, and the animal 
examined again after a proper interval. 

To base an opinion on the character of the abnormal sound as to 
whether it is likely to be temporary or permanent is to assume a degree 
of skill which we do not possess. 

The question has often been asked: ‘‘ Do whistlers ever become sound 
in their wind?” To this we would reply in the affirmative. Such 
instances, however, depend on a temporary thickening of the laryngeal 
mucous membrane. In the large majority of cases the affection is per- 
manent. Occasionally we find that a young horse, when out of condi- 
tion, will emit the characteristic whistling sound, but when he is got into 
good condition, and is examined again, he may be perfectly sound in his 
wind. Of course, these are exceptional cases, and we cannot regard 
them as in any way influencing the accepted view that whistling con- 
stitutes an unsoundness. 

Does whistling ever occur as an intermittent affection? This is an 
important question from a medico-legal aspect. We can state from 
experience that whistling may be an intermittent affection at times, 
although such instances are not common. Thus, it is possible for a 
horse to be examined and passed sound, and in a short time afterwards 
to give distinct evidences of being a whistler. Moreover, evidence may 
be forthcoming that shortly before examination he was so affected. 
This will explain at any rate some of those peculiar differences of opinion 
which occur amongst practitioners as to the soundness of a certain horse’s 
wind. Thus, the animal on one day may show distinct evidences of 
being a whistler, and on another may be perfectly sound. We are 
unable to offer any explanation for this phenomenon. All we know is 
that it can, and does, occur. 

A horse ridden in a double bridle by a rider with heavy hands, espe- 
cially if made to go in a circle, may whistle distinctly; while if the same 
animal be ridden in a snaffle bridle or by a good horseman, the wind may 


824 SYSTEM OF VETERINARY MEDICINE 


be perfectly sound. We have seen this to occur on several occasions, 
and the after-history of the horses proved that they were sound. Prob- 
ably the arching of the neck produced by the severe bit and the heavy 
hands of the rider is the explanation of the apparent whistling that 
occurs. It is more likely to result in the case of a fresh, spirited horse 
who is anxious to extend himself and is checked by the rider. We must 
point out, however, that at times during the test it is necessary for the 
rider to “catch hold of the horse’’ and make the animal extend 
himself, and then “take a pull at him occasionally,’ in order that 
the examiner may detect slight whistling. 

Another important question in connection with whistling is the 
period of time in which a sound horse may develop the affection. We 
are of opinion that it is impossible to state even the average time in 
which such a disease may occur. It is a well-known fact that horses 
sound in their wind may become unsound at any time without any 
apparent cause. This also occurs in roaring (see p. 837), and we are 
only aware of the existence of such affections by the abnormal sounds 
produced. As to the gradations which lead up to the production of the 
sound and the time when such sound is first audible, and can be appre- 
ciated by the usual test, we know nothing definite. 

No doubt a pronounced whistler very often starts as a slight whistler, 
but we know that as the result of laryngitis, influenza, or strangles, the 
pronounced whistler may be described as such from the start, and the 
defect may arise at any time, although all traces of the above diseases 
may be absent. 

Here we may remark that, although whistling is a very common 
affection in horses, there is still much to be learned in connection with 
its etiology and pathology. It is assumed that the lesion is a thickening 
of the laryngeal mucosa, but, as already remarked, we are not aware that 
such a view is based on the result of post-mortem examinations. We 
may also point out that a sound of a shrill, whistling character emitted 
during expiration is not uncommonly met with in some horses. It is 
more readily detected when the animal is pulled up after a gallop, and 
appears to proceed from some obstruction in the nasal passages. Such 
cases may continue to do fast work for years without any apparent 
distress, and without becoming pronounced whistlers. Of their real nature 
we know nothing, but of course they are properly regarded as unsound. 

Whistling is an affection of very frequent occurrence in Ireland; 
indeed, it may be stated that more horses are rejected for this defect 
than for any other. This may be accounted for by the great frequency 
of strangles and catarrhal affections in that country, by the inferior 


DISEASES OF THE LARYNX: HORSE 825 


sanitary surroundings, and the irrational treatment of young horses, 
Whether the affection is due to hereditary influences or otherwise is a 
debatable point, and further investigation is necessary before the matter 
can be definitely decided. 

TREATMENT.— With reference to. the treatment of whistling, we know 
from experience that in well-developed cases medicinal treatment of any 
kind proves of no value. Even in the large majority of slight cases similar 
remarks will apply. Reputed instances of recovery after treatment are 
explained by regarding the affection as being of a temporary character. 
In such, the application of a strong blister to the laryngeal region and the 
internal administration of potassium iodide probably succeeds in removing 
the temporary thickening of the laryngeal mucous membrane. Similar 
treatment is also indicated after attacks of laryngitis, influenza with laryn- 
geal complications, and strangles, as a possible preventive of whistling. 

It is now claimed that the modern surgical treatment for roaring 
(see p. 839) also proves successful in cases of whistling. 


ROARING. 


Synonyms.—Laryngeal hemiplegia; Paralysis of the recurrent nerve. 

GENERAL RemarKs.—This interesting disease has been recognised 
from early times; much investigation has been devoted to elucidate its 
pathology, and many theories have been advanced to explain its etiology. 
It has always been an important affection from the horse-breeder’s 
point of view, not that it causes any mortality amongst animals suffering 
from the disorder, but because of the serious depreciation in value that 
results, owing to interference with the respiratory function and the 
incapacity for full work that is induced. Of late years, owing to the 
researches of Thomassen, Malkmus, and other investigators, our know- 
ledge of the disease, so far as its morbid anatomy is concerned, has 
undoubtedly increased. As regards its etiology, we have still much to 
learn, and a similar remark applies to prophylactic measures. With 
reference to treatment, much patient investigation has been carried out, 
and many surgical procedures have from time to time been adopted, but 
it was not until recent years that any practical results have followed 
operative measures for the relief of the condition. This is not surprising 
when we consider that in any form of treatment adopted our efforts can, 
in our present state of knowledge, only be directed towards overcoming 
the results of the disease and not the cause thereof. Moreover, as the 
affection generally depends on degenerative lesions of the recurrent 
nerve, the etiology of which is not definitely determined, the application 


826 SYSTEM OF VETERINARY MEDICINE 


of direct therapeutical measures, either medical or surgical, is not possible, 
as we are not aware of the existence of the nervous lesions until the 
characteristic symptoms of the disease are manifested. When such 
symptoms appear, serious morbid alterations have taken place in the 
nerve and in the muscles supplied by it, and no form of treatment that 
we are aware of can restore these structures to their normal condition. 
The surgical treatment to which we shall refer later on can only be 
directed towards overcoming the mechanical effects produced by the 
nervo-muscular lesions. It may thus enable the animal to perform fast 
work, which, owing to respiratory distress, would be impossible except 
by the use of a tracheotomy tube. It may also do away with the abnormal 
sound which is so disagreeable to the owner or rider. 

We have already drawn attention to the affection termed “‘ whistling,” 
and pointed out that its relation to roaring is not definitely determined. 
But roaring is a complex affection, and in reality includes more than the 
abnormal sound and respiratory distress induced during exertion. It 1s 
essentially a nervous disease, depending on degeneration and paralysis 
of the left recurrent nerve, with subsequent alterations in the intrinsic 
muscles of the larynx supplied by this nerve. The result is a displace- 
ment of the arytenoid cartilage and vocal cord on the affected side, 
which, when the horse is subjected to exertion, produces an abnormal 
respiratory sound and dyspnoea. These latter vary according to the 
extent of the lesions present. 

As we shall point out later on, roaring does not always depend on 
laryngeal hemiplegia; still, according to the observations of several 
authorities, 95 per cent. of the cases met with are due to paralysis of the 
recurrent nerve. We are inclined to rather modify these figures. Since 
operative treatment has been adopted, it has been found on opening 
the larynx of many “roarers”’ that there has been no paralysis of the 
left side—both cartilages have been found to be working equally and 
freely. One of us (M.), in carrying out early attempts at this operation, 
was struck by this, and in support of this point we would quote the 
following: : 

Guy Sutton stated at a meeting of the Royal Counties Veterinary 
Medical Association:* ‘‘ Until recently I had the impression—and I 
believe it to be the general one—that roarers always had a paralysed 
left arytenoid cartilage and vocal cord, with consequent atrophied ' 
laryngeal muscles on that side. During the last nine months I have had 
the opportunity of viewing the interior of the larynx in more than fifty 
roarers and whistlers, and in quite a number—I should say about 


* See Veterinary Record, May 7, 1910. 


DISEASES OF THE LARYNX: HORSE 827 


half—movement has been discernible in the left cartilage, sometimes to 
a far lesser degree than the right, and in other cases both cartilages have 
appeared to move equally. In these cases probably the nerve-supply 
is sufficient for the movement of the larynx whilst at rest. When, how- 
ever, the horse is extended or distressed, the nerve becomes fatigued, 
ceases to transmit its impulses perfectly, and paralysis ensues. These 
are possibly the horses that give rise to disputes when brought for 
examination.” 

Again, at the Central Veterinary Society,* Wooldridge remarked: 
‘* When the larynx was opened, if there was paralysis, it was very obvious 
on which side it was. The arytenoid cartilage of the one side would be 
moving quite freely, and on wae other side lying aaa the larynx 
immobile or slightly moving.” 

Mr. Sutton objected to this remark, and said that “if twenty affected 
larynges were opened, less than half would show complete unilateral 
paralysis. In some the arytenoid cartilages would be moving equally, 
although the horse was a roarer,”’ and gave the same explanation previously 
quoted. Macqueen said: ‘‘ With regard to the cause of the roaring, 
Mr. Sutton had mentioned a condition which was not generally known . . . 
but he disagreed with Mr. Sutton’s explanation ofthe cause. He (Macqueen) 
believed that many horses were mechanical roarers, and that no operation 
would cure such cases. A horse that roared owing to partial telescoping 
of the first two or three tracheal rings with the cricoid would not be cured 
even though both ventricles were cut out. A number of horses used 
for fast work made a noise, not because of laryngeal disease, but because 
of circulatory weakness, and the cause was failure of the heart to 
pump the blood into the lungs in proper proportion. It is very advis- 
able, therefore, to bear in mind that recurrent paralysis is by no means 
the only cause of roaring.” 

According to Professor Bernardini,f in eight horses affected with 
roaring, only three were found to suffer from laryngeal hemiplegia. 

The. affection is described by Hutyra and Marek in the section on 
‘Diseases of the Peripheral Nerves.” No doubt, properly speaking, it 
should be regarded as a nervous disease, but the clinical phenomena by 
which it is recognised, being associated with abnormal respiration, it is 
generally dealt with under the heading of Respiratory Diseases. 

The connection between roaring and paralysis of the recurrent nerve 
was first demonstrated by Dupuy in 1826. This observer showed that 
patalysis of the nerve was followed by atrophy of the laryngeal muscles 


* See Veterinary Record, June 25, 1910. 
+ Clinica Veterinaria, December, 1912. 


828 SYSTEM OF VETERINARY MEDICINE 


supplied by it. According to G. Fleming, the first marked step in 
elucidating the pathology of roaring was made by Bouley in 1825, who, 
in dissecting the carcass of a horse that had been seriously affected, 
found considerable engorgement of the prepectoral lymphatic glands, 
and observed that the left recurrent nerve, which passed through them 
on its course to supply the muscles of the larynx, was compressed by 
these glands and altered in its structure. This observation led Dupuy 
to conduct experiments on horses, in which, after dividing or compressing 
the recurrent nerves, roaring was produced, and on post-mortem the 
lesions in the laryngeal muscles were observed. Field (1837) repeated 
one of Dupuy’s experiments, and obtained similar results. Amongst 
other British veterinarians who devoted special attention to the disease 
we may mention Percivall, Youatt, Turner and Cartwright, Owles, 
Reeve, and Fleming. In 1834 Giinther conducted numerous investiga- 
tions, and added much to the existing knowledge of the affection. In 
more recent times Schindelka and Polansky, Malkmus, Dieckerhoff, 
Thomassen, and Liihrs, have, by their researches, contributed largely to 
a more exact knowledge of the subject. 

With reference to the occurrence of the disease, it is said to be rarely 
met with in the Argentine Republic, South America, Egypt, India, 
Arabia, and Australia. 

In the Report of the Army Veterinary Service for 1911-12, we find 
that 117 cases of roaring are recorded; of these, 72 were cast and 1 was 
destroyed. In the Report for 1912-13, the numbers were 132 cases, of 
which 121 were cast. In the Report of the Army Veterinary Service in 
India (1911-12), 11 cases of roaring are recorded, of which 5 were cast 
and 2 were destroyed. In 1912-13, the numbers were 13 cases, of which 
11 were cast and 2 were destroyed. 

EtioLogy.—The majority of observers agree that the degenerative 
lesions occur in the terminations of the recurrent nerve in the immediate 
vicinity of the larynx, and it was shown by Thomassen that the altera- 
tions gradually became less pronounced in the central direction, until 
they were absent in the nerve in the inferior cervical region and in the 
thorax. As already mentioned, many observers maintain that the left 
recurrent is affected in 95 per cent. of roarers. 

The cause of the nervous lesions, according to recent views on the 
subject, is an inflammation set up by bacterial toxins circulating in the 
blood. This view is based on the fact that in the large majority of cases 
roaring occurs as a sequel to infectious diseases, such as strangles and 
pneumonia. Up to the present it has not been explained why the left 
recurrent nerve should be specially susceptible to the action of toxins. 


DISEASES OF THE LARYNX: HORSE 829 


In cases of poisoning by Lathyrus sativus (lathyrism) and by lead, 
paralysis of the left recurrent nerve also occurs. Stewart of Cardiff 
informs us that he has observed several cases of roaring due to lead and 
arsenic-poisoning. ‘The experiments of Thomassen and the observations 
of Beckmann and Schmidt showed that in lead-poisoning all the branches 
of the vagus may suffer from degeneration, but the lesions were most 
marked in the terminal portion of the left recurrent nerve. 

Various theories have been advanced in order to account for the 
occurrence of the lesions on the left side. The peculiar anatomical dis- 
position of the left recurrent nerve, as compared with that of the right, 
was at one time believed to offer some explanation of the problem, but 
these and other suggestions when fully discussed yielded nothing definite 
and could not be accepted. Space will not permit us to consider these 
points, nor would it be of any benefit to do so, as the matter is still sub 
qudice. 

Amongst other pathological conditions which may produce similar 
symptoms we may mention: Aneurism of the aortic arch, causing pressure 
on the recurrent nerve; tumours at the entrance of the thorax; enlarged 
lymphatic glands; malignant growths in the vicinity of the nerve; 
traumatic injuries of the nerve, due to operative measures in its vicinity 
or to venesection; polypi in the posterior nares or in the larynx; con- 
striction of the trachea; partial telescoping of the first two or three rings 
of the trachea with the cricoid; circulatory weakness due to failure of 
the heart to pump the blood into the lungs in proper proportion. In 
that peculiar disease known as “ mountain sickness ” in Wales, occurring 
in ponies, roaring is a prominent symptom. The etiology is unknown. 

Some observers were of opinion that roaring may depend on a 
myositis of the laryngeal muscles, succeeded by atrophy and narrowing 
of the rima glottidis, but this view is not accepted by either Hutyra 
and Marek, or by Cadéac. 

As regards the manner in which the nerve becomes involved and the 
abnormal sound produced, Hutyra and Marek hold the following views: 
‘““The recurrent is a mixed nerve,* and the excitability of its sensory 
fibres is first increased; but when the disease develops slowly, the 
irritability of these fibres is only slightly accentuated. In a variable 
period the motor fibres lose their conductivity, and as a result the muscles 
supplied by them become atrophied and paralysed. The nerve fibres 
supplying the dilator muscles are first involved, hence these muscles are 


* According to Chauveau, the recurrent gives off a sensory filament to the 
mucosa of the subglottal portion of the larynx, and to the inferior border and inner 
surface of the vocal cords. 


830 SYSTEM OF VETERINARY MEDICINE 


the first to become affected, but the constrictors may subsequently be 
attacked. Exceptionally the constrictors are first involved, or these. 
with the dilators, may be simultaneously affected, this latter, according 
to Malkmus, being the common condition met with. The result of the 
muscular lesion is that the vocal cord on the affected side ceases to 
move, or does so very slightly, and is drawn towards the middle line by 
the unaffected constrictor muscle. It may, however, be forced into the 
lumen of the larynx, together with the arytenoid cartilage, by a forcible 
inspiration, and in either case a stenosis of the larynx results.” 
According to Cadéac,* “‘ When the posterior crico-arytenoid muscles 
are paralysed, the superior border of the arytenoid cartilage descends 
and tends to approach the median line. The pharyngeal opening of the 
larynx, circumscribed by the epiglottis, the aryteno-epiglottic folds, and 
the arytenoid cartilages—clearly visible when the crico-thyroid mem- 
brane and the cricoid cartilage are incised—appears narrowed and 
asymmetrical owing to the displacement of the arytenoid cartilage. In 
young animals it is observed that the descent of the cartilage and its 
projection inwards is more marked, as the soft parts of the larynx are 
more pliant and the inspiratory current is more intense. Consecutively 
with the altered position of the cartilage, the vocal cord is slightly drawn 
downwards and inwards, and tends to approach the vocal cord of the 
opposite side, thus inducing a well-marked narrowing of the inferior 
region of the glottis; this, however, is not the principal cause of the 
roaring sound.” According to this author, the abnormal sound arises 
from the arrest of the inspired air against the superior border of the 
arytenoid. He sums up the situation thus: “When the arytenoid 
cartilage and the left .vocal cord become inert owing to insufficiency of 
contraction in the muscles which cause their movement, there results, 
under the influence of the pressure of the inspired air, a displacement of 
the arytenoid of the affected side towards the lower portion of the 
laryngeal cavity. At the same time this cartilage is drawn towards its 
fellow of the opposite side. So long as the inspiration is calm the laryngeal 
opening suffices for the passage of air, without producing an abnormal 
sound. But when breathing is accelerated the pressure is increased, the 
displacement of the arytenoid is exaggerated, and the opening of the 
larynx is considerably diminished in calibre. The inspiration is then 
interrupted, and in all cases the air passes with force into the narrowed | 
passage, and produces the roaring sound, the arytenoid acting like the 
mouthpiece of a whistle.’ Cadiot remarks that in cases of bilateral 
paralysis of the larynx the two arytenoid cartilages are drawn simul- 


* “ Pathologie Interne.” 


DISEASES OF THE LARYNX: HORSE 831 


taneously towards the glottis during inspiration, and the two vocal cords 
follow the movements of the cartilages, the calibre of the superior region 
of the larynx is considerably reduced, and roaring occurs with its 
maximum of intensity. 

In experimental section of the recurrent nerve various investigators 
observed paralysis of the vocal cord of the same side, atrophy of all the 
muscles supplied by this nerve, roaring, constriction of the larynx, and 
paralysis of the dilator muscles. According to Thomassen, the younger 
the animal experimented on, the more intense is the roaring sound; 
while in animals aged more than twelve years section of the nerve only 
produces mild roaring, which is hardly perceptible during trotting, and 
ceases when the horse is pulled up. Also in young horses the noise is 
never as intense as in spontaneous cases of the disease. Moéller observed 
that in complete immobilisation of the arytenoid the noise is less marked 
than when the cartilage still possesses a certain degree of movement. 

Cadéac points out that experimental section of the recurrent nerve pro- 
duces immediate and complete loss of movement in the arytenoid and vocal 
cord, while in spontaneous cases of the disease the paralysis is progressive 
and incomplete. All the nerve fibres are not attacked simultaneously, 
nor with the same degree of intensity ; the dilator muscles are first affected, 
while the constrictors may remain a long time in a normal condition, or 
even permanently so. The spasmodic contraction of the constrictors 
produces a marked laryngeal stenosis, and is regarded as an important 
cause of dyspnea, which is absent in cases of complete paralysis; also the 
spasm of the constrictors aggravates the stenosis induced by paralysis of 
the dilator muscles. 

We consider these observations of Cadéac extremely important, and 
they have to be taken into consideration when giving an opinion as to 
the chance of improvement in a bad roarer. They also may throw some 
light on the improvement that is sometimes found after the modern 
operation, the effect of which, in producing obliteration of the ventricle, 
would spoil the action of the constrictors, notably that of the thyro- 
arytenoideus, whose two fasciculi are normally separated by the mucous 
membrane of the ventricle. 

Influence of Breed and Conformation, etc—Many observers state that 
horses with long, slender necks, such as English thoroughbreds, are more 
likely to suffer from roaring than those with the opposite conformation. 
But it must be remembered that many heavy cart-horses and cart- 
stallions are affected. In our experience the disease is very common in 
large, weight-carrying hunters—in fact, it is difficult to meet with horses 
of this class that are sound in their wind, and there is a marked tendency 


832 SYSTEM OF VETERINARY MEDICINE 


for such animals to become roarers if they suffer from an attack of 
strangles, influenza, or pneumonia. Ponies are very seldom affected, 
although they frequently suffer from pulmonary emphysema (broken 
wind). 

As regards age, the majority of cases are said to occur between the 
ages of three and six years, the disease being rarely met with during the 
second or third year. In our experience whistling 1s comparatively 
common in three-year-olds or four-year-olds, and cases occurring at 
these ages generally terminate in roaring. Some authors state that 
roaring is not so frequently met with in mares as in geldings or stallions, 
but, according to Hutyra and Marek, sex appears to have no influence 
on the occurrence of the disease. 

Hereditary Influences——On this subject some difference of opinion 
exists. Probably the majority of veterinary surgeons and of breeders 
recognise the hereditary nature of the affection. In the Argentine 
Republic, where the disease is of rare occurrence, it is said that imported 
stallions known to be roarers are used for breeding purposes without 
any tendency to the disease being transmitted to their offspring. 
According to Cadéac, the tendency to the disease is transmitted in the 
form of a certain weakness or vulnerability of the recurrent nerve, owing 
to the latter having suffered from degeneration in the progenitors due 
to the action of toxins. However this may be, it seems desirable in our 
present state of knowledge to advise that both stallions and mares suffering 
from roaring should not be used for breeding purposes. 

Morsip Anatomy.—The structures involved are the recurrent nerve 
and the intrinsic muscles of the larynx supplied by this nerve. 

Muscutar Lestons.—These are generally confined to the intrinsic 
muscles of the larynx on the left side, with the exception of the crico- 
thyroid. This latter, being supplied by the external laryngeal nerve (a 
branch of the superior laryngeal), is not involved. In rare instances the 
lesions are bilateral. The morbid changes are best marked in the 
posterior crico-arytenoid (the dilator muscle), but as the disease progresses 
the other muscles become affected. According to Hutyra and Marek, in 
the early stages and in slight cases the only recognisable lesions are pale 
yellow streaks in the posterior crico-arytenoid ; these may also be present 
to a less extent in the other muscles. In severe cases the muscles show a 
more or less marked atrophy, and are of a pale yellow or greyish-red 
colour. Cadéac describes the following lesions: “‘ The crico-thyroid shows 
a compensatory hypertrophy. The degenerative changes in the posterior 
crico-arytenoid may be total or partial, great differences in the degree of 
atrophy being observed. In some cases it is reduced to a thin muscular. 


DISEASES OF THE LARYNX: HORSE 833 


ribbon in its superior third, while in its inferior two-thirds it is converted 
into a fibrous patch, and not rarely the degeneration may be limited to 
certain parts of the, muscle, and even to some fasciculi, which are replaced 
by fibrous tissue. The degenerated fasciculi have lost the half or even 
two-thirds of their volume. The strize disappear early, and the inter- 
stitial connective tissue is hypertrophied. ... These alterations are not 
exclusively limited to the posterior crico-arytenoid. ... The other 
muscles supplied by the recurrent are atrophied to a degree which varies 
with each case; sometimes one muscle, sometimes another, is atrophied 
more completely than the neighbouring ones. In rare cases the posterior 
crico-arytenoid is unaffected, while the other muscles are atrophied. In 
well-marked instances the atrophy of the muscles on the left side of the 
larynx can be easily detected by palpation.” 

Nervous Lrestons.—According to the researches of Thomassen the 
alterations in the terminal ramifications of the recurrent nerve are 
always more advanced than those of the corresponding muscles. The 
macroscopical appearances are a reduction in the size of the affected 
nerve, and a well-marked grey colour. According to Cadéac, this reduc- 
tion in diameter occurs in its peripheral portion. The chief alterations 
can only be discovered by histological examination. The above author 
states that under normal conditions the peripheral portion of the nerve 
is formed of twelve or thirteen fasciculi, the greater portion being com- 
posed of large fibres, the lesser of fine fibres. The lesions are specially 
marked in the fasciculi composed of fine fibres, but sometimes all the 
fasciculi are involved. The alterations comprise a disappearance of the 
medullary sheath, fragmentation of the axis-cylinder, and increase of 
cells in the substance of Schwann. The lesions are generally limited to 
the peripheral extremity of the nerve, but traces of degeneration may be 
observed at a distance of 30 to 40 centimetres from the larynx. 

With reference to central lesions, Vermeulen, of the State Veterinary 
School, Utrecht, in a work on “ Roaring in Horses ”’ (1914), states that 
he cannot decide whether the nervous lesion is always primarily per- 
ipheral or primarily central. He does not dispute the conclusions of 
Thomassen, but in two advanced cases of laryngeal hemiplegia in which 
he examined the medulla oblongata he found degeneration of the “ nucleus 
ambiguus.” He concludes from these observations that “we should 
admit the possibility that we have not to deal with a peripheral nerve 
lesion in every case which advances centrally, but rather that the in- 
jurious influences can also directly attack the centrum.” 

_ Symproms.—These consist of a roaring sound and the occurrence of 
dyspnoea, when the affected animal is subjected to exertion. The 

VOL. I. 53 


834 SYSTEM OF VETERINARY MEDICINE 


intensity of both symptoms varies according to the degree of stencsis of 
the larynx that is present. In far-advanced cases the abnormal sound is 
heard even when the horse is driven or ridden at a trot; when going up- 
hill the roaring is much more marked. In moderate cases the animal 
may be driven in harness on the flat without any abnormal sound being 
detected. The sound is influenced by the quantity of air entering the 
trachea and the rapidity of respiration. As a rule roaring is heard only 
during inspiration, but in rare instances, owing to bilateral paralysis, it 
occurs during expiration as well. In the great majority of cases a roarer 
“ orunts ”’ loudly when threatened with a stick, or when landing from 
a jump (see Grunting, p. 840). The character of the “ grunting ”’ is 
distinct from the expiratory sound often heard when a nervous horse is 
subjected to the above tests. According to Cadéac, a horse suffering 
from simple paralysis of the dilator muscles makes a more intense roaring 
sound than is the case when a complete paralysis of the constrictor 
muscles is present as well, because the latter are then unable to con- 
tribute by their spasmodic contraction to stenosis of the glottis. In 
rare instances the roaring sound is audible when the horse is at rest, but 
in such cases the abnormal sound generally depends on causes other than 
laryngeal hemiplegia. In well-marked cases, if the horse is subjected 
to severe exertion, dyspnoea accompanies the roaring sound, and if he is 
pressed he may show evidences of asphyxia. 

When a roarer is pulled up after a gallop, the sound disappears after 
a few minutes. With reference to cough as a symptom in roaring, 
Hutyra and Marek state that in the early stages, before conductivity is 
lost, the irritability of the sensory nerves tends to become exaggerated and 
a dry cough occurs, which is readily induced by palpation of the laryngeal 
region. In more advanced cases it is often difficult to make the animal 
cough. Roarers, however, often cough spontaneously, the cough being 
deep and prolonged, and aptly described by the late Professor Williams 
as ‘“‘ sepulchral,” a sort of half roar, half cough. 

Some authors state that the neigh in roarers is of a hoarse character; 
and Thomassen observed that many horses showed this alteration 
before any evidence of roaring appeared; this phenomenon, according 
to Hutyra and Marek, seems to indicate that the constrictor muscles only 
may be affected for a time. It is also stated by some observers that by 
palpation of the larynx in roarers the arytenoid cartilage of the left side | 
can be pressed more easily into the cavity of the larynx than its fellow of 
the opposite side, and the procedure sometimes produces a roaring sound. 

CouRSsE AND Proenosis.—In the large majority of cases roaring is a 
chronic affection, and tends to increase in intensity. Until recent years 


DISEASES OF THE LARYNX: HORSE 835 


it was regarded as beyond relief, except by means of the tracheotomy 
tube, but by adopting certain operative measures it is now possible in a 
number of instances to render the affected animal capable of doing his 
work. No doubt the nervous lesion is incurable, but the effects can be 
treated by surgical means (see Treatment, p. 839). 

Ebinger, Coster, Labat, Limbaret, and others, record cases of spon- 
taneous recovery. Cadéac states that many stallions affected with 
roaring on their arrival at the stud recovered perfectly in a short time 
afterwards. He also observed several instances in which the symptoms 
became ameliorated, and found that in some stallions affected with 
roaring improvement occurred after they had been castrated. Various 
writers have reported cases of spontaneous recovery as a result of a 
change of climate—such as from Europe to the Argentine, or Europe to 
South Africa. A case of this kind occurred in the experience of one of 
us (M.) on a change from India to South Africa. Gray has observed 
many recoveries in harness-horses, and numerous instances in which 
marked improvement occurred when the animals got into good muscular 
condition, so that they were able to do their ordinary work without 
making much noise or showing distress. 

In our experience, in young horses affected with the disease the 
symptoms tend to become exaggerated; but in older animals, when the 
disease is not well marked, the symptoms are not so likely to increase, 
and a prognosis of a limited capability for work may be given with more 
confidence if the test, by subjecting the horse to exertion, is satisfactory. 

As regards the mode of development of roaring there is still much to 
learn. Some authors state that it may develop in various ways, as 
follows: (1) It may start in an intermittent manner, and gradually become 
permanent. (2) The abnormal sound may be slight at first, and gradually 
increase in intensity ; or the disease may start as whistling, and terminate 
in roaring. (3) It may occur suddenly. 

According to Hutyra and Marek, the progress of the disease (except 
in those rare cases in which it appears suddenly with pronounced symp- 
toms of illness, persists for several weeks, and then gradually disappears 
or becomes chronic) is slow. The symptoms generally appear in four to 
six weeks after the commencement of the primary disease, and reach 
their maximum after a long time, in some instances in one to two years. 
Rosenfeld and Fréhner state that sometimes the paralysis makes its 
appearance in ten to eleven days after the commencement of the primary 
disease. K. Giinther held the view that the symptoms might occur quite 
suddenly. With reference to this question, we must remember that it is 
very difficult to decide the exact time or date on which a horse first shows 


836 SYSTEM OF VETERINARY MEDICINE 


evidences of roaring. Whether the case starts as whistling, or as roaring 
from the commencement, we find that it is by no means an easy matter 
to ascertain from the owner with any degree of exactness when he first 
observed the characteristic sound. As compared with whistling, we may 
remark that roaring is easily detected even by the non-professional, and 
not infrequently the history given is that the abnormal sound was heard 
on the first occasion when the horse was galloped after recovery from an 
attack of strangles or influenza. The question is an important one from 
a medico-legal point of view, as instances have occurred in which a horse 
has been examined and passed as sound, and in a short time afterwards 
examined by another veterinary surgeon and certified to be a roarer. 
In some at least of such cases it is probable that the roaring was of an 
intermittent character (see p. 837). Weare perfectly satisfied that cases do 
occur occasionally quite suddenly,* but we are not so sure that these are 
true cases of left recurrent paralysis. In fact, if it were recognised more 
frequently that cases of roaring occur from other causes than left recurrent 
paralysis, we think a great many obscure points would be more easily 
understood. Judging from our own experience, we conclude that it is 
impossible to state the exact time which roaring takes to develop, and 
that it may arise at any time, thus resembling other nervous affections, 
such as “ shivering.”” Owing to a wider knowledge of such subjects, and 
to more appreciation of the uncertainty connected with the development 
of nervous affections, we do not find so many veterinary experts in the 
present day who are prepared to give dogmatic evidence in a Court of 
Law with reference to the number of days, weeks, or months that must 


* A case of this kind oecurred in a polo pony, the property of one of us (M.). The 
animal, a brown Australian gelding aged ten years, and standing about 14 hands 
3 inches in height, was being played in a polo tournament in India. Two rounds 
in the tournament had been played on the Monday and Wednesday respectively, 
in each of which this animal had played two periods, and the final game was to be 
played on the Friday. On mounting for a preliminary canter previous to the game, 
the pony made such a noise, and in galloping showed such evident distress, that he 
could not be played. Thus, on the Wednesday he was sound in his wind and playing 
a hard game, and on the following Friday making such a noise and so distressed 
that he was useless. The after-history of the case was as follows: For some months 
he was kept at quiet exercise, and then, as very little improvement was seen, he 
was broken to harness. Six months after the development of the roaring operation 
he was put down, and the larynx opened up with a view to stripping the ventricle. 
Both cartilages were found to be moving well, with no difference in the sides. No 
obstruction could be seen anywhere else, so the operation was carried no further. 
He was driven in harness for a few more months, then ridden again; the noise and 
distress gradually got less, and as the writer was leaving the country the pony was 
sold some twelve months after the first onset of the affection. The case was explained 
to the buyer, and a veterinary surgeon who knew the case from the commencement 
tested him for wind, and found he was making no noise. 

One point that should be mentioned in this case is that the animal had a very 
long neck, with the head carried high and much bent on the neck—in fact, the con- 
formation that is generally spoken of as “‘ cock-throttled.”’ 


DISEASES OF THE LARYNX: HORSE 837 


elapse before a horse can develop symptoms of roaring. These remarks 
also apply to many other affections in connection with which charges of 
neglect have been brought against practitioners in the examination of 
horses as to soundness. 

Temporary Roaring.—A roaring sound may be present during an 
attack of acute laryngitis or strangles, and depends on an cedematous 
condition of the glottis, or from pressure exerted by an abscess. 

It occasionally happens that if a horse is galloped in a short time 
after convalescence from the above affections, a roaring sound can be 
detected, which, however, may disappear at a later period. This is also 
observed with reference to whistling, and is probably due to circulatory 
or muscular weakness. 

Intermittent Roaring—The affection may occasionally be of an 
intermittent character—z.e., present at one time, and absent at another. 
This is more likely to occur during the early stages of the disease than in 
far-advanced cases. It probably accounts for the differences of opinion 
which sometimes occur with reference to the soundness or otherwise 
of a certain horse’s wind. A similar condition is met with in connection 
with ‘“‘ whistling.” Intermittent roaring is observed in cases of polypi 
of the pharynx, larynx, and posterior nares, and in such cases depends 
on the neoplasms altering their position and falling between the arytenoid 
cartilages or into the glottis durmg an inspiratory movement, and 
subsequently returning to their former location. 

DIFFERENTIAL D1aqnosis.—We have already mentioned that other 
pathological conditions than laryngeal hemiplegia may produce a roaring 
sound during exertion. In many instances it is impossible to exclude 
paralysis of the recurrent nerve without performing an exploratory laryn- 
gotomy. By this means also we may detect the presence of stenosis of the 
larynx due to other causes. The history of the case will prove of assistance 
in some instances. Thus, if roaring follows an attack of strangles, influenza, 
or pheumonia, itis very probably due to paralysis of the recurrent nerve. 
Again, if the abnormal sound is audible when the animal is at rest, it 
probably depends on the presence of a neoplasm or some deformity in 
the upper respiratory passages. Cadéac states that the character of the 
sound gives a valuable indication of the presence or absence of paralysis 
of the recurrent nerve, and that confusion is not possible. This, however, 
is not our experience. 

Professor Bernardini, in an article entitled ‘‘ The Clinical and Legal 
Diagnosis of Laryngeal Hemiplegia in the Horse,’’* states that neither 
the character of the cough nor the evidence obtained from external pal- 


* Clinica Veterinaria, December, 1912. 


838 SYSTEM OF VETERINARY MEDICINE 


pation of the larynx can be relied on in the differential diagnosis of 
laryngeal roaring. Direct palpation of the vocal cord through the mouth 
or by means of an opening in the crico-thyroid ligament is a very good 
method to confirm the diagnosis, when, for example, the paralysis of the 
arytenoid may be attributed to paralysis of the recurrent nerve or to a 
process of anchylosis. But he prefers direct examination of the larynx 
by means of a laryngoscope, in order to discover the existence of paralysis 
of the vocal cords. He used at first the rhino-laryngoscope of Polansky 
and Schindelka, and afterwards the gastroscope of Formatti, and found 
that the latter instrument gave the best results. 

The examination of the respiration by special means is also advised 
by this author. He found in cases of laryngeal roaring that the inspira- 
tory intrathoracic pressure was lessened, owing to the obstacle caused by 
the paralysed vocal cords, but expiration was not affected. By means 
of a fine trocar and cannula inserted between two rings of the trachea, 
and connected by an elastic tube to a Marey’s registering apparatus, he 
obtained tracings which enabled him to recognise laryngeal roaring, with 
its differential characters. He is of opinion that with the “ tracing ”’ 
method diagrams can be obtained, which constitute exact evidence of 
the presence of laryngeal roaring in medico-legal cases. 

Test for Roaring —This is carried out in a similar manner to the 
procedure advised for detecting “‘ whistling ” (see p. 822). But the same 
degree of exertion on the part of the horse is not necessary, and in well- 
marked cases the affection is detected by an ordinary canter. When the 
disease is advanced, the “‘ grunt”? emitted when the horse is threatened 
with a stick is very characteristic; but too much reliance must not be 
placed on this test (see p. 840). It seems hardly necessary to point out 
that the sound known as “ high-blowing ”’ (see p. 844) should not be 
mistaken for roaring, as even a neophyte is not likely to commit such 
an error. In testing the wind, care should be taken not to mistake for 
roaring the harsh respiration occurring in horses that are out of con- 
dition, especially when they are ridden in a double bridle by a horseman 
with heavy hands. We do not agree with the suggestion made by Giinther 
that “the head should be held well in, because this puts the muscles of 
the larynx in an unfavourable position, and consequently the noise is 
appreciable earlier.” On the contrary, we maintain that the rider should 
have good hands, and should not hold the animal’s head in an abnormal 
position, as otherwise a sound may be produced which cannot be dis- 
tinguished from an abnormal one. Roaring in any form and in any degree 
constitutes unsoundness. 

The modern operation for the relief of the condition (see p. 839) leaves 


DISEASES OF THE LARYNX: HORSE 839 


no signs by which the presence of paralysis of the recurrent nerve can be 
detected, and it is an open question whether cases so operated on, and 
emitting no abnormal sound when the usual test is applied, should be 
regarded as sound. Probably the point can be more definitely decided 
when we have fuller statistics with reference to the ultimate results of 
cases operated on after a number of years. 

But with regard to stallions or mares for stud purposes that were 
roarers and were operated on, with the result that no evidences of roaring 
can be detected, we certainly think that not only are such animals unsound, 
but we will go further and state that to operate on such cases is only 
assisting dealers to pass off unsound horses. The disease being due to a 
nervous lesion is not “cured ”’ by the operation, and being hereditary is, 
of course, transmitted in spite of the surgical measures. 

TREATMENT.—Various therapeutical measures, both medical and 
surgical, were suggested and practised from time to time for the cure 
of roaring. The time-honoured method for enabling the roarer 
to perform fast work without distress—viz., by the insertion of a 
permanent tracheotomy tube—has still many advocates. No doubt it 
proves very useful, but it has certain drawbacks, amongst which is the 
tendency for excessive granulation tissue to form around the opening in 
the trachea, due to the irritation set up by the flanges of the tube, 
especially when it is removed and replaced by unskilled hands for 
cleansing purposes. Some practitioners avoid this unpleasant sequel by 
letting the tube remain in sitd, and claim good results. 

According to Cadéac, Giinther practised without success an operation 
consisting of the excision of the vocal cord and of the corresponding 
ventricle, and then bringing about union of the arytenoid to the thyroid. 
Fleming,* however, stated that Gimther and his son, K. Giinther, “ after 
trying many methods, finally endeavoured to bring about a firm adhesion 
between the inner surface of the thyroid and the outer surface of the 
arytenoid cartilage by excising the laryngeal sac, but leaving the vocal 
cord intact. The result was uncertain, for while in some cases adhesion 
between the cartilages took place sufficiently high to fix the arytenoid 
cartilage well back out of the way, and consequently to prevent roaring, 
in others this union occurred too low or was incomplete, and the horses 
remained roarers.” 

The operation recently introduced by W. L. Williams, and practised 
by Hobday, is exactly similar to the last-mentioned one. It is essentially 
that of stripping off the mucous membrane lining the ventricle of the 
larynx, either on one or both sides, aims at complete obliteration of the 


sd 


* “ Roaring in Horses’’ (1889), p. 137. 


840 SYSTEM OF VETERINARY MEDICINE 


ventricle, and consequent fixation by cicatrisation of the arytenoid 
cartilage and vocal cord to the inner surface of the wing of the thyroid. 

When properly performed, and when cicatrisation is perfect, it cer- 
tainly does this, and it is very seldom accompanied by excessive granula- 
tion (an after-effect that was the bugbear of nearly all the earlier opera- 
tions which involved removal of cartilage). 

Though nearly five years have now passed since the operation has 
been performed on anything like a large scale in this country, it is still 
difficult to decide if it is really successful. Hobday claims a large number 
of successes, and we believe his figures work out approximately at 10 per 
cent. absolute cures, 80 per cent. improved, and 10 per cent. no 
improvement. | 

While not wishing to decry the operation in any sense, itis only right 
to point out, firstly, that there is no doubt that a certain number of 
roarers do recover spontaneously, though this is not the same as saying 
that roarers from left recurrent paralysis recover spontaneously. Hobday 
and Sutton admit that, in a large proportion of the cases operated on, the 
movements of the cartilages on both sides of the larynx were equally 
good (a fact which to most practitioners would indicate that many of 
their cases were not roarers from left recurrent paralysis), and therefore 
it is quite possible that a proportion of their cases would have recovered 
without operation. Secondly, that the question of improvement is an 
extremely difficult one to assess, and there is a tendency towards opti- 
mism both in the mind of the operator and that of the owner. In other 
words, the wish is often father to the thought. 

The Army figures for 1911-12 are not very convincing. Of 50 cases 
operated on, 13 were not tested, so eliminating these the number is 
brought to 37. Of these, 18 were shown improved and 18 not improved, 
and: 1 died. 

Of the 18 shown as improved, 7 were still decided roarers, and of the 
18 shown as not improved, 6 were worse, 3 were cast and sold, and 
1 destroyed as incurable. 

The figures for 1912-13 show that 62 cases were operated on. Of 
these, 31 were improved, 22 were not improved, 8 were not tested, and 


1 died. 
GRUNTING. 


This is a peculiar sound of the nature of a grunt, which is emitted by 
some horses when threatened with a stick. The sound occurs during 
expiration, and it may also be induced when the horse is galloping if he 
is struck suddenly by the rider, either with a stick or with the heels; in 


DISEASES OF THE LARYNX: HORSE 841 


many instances it is heard when the horse lands after jumping a fence, 
or when he is rapidly moved into a different position. 

Grunting varies in degree; thus a nervous horse may emit a slight 
~ grunt, which cannot be considered as abnormal. On the other hand, the 
deep, prolonged, well-marked grunt (half roar, half grunt) which so 
frequently accompanies roaring is characteristic. 

Authorities are not agreed as to the exact causation of the sound. 
Robertson was of opinion that it may be “ associated with or dependent 
on disease of the larynx, or, the larynx being healthy, the sound may be 
indicative of an abnormal state of the chest.” He also believes that it 
may be dependent upon nervous. irritability. Many practitioners hold 
that a “ grunter,” although giving no evidences of unsoundness in wind 
after being subjected to the usual test, 1s likely to become unsound in this 
respect. Of course, we are referring to well-defined grunting, and not 
to the slight sound which may occur in the case of nervous horses. 

From a medico-legal aspect the subject of grunting is one of great 
importance. Although the majority of roarers are grunters also, it by 
no means follows that all grunters are unsound in their wind. Hence 
differences of opinion are by no means uncommon as to whether grunters, 
which are otherwise sound, should be passed or rejected. 

The deep, well-marked, prolonged grunt, which is readily produced, 
should be a sufficient cause for rejection, especially in a young horse, as 
although the animal may not show evidences of whistling or roaring at 
the time of examination, it is exceedingly probable that he will develop 
the affection at no distant date, particularly if he is attacked by strangles, 
pneumonia, etc. It is, however, with cases of grunting of ordinary 
intensity that differences of opinion are likely to occur. 

Williams was of opinion that “‘if the grunter stands the tests used to 
detect roaring without making any noise in its breathing it may be con- 
sidered sound.’ Many veterinary surgeons, however, reject grunters as 
being unsound, basing their action on their experience that the majority 
of such cases ultimately become whistlers or roarers. Most horsemen 
hold similar views. 

In the examination of horses as to soundness, the presence of grunting 
should always be mentioned on the certificate, and the attention of the 
purchaser specially drawn to the defect. This protects the practitioner 
from blame, and enables the purchaser to use his discretion as to whether 
he will run certain risks, either of the horse becoming unsound, or, should 
he sell the animal, of another practitioner rejecting it for grunting. The 
question is still a vexed one, and is likely to remain so. 

As regards the slight form of grunting which occurs in nervous horses, 


842 SYSTEM OF VETERINARY MEDICINE 


it is quite evident that such is of no importance. In a well-bred nervous 
horse that is subjected to the rough usage so frequently adopted in order 
to test for grunting, it is not surprising to find such a sound produced. 

The absence of grunting is not to be regarded as evidence that the 
horse is sound in his wind, as it is well known that some whistlers or 
roarers do not grunt. It is said that if the usual tests for grunting be 
constantly applied to an animal suffering from this defect he eventually 
ceases to emit the sound. 

The period of time in which a horse may ae orunting is a question 
which has arisen in medico-legal cases. It is not easy to give a definite 
answer, but just as in the case of whistling, roaring, shivering, etc., we are 
of opinion that grunting may develop suddenly or at any time. 

Grunting is especially frequent in heavy cart-horses, stallions, and 
over-fed animals doing but little work. Probably the most lucid and 
practical article on “‘ Grunting”’ that has ever appeared in veterinary 
literature is that written by Macqueen.* A complete history of the term is 
given, and also the views of the old and modern writers on the subject. 
The only point on which we are in disagreement with the author is 
with reference to the usual custom of the profession when dealing with 
erunters in the examination of horses as to soundness. One would 
gather from certain passages that it was not usual to reject horses for 
grunting. For example, he states: ‘‘ Bearing these decisions in mind, 
veterinary surgeons have continued to condemn as unsound horses that 
roar or whistle, and to refuse to reject as unsound horses that only grunt. 
And the practice has been well founded.” 

Now, as a matter of fact a large number of veterinary surgeons do 
reject horses that. grunt; this is demonstrated by every-day experience, 
by the views given by experts in medico-legal cases, and also in dis- 
cussions on the subject at veterinary associations. Hence, as already 
remarked, we advise the practitioner, in order to protect himself, that 
when he examines a horse and finds the animal a grunter, he should 
mention the fact on the certificate. He may give his own view on the 
question of grunting not being a cause of unsoundness, but his duty is to 
point out the fact that the horse grunts. If he omits to do this, he lays 
himself open to a lawsuit, in which the client will have little difficulty 
in producing an array of experts to prove that grunting is an unsound- 
ness. True, the veterinary surgeon can secure an equal number of 
experts to prove the opposite, but lawsuits are expensive, annoying, and 
uncertain, and we prefer to avoid having the matter decided by a judge 


* Journal of Comparative Pathology and Therapeutics, vol. ix., p. 112. 


® 


DISEASES OF THE LARYNX: HORSE 843 


and jury, more especially in the face of the views expressed in some of 
the textbooks, and in “ Oliphant’s Law of Horses.” 

It would, however, be of great importance both to the profession and 
to the sellers of horses if the matter was definitely settled. As the subject 
stands at present it is full of uncertainty, but one point must be kept in 
view—viz., that the majority of horsemen will not purchase an animal 
that is found to be a grunter. We agree with Macqueen that grunting 
has not been proved to depend on any diseased condition, and we can 
only wish that the concluding remarks in his article were adopted in 
practice. These remarks are so important that we quote them in full: 

“Until grunting, short or long, can be irrefutably connected with a 
constant lesion—whether of the respiratory or another apparatus does not 
matter—no one may justly condemn a horse for grunting alone. To 
constitute unsoundness a noise must depend upon disease, and until the 
cause of grunting has been ascertained nothing will be gained by sacri- 
ficing accuracy to expediency, mistaking functional flutter for structural 
incompetence, accepting the outcome of fear for the effect of effort, 
expiratory sound for inspiratory symptom, or grunting for roaring.” 

With this view we are in agreement, provided that the deep, pro- 
longed, well-marked type of grunting to which we have already referred 
is not included. 


THICK WIND. 


This is a condition concerning which more definite knowledge is 
desirable. Some practitioners apply it to a harshness of character in 
the respiratory sounds which is met with in horses in gross condition, 
or in animals out of condition that show more distress than usual when 
subjected to exertion. This may be quite normal, and must be carefully 
distinguished from the laboured respiration that accompanies chronic 
bronchitis or the early stages of broken wind. 

It is very difficult to lay down a standard for normal breathing, as 
much depends on the fitness of the animal for exertion. A grass-fed 
horse, or one out of condition, when subjected to exerticn, will have his 
respirations accelerated to a far greater extent, and the character of the 
respiratory sounds by no means so clear, as a horse in hard-fed condition, . 
and rendered fit for fast work by suitable training. 

As a pathological condition, thick wind is met with in horses that have 
recently recovered from a pulmonary affection, especially bronchitis. 
In such instances the respiratory distress is well marked after moderate 
exertion, and the breathing laboured, so that the anima] must be regarded 
as unsound, 


844 SYSTEM OF VETERINARY MEDICINE 


This unsoundness may be temporary, disappearing when the respira- 
tory organs return to a normal condition, or, on the other hand, the thick 
wind may be one of the early symptoms of broken wind. In such cases 
it is always advisable to defer giving a definite opinion until the horse 
has been examined a second time. This applies also to instances where 
we suspect that a defect in the wind may be of a temporary character; 
the examination should be deferred until such time that we can state 
confidently whether the wind is sound or unsound. Even the existence 
of an ordinary attack of nasal catarrh may cause the presence of abnormal 
respiratory -sounds, but it would obviously be very unwise to give a 
definite opinion under such circumstances. Moreover, the affection said 
to be ‘“ only a cold” may be the forerunner of permanent whistling. 


HIGH-BLOWING. 


This is a peculiar respiratory sound emitted during expiration, and 
said to arise from the region of the nostrils. It occurs especially when 
the horse is fresh, and usually ceases when a moderate degree of exertion 
is given, but in some instances it persists even during a full gallop. The 
real origin of the sound is not known. It is not an unsoundness, and is 
readily distinguished from whistling or roaring. In our experience a 
‘* high-blower ” is seldom affected by either of these defects. 


DISEASES OF THE BRONCHI. 
ACUTE BRONCHITIS (ACUTE BRONCHIAL CATARRH). 


This is an acute catarrhal inflammation of the bronchial mucous 
membrane. A croupous form of bronchitis is also recognised (see p. 849). 
Acute bronchitis may affect the large tubes and those of medium size, 

or the bronchioles. 

The latter is termed “capillary bronchitis,’ and as it is always 
associated with inflammation of the pulmonary tissue, it forms part of the 
affection known as “‘ pneumonia,” hence it will be described under that 
heading. Neither clinically nor pathologically can the two affections be 
differentiated. . 

In some instances the affection may be of a diffuse character, involving 
the large and medium tubes as well as the bronchioles; in such cases the 
bronchitis will be combined with pneumonia. 


DISEASES OF THE BRONCHI: HORSE 845 


Bronchitis affecting the large and medium-sized tubes will be con- 
sidered under the present section. 

Etrotogy.—1l. The affection may follow an attack of acute nasal 
catarrh or laryngitis, especially if the animal be exposed to chills and 
kept at work. The inflammatory action spreads in a downward direction, 
and in such instances the mucous membrane of the trachea is also 
involved. Hutyra and Marek state that only in rare instances does 
inflammation of the larynx or trachea extend to the bronchial mucosa. 

2. Exposure to cold, chills, inclement weather, etc. These are recog- 
nised as common causes, but it is highly probable that microbial influences 
play an important part in the etiology of the disease, and that the above 
are in reality but accessory causes, acting by lowering the vital resistance 
of the bronchial mucosa. 

3. Mechanical—The inhalation of irritating fumes, such as smoke 
from burning buildings, can produce bronchitis. Also the entrance to the 
bronchi of fluids of an irritating nature, such as may occur by the careless 
administration of drenches. 

As fluids of a non-irritating nature may also produce this effect, 
although to a less extent, it seems probable that microbial influences exert 
their effect in these instances also. 

4. Bronchitis may accompany infectious diseases, such as influenza, 
strangles, etc. In such instances capillary bronchitis is the form most 
frequently met with. Acute bronchitis as.a disease per se is not of 
frequent occurrence; more often it forms part of the specific affections 
mentioned. 

Morsip ANaTtomy.—As uncomplicated cases of this form of bronchitis 
rarely prove fatal, opportunities for observing the lesions of the affection 
are seldom afforded. The bronchial mucous membrane shows con- 
gestion, swelling, and redness, either in a uniform manner or in patches, 
and is covered by an exudation which may be mucous or muco-purulent in 
character. 

In addition to the above, desquamation of the ciliated epithelium is 
observed, and the submucosa is swollen, cedematous, and infiltrated with 
leucocytes. The mucous glands are also swollen. Similar changes may 
occur in the mucous membrane of the trachea. 

Symproms.—In many cases the usual symptoms of coryza are present, 
and may be premonitory to those of bronchitis; a varying degree of 
laryngitis may also appear. In mild instances the elevation of tempera- 
ture is slight, and the respirations are but little accelerated. 

In severe cases febrile symptoms are more marked, dulness, elevation 
of temperature, a quick, soft pulse, accelerated respirations, loss of 


846 SYSTEM OF VETERINARY MEDICINE 


appetite, cough, and nasal discharge being in evidence. The cough is at 
first dry, hard, and distressing in character, and may appear in paroxysms. 
Later on, when exudation occurs, the cough becomes looser and of a 
softer character. The nasal discharge is at first thin, watery, and scanty, 
later on altering to muco-purulent and becoming more profuse. 

Auscultation.—In the early stages auscultation of the lower end of the 
trachea and upper border of the middle third of the chest shows a harsh, 
blowing, bronchial sound. Sibilant rales of an intermittent character 
may be heard in the latter region. Later on, when exudation occurs, 
the rales alter to a moist or mucous type. 

Percussion.—In uncomplicated bronchitis percussion reveals nothing 
abnormal. 

Expectoration does not occur in animals in the same sense as In man. 
The bronchial discharge when coughed up is only partly got rid of by 
way of the nostrils; the major portion enters the fauces and is swallowed. 
In the early stages the expectorate is thick, scanty, and tenacious; later on 
it becomes more profuse, and issues from the nostrils as a muco-purulent 
discharge. 

Coursre.—Bronchitis of the type we are considering usually runs a 
favourable course if the animal is taken from work sufficiently early and 
treated in a rational manner. Otherwise, the inflammatory action may 
extend to the bronchioles, and pneumonia results. In aged and debili- 
tated animals this extension is more likely to occur, as the muco-pus 
tends to enter the dependent parts and to produce dilatation of the 
smaller bronchi. 

DIFFERENTIAL D1acNnosts.—Bronchitis affecting the larger tubes is 
distinguished from the capillary form (broncho-pneumonia) by a con- 
sideration of the general symptoms, and by a physical examination of 
the chest. In broncho-pneumonia, fever, dyspnoea, and constitutional 
symptoms are well marked, and the physical signs are different. 

TREATMENT.—Harly treatment, rest, and attention to hygienic and 
dietetic details, are of first importance. 

Inhalations of steam, medicated with terebene, oil of eucalyptus, or 
compound tincture of benzoin, prove useful by allaying irritation of the 
bronchial mucosa, promoting secretion, rendering the latter less viscid, 
and thus facilitating its discharge by the nasal cavities. If laryngitis 
accompanies the affection, a blister should be applied to the region of the 
throat, and an electuary, composed of extract of belladonna, potassium 
chlorate, and honey, administered on the back of the tongue twice or 
three times daily. 

Salines, such as sulphate of magnesia with nitrate of potassium, may 


DISEASES OF THE BRONCHI: HORSE 847 


be given in the drinking-water. Drenching should be rigidly avoided, as 
there is great danger during the fit of coughing induced by the process 
that some of the fluid may enter the trachea. Besides, there is no neces- 
sity to prescribe medicinal agents in this form of the disease, and the 
large list of drugs mentioned in some textbooks for the treatment of 
bronchitis are totally unnecessary, and are far better avoided. We are 
very sceptical as to the value of expectorants administered internally in 
the case of horses. Neither is it advisable to administer the moderate 
dose of aloes mentioned by some authors; not only is there a danger of 
superpurgation resulting, but this drug also produces nausea and loss of 
appetite. If laxatives are indicated, they can be prescribed in the form 
of sulphate of magnesia in the drinking-water, also by the administration 
of enemas of warm water. 

As regards local applications to the thoracic walls and the value of 
counter-irritation, see remarks on Pneumonia (p. 881). 

It is not uncommon to find a persistent irritable cough remaining 
after an attack of bronchitis, accompanied by an intermittent nasal 
discharge when the horse is exercised. In such cases we find that tonics 
prove serviceable, and a combination of sulphate of iron with arsenious 
acid may be given in the food twice daily. | 


CHRONIC BRONCHITIS. 


This condition may follow an acute bronchial catarrh, or repeated 
attacks of the same. In our experience the majority of cases occur as 
“the result of capillary bronchitis. Cases, however, are met with in which 
there has been no history of an acute attack. Such instances usually 
occur in aged animals suffering from debility, and kept under insanitary 
conditions. Occasionally chronic bronchitis is a complication of chronic 
valvular disease of the heart. It is also present in many cases of pul- 
monary emphysema. The border-line between advanced cases of chronic 
bronchitis and pulmonary emphysema, or broken wind, cannot be clearly 
drawn, as the former often merges into the latter. 

Morsip Anatomy.—The bronchial mucosa is thickened, granular, 
and infiltrated. It may be of a dark red, a greyish-red, or a brown colour, 
and in cases of long standing the entire structures composing the walls of 
the bronchi are involved by new growths of connective tissue unequally 
distributed. The secretions are usually purulent or muco-purulent, 
and in some instances may be fcetid in character or caseous. They may 
extend into the smaller bronchi and distend them, and atelectasis and 
pulmonary emphysema may result. 


848 SYSTEM OF VETERINARY MEDICINE 


Occasionally nodules are formed in the peri-bronchial tissue; this 
condition was termed “ peribronchitis nodosa” by Dieckerhoff. These 
nodules are believed to be due to a peribronchitis, the inflammation 
extending from the mucosa to the outer wall of the bronchi. Small 
nodules are formed, with a thick external coat, containing in their centres 
either a small amount of pus, or caseous or calcified material. Inter- 
stitial pneumonia may accompany the condition. ? . 

According to Ziegler, this condition in reality belongs to broncho- 
pneumonia. These nodules resemble the pulmonary nodules of glanders: 
For the differential diagnosis, see Glanders vel I.). 

The condition known as “ bronchiectasis”? may be present. This 
signifies dilatation of the bronchi due to a weakening of their walls, so 
that they are unable to resist the pressure of the air during paroxysms 
of severe coughing. These dilatations may be of large size and of various 
forms—e.g., cylindrical, saccular, or spindle-shaped; their location is 
usually at the apex of the lungs. Occasionally the contents of some of 
the larger cavities may be foetid. Rarely the muco-purulent contents may. 
become calcified, forming pulmonary concretions. A varying degree of 
emphysema may also be present. 

Symptoms.—The usual symptoms are a loud, hard cough, often appear- 
ing in paroxysms, especially on exposure to cold air. Respiratory distress 
is evinced on slight exertion. The nasal discharge may be intermittent, 
whitish, or flocculent in character, or muco-purulent, and appears after 
exercise or after a fit of coughing. In some instances the nasal discharge 
is scanty, and the paroxysms of coughing are frequent; this is termed 
“dry catarrh,” and is often evidence of the commencement of pulmonary . 
emphysema (broken wind). 

Percussion is said to give a tympanitic sound over certain areas, but 
this we have never been able to demonstrate to our satisfaction. 

Auscultation reveals the presence of a variety of abnormal sounds. 
The rhonchi may be high-pitched or deep. Expiration is prolonged, and 
accompanied by sounds of a wheezing character. 

Occasionally the nasal discharge is foetid and very profuse, and the 
animal loses condition; these are evidences of the presence of bronchial 
dilatation. 

Proenosis.—Chronic bronchitis must always be regarded as a serious 
affection, as it often persists in spite of treatment, and frequently merges | 
into pulmonary emphysema (broken wind). 

TREATMENT.—The employment of inhalations of steam, medicated 
with terebene, oil of eucalyptus, or compound tincture of benzoin, etc., is 
indicated, and should be diligently carried out three times daily. For 


DISEASES OF THE BRONCHI: HORSE 849 


the relief of the cough, which is a distressing symptom, the administration 
of heroin has been highly recommended, but in our experience this agent 
often fails to exert any beneficial effect.- We have found a combination 
of arsenic, iodide of potassium, and bicarbonate of soda useful. Tar-water, 
allowed ad lib., often produces good effects. 

Attention to diet is also essential; the amount of hay should be 
limited, and when circumstances permit, the addition to the food of young 
furze (gorse) tops, chopped, is useful. Boiled linseed should also be 
added to the dietary, and occasionally small amounts of raw linseed oil 
may be given in the food, if the animal does not object to it. 

If the nasal discharge becomes foetid, antiseptics, such as cyllin or 
lysol, should be used in the form of medicated inhalations of steam. 
Unfortunately, many cases of chronic bronchitis terminate in broken 
wind, in spite of every form of treatment. 


CROUPOUS BRONCHITIS (PLASTIC OR FIBRINOUS BRONCHITIS, 
AND BRONCHIAL CROUP). 


This form of bronchitis is described by Friedberger and Froéhner, also 
by Law, as occurring in the horse. It is, however, admitted that croupous 
bronchitis is far more commonly met with in cattle and sheep, and Hutyra 
and Marek only describe it as occurring in these animals. 

The characteristic feature of croupous bronchitis is the formation of 
fibrinous casts in some of the bronchial tubes; portions of these casts are 
expelled in the nasal discharge during a paroxysm of coughing. The 
tracheal mucous membrane is generally involved as well as the bronchial 
mucosa. In addition to the swelling and injection of the mucose, 
tough membranes of a yellowish colour are found adherent to its 
surface. In some instances the smaller bronchi may be completely 
blocked by portions of membrane which have assumed a cylindrical shape. 

The pathology of the disease is obscure. 

Law quotes cases described by Reynal as occurring in young army 
horses in France. In this outbreak the capillary form of bronchitis was 
present, and in the later stages shreds of false membranes appeared in the 
nasal discharge. Constitutional disturbance and dyspnoea were marked 
features, with paroxysms of coughing, great distress, and death from 
asphyxia. 

The treatment of croupous bronchitis does not differ from that of 
ordinary bronchitis. 


VOL. II. 54 


850 SYSTEM OF VETERINARY MEDICINE 


BRONCHIAL ASTHMA (SPASMODIC ASTHMA). 


The term “asthma” is often loosely applied in veterinary medicine 
to various conditions associated with dyspnea. Thus some authorities 
place asthma and the affection known as “ broken wind” under one 
heading. Again, the dyspnoea which may accompany certain diseases of 
the heart and of the kidneys is termed respectively “cardiac asthma ” 
and ‘‘ renal asthma.’’ Spasmodic or bronchial asthma, however, should 
be regarded as a special and distinct affection ; although possessing certain 
characteristics in common with broken wind, a differential diagnosis 
can be made in the majority of cases (see Broken Wind, p. 893). Long- 
standing cases of spasmodic asthma usually terminate in pulmonary 
emphysema, the condition on which broken wind depends. Again, 
attacks of spasmodic asthma may occur in cases of broken wind, and 
it has been observed that the former affection may be the precursor of 
the latter. 

Robertson* described spasmodic asthma as a distinct disease in the 
horse. Penberthy+ also recognised and described cases of the affection. 

The disease is characterised by sudden intermittent attacks of dyspnoea 
of a distressing nature and of variable duration, the symptoms subsiding 
in an abrupt manner. 

EtioLogy.—The etiology of the affection is by no means settled, and 
various theories have been advanced to account for the attacks. 

Most authorities believe in a neurotic origin or disturbed innervation, 
as the result of which the following phenomena occur: (1) Spasm of the 
bronchial muscles. (2) Congestion and turgescence of the mucous mem- 
brane of the smaller bronchial tubes, accompanied by an exudation of 
thick mucus in the form of rounded pellets, which may appear in the 
nasal discharge. 

The disturbed innervation is generally reflex in character, and may 
arise indirectly from the stomach or intestines. In man certain nasal 
affections, such as hypertrophic rhinitis and nasal polypi, are recognised 
as being exciting causes of bronchial asthma. Such cases are explained 
by a vaso-dilatory action reflexly induced, which produces congestion, 
turgescence, swelling of the mucosa of the bronchial tubes, and conse- 
quent stenosis of their lumen. Whether such causes exist in animals is 
not definitely known. | 

A case is recorded by Priimmers of spasmodic asthma in the horse, 
associated with the presence of a tumour of the right superior maxillary 


* “ Practice of Equine Medicine.”’ 
{ Journal of Comparative Pathology and Therapeutics, December, 1894. 


DISEASES OF THE BRONCHI: HORSE 851 


bone and swelling of the nasal mucosa. With the reduction of the 
tumour and swelling the dyspnoea was relieved. 

We have no evidence that attacks of the disease may be induced, as 
in man, by climatic or atmospheric influences, or certain foods, odours, 
emanations, fright, etc. That some cases of the disease may depend 
on inflammation of the smaller bronchioles, associated with exudation 
of a viscid tenacious mucus, seems very probable. 

In the instances recorded by Penberthy the cause could not be detected. 
These cases, six in number, occurred in geldings over seven years old, of 
the lighter and better class, and kept under good conditions. In three of 
the cases whose after-history was traced the symptoms recurred at 
indefinite periods. In other cases the symptoms disappeared suddenly, 
some temporary debility being left, and on resuming work there was no 
evidence of broken wind. In two instances, in which the paroxysms were 
very severe and prolonged and recurrences frequent, evidence of pul- 
monary emphysema was present on physical examination, and symptoms 
of broken wind developed. 

We have observed a case of the disease in a well-bred cob in which 
the symptoms were very urgent, and disappeared within two days. 

As regards the frequency of bronchial asthma, judging from the small 
number of cases reported, it must be regarded as a comparatively rare 
disease. On the other hand, broken wind in horses is of common 
occurrence. 

From a medico-legal aspect, the subject of asthma is of importance, 
as an attack may occur in a horse recently examined and passed as sound. 
In such an instance the purchaser may assert that the affection is broken 
wind, which must have been overlooked by the examiner; hence the 
latter may be accused of neglect. Now, broken wind does not arise 
suddenly, and unless certain tricks are resorted to by the seller (see p. 902), 
there are evidences of its existence present. On the other hand, asthma 
occurs suddenly, and in an animal subject to such attacks there are no 
symptoms suggestive of this tendency during the quiescent period ; hence 
it cannot be detected. 

Morsip Anatomy.—As a fatal termination during an attack seldom 
occurs, little is known of the morbid anatomy of the affection. In old- 
standing cases chronic bronchitis and emphysema have been observed. 

Symproms.—The attacks of dyspnoea in spasmodic asthma are sudden 
in their development, and the symptoms disappear quite as rapidly. 
These attacks may recur at indefinite periods, and during the quiescent 
intervals no symptoms are observed, the animal appearing in perfect 
health. The symptoms may arise during work or when at rest; more 


852 SYSTEM OF VETERINARY MEDICINE 


frequently in the latter instance. The evidences of dyspnoea may be 
well marked—viz., the animal stands with fore-legs apart and elbows 
turned out, neck extended, and nostrils dilated. 

The act of inspiration is abrupt, and appears as if suddenly arrested, 
while the expiratory act is prolonged, and is completed in a peculiar, 
jerky manner. 

Respiration is of the abdominal type, and peculiar wheezing sounds 
accompany the breathing. An anxious expression of countenance and 
exhaustion may coincide with the attack. The temperature may be 
normal, or may rise to 101° F. At the outset a nasal discharge may be 
absent; later on it may appear in considerable amount, and be of a frothy 
character, or may contain pellets of thick tenacious mucus, which are 
coughed up. The cough in the earlier stages is not well marked, but 
lateron it may assume a moist paroxysmal character. Robertson has 
observed a short, quick, suppressed cough in his cases. Percussion may 
show increased resonance, especially if emphysema be present. Auscul- 
tation may show in some instances feeble respiratory sounds, which may 
result from spasm of the bronchial muscles (Penberthy). In other cases 
varieties of rales, both high and low pitched, are heard. On auscultation 
of the anterior and lateral regions of the chest distinct wheezing sounds 
are detected. 

In some cases during the paroxysms the nasal mucous membrane may 
be of a dusky hue, which returns to normal when the dyspnea dis- 
appears. In the case which we observed the dyspncea was extreme, the 
thorax appeared barrel-shaped, the wheezing respirations were audible 
while standing by the animal, and on a superficial examination it could 
easily be mistaken for an exaggerated case of pulmonary emphysema. 
Paroxysms of cough of a dry, short character occurred at intervals. 

CourseE.—The duration of the attack varies. It may continue for 
several hours or days, and in some instances for four or five hours only. 
Robertson found that the affection may continue for weeks. It may 
disappear and not return for a considerable time, or it may gradually 
terminate in broken wind. In the latter affection it is not uncommon for 
attacks of asthma to supervene at times. 

Clinical observation, however, demonstrates the fact that asthma is 
not always followed by broken wind. 

Again, the frequent occurrence of broken wind, compared with 
the number of cases of asthma met with, goes to prove that the latter 
affection 1s not a common precursor of the former. 

DIFFERENTIAL DiaGnosis.—T he affection must be differentiated from 
broken wind. Asthma is distinguished by its sudden appearance in 


DISEASES OF THE BRONCHI: HORSE 853 


an animal previously healthy, by the intermittent nature of the attacks, 
the paroxysmal character of the symptoms, and by their abrupt cessation. 
When the attack has passed off, there may be no evidences of respiratory 
distress after exertion. 

In broken wind, on the other hand, there is no intermittency in the 
symptoms. No doubt after exertion or in consequence of dietetic errors 
the evidences of respiratory distress are more marked than when the 
animal is at rest and carefully dieted. But even when at rest the 
peculiar double expiratory movement and the characteristic cough can 
be observed (see p. 898). The history of the case must also be considered, 
and will assist in the differential diagnosis. 

From acute pulmonary affections asthma is distinguished by the 
slight degree of fever present, by a physical examination of the chest, and 
by a consideration of the history of the case. - 

TREATMENT.—Many medicinal agents of an antispasmodic nature 
have been tried in the treatment of this affection. It cannot be said that 
one agent possesses any special advantages over another. Penberthy 
found inhalations of amyl nitrite, chloroform or ether, and the internal 
administration of ethereal tincture of lobelia, the most effective treat- 
ment. In one case hand-rubbing the legs seemed to cut short the spasm. 
Robertson found that the administration of a mild laxative, and the 
application of a smart vesicant to the chest-walls, proved as useful as 
treatment with drugs. Other practitioners have found belladonna, 
hyoscyamus, or chloral hydrate, useful in relieving the dyspneea. 

Attention to diet and to the surroundings is essential. In human 
medicine the administration of iodide of potassium in full doses, three 
times daily, is highly recommended to prevent a recurrence of the attacks. 
We have prescribed this agent in combination with arsenic and belladonna, 
and obtained good results. Inhalations of steam medicated with 
terebene prove useful in relieving the spasm and dyspnea. 


DISEASES OF THE LUNGS. 


For convenience of description we shall consider the above diseases 
under the following headings: 


I. Circulatory Disturbances of the Lungs. 
II. Pneumonia. 


IIT. Other Morbid Conditions of the Lungs. 


854 SYSTEM OF VETERINARY MEDICINE 


I. CIRCULATORY DISTURBANCES OF THE LUNGS. 


These include congestion of the lungs, acute pulmonary congestion 
pulmonary cedema, pulmonary hemorrrhage. 


Congestion of the Lungs. 


Synonym.—Pulmonary hyperemia. 

Two forms of this affection are recognised—viz., (1) Actwe ; 
(2) Passive. 

1. Active pulmonary congestion may be associated with various 
pulmonary affections, such as pneumonia, bronchitis, and pleurisy; it 
may also accompany attacks of laminitis, traumatic arthritis, etc. A 
special form of intense pulmonary congestion is met with in the horse, 
occurring as the result of severe exertion when the animal is not in fit 
condition for work of the kind. From a clinical aspect this form is the 
most important, and merits special consideration. 

Pulmonary congestion occurs in the early stage of pneumonia, but 
clinical evidences of its presence are not often observed, as the prac- 
titioner is seldom called in at this period. 

We recognise a form of pulmonary congestion in the horse which is 
obscure as to its etiology, and tends to recover with simple treatment. 
Such cases are met with during epidemics of influenza, but also occur 
sporadically. This form is ushered in by rigors, a variable rise in 
temperature, accelerated respirations, loss of appetite, dulness, quickened 
pulse, etc. A physical examination may reveal: slightly defective 
resonance on percussion, and the presence of fine crepitations or fine rales 
on auscultation. It is impossible to give a definite opinion as to the 
course such cases may take—i.e., they may recover in a short space of 
time, or may develop pneumonia. Some authorities are of opinion that 
such cases are in reality mild, abortive, or larval types of pneumonia. 

Occasionally we meet with cases of very acute pulmonary congestion 
occurring in connection with attacks of influenza, when animals suffering 
from the latter are brought long distances by rail or boat in inclement 
weather. Such cases are more likely to occur in high-conditioned horses. 
The symptoms are similar to those described as occurring in that form 
of the affection depending on excessive exertion (see p. 855). 

2. Passive pulmonary congestion may occur as a secondary condition 
in certain cardiac affections—e.g., in valvular disease of the left side of 
the heart. When compensation fails, there is interference with the return 
of the blood from the lungs to the heart, resulting in pulmonary engorge- 
ment. This is sometimes known as “ mechanical congestion.” 


DISEASES OF THE LUNGS: HORSE 855 


Hypostatic Congestion.—This is another form of passive pulmonary 
congestion. It occurs in adynamic conditions and debilitating diseases, 
especially when the animal assumes the recumbent position for a long 
period, and it is usually unilateral. It may also arise from standing for 
long periods on board ship. It results from weakened cardiac action, 
and also because the venous blood has to overcome the effect of gravity. 
The base of the lungs is chiefly affected, being deeply congested and dark 
in colour. In advanced cases, so extensive is the engorgement with 
blood and serum, that the alveoli are devoid of air, and portions of the 
lung sink if placed in water. To such a condition the terms “ splenisa- 
tion ” and “‘ hypostatic pneumonia ” are sometimes applied. Hypostatic 
congestion of the lung may alsovoccur post mortem. 

Passive pulmonary congestion may also occur in tympanitic conditions 
of the stomach or intestines, in ascites, and from the presenceof abdominal 
tumours. Such conditions may exert compression on the large vessels or 
on the base of the lungs, and thus induce passive congestion in these 
latter organs. 

Acute Pulmonary Congestion. 

Synonyms.—Mechanical engorgement of the lungs; Pulmonary 
apoplexy. 

This is a special form of pulmonary congestion occurring in the 
horse, and, in consequence of its serious and often fatal nature, it merits 
a separate consideration. 

ETIOLOGY.—Severe exertion, when a horse is not in fit condition, is 
the common cause of this affection. Thus, if a hunter in plethoric 
condition, whose circulatory, respiratory, and muscular systems are not 
trained by gradual work to stand severe exertion, is forced to a quick run 
with hounds, acute pulmonary congestion is apt to develop. This is more 
likely to occur when the rider lacks judgment or experience, and over- 
looks the primary evidences of respiratory distress and the animal's 
unfitness for further exertion. The affection may also occur in grass-fed 
horses subjected to exertion for which they are unfit. 

While the above is true in the majority of instances, one should 
remember that the subjects in which it occurs are by no means always 
_plethoric, though they will not be in first-class galloping condition; and in 
some keen horses the premonitory symptoms are so short that the most 
experienced rider may be taken unawares. 

Under any of these conditions respiratory distress becomes manifested, 
and other characteristic symptoms appear, all being due to engorgement 
of the pulmonary vessels and over-distension of the right side of the 
heart, 


856 SYSTEM OF VETERINARY MEDICINE 


Morsip Anatomy.—When the thoracic cavity is opened, the lungs 
do not collapse. The pulmonary vessels are engorged, and the lungs are 
dark red in colour, and in some instances may be almost black. In con- 
sistence the pulmonary tissue is more or less friable at certain points, and 
tends to early putrescence. Extravasation may occur into the parenchyma, 
due to rupture of some of the pulmonary capillaries, indicated by darker 
points throughout the lung tissue. The bronchi contain frothy mucus, 
which may be blood-stained. The lungs generally float when placed in 
water, but portions which are airless will sink; these airless portions 
depend on the alveoli and bronchioles being obliterated by swelling of 
their mucous membrane and by the presence of blood-clots. Micro- 
scopical examination shows an absence of exudate from the alveoli and 
bronchioles, thus differing from the condition met with in pneumonia. 
On section, the lung presents a dark red or dark purple colour, and the 
blood which exudes is dark, and in some cases may be of a tarry con- 
sistence. The lungs are heavier than normal, and pulmonary cedema in 
varying degree is present. The right side of the heart and the large veins 
are distended with dark-coloured blood, which is viscid in consistence. 

In those cases which collapse and die in a few minutes, the cedema is 
slight, and the pulmonary engorgement appears less than in those cases 
lasting some time; but the distension of the right side of the heart and 
the large veins is very marked. 

Symptroms.—The first symptoms are a tendency to hang heavily on 
the bit, or, in the case of a keen horse, the animal just fails to catch hold 
of the bit. This is followed by a tendency to “ sprawl,” and if the horse 
is not quickly pulled up, he stops of his own accord, or perhaps he actually 
falls. In such cases death may occur in a few minutes, due not only to 
asphyxia from pulmonary engorgement, but also from over-distension of 
the right side of the heart. Usually, however, the rider dismounts, and 
finds the horse showing the following symptoms: Laboured breathing, 
heaving at the flanks, forelegs stretched out and wide apart, dilated 
nostrils, eyes protruding and bloodshot or sunken and dull, head extended, 
visible mucous membranes injected, a blue tinge of the Schneiderian 
mucous membrane, marked coldness of the legs and ears, cold sweating, 
and general tremors of the muscles. 

The cardiac action is tumultuous in character; the pulse is small, real 
rapid, and indistinct, and may be almost ena in the sub- 
maxillary artery; the superficial veins are dilated. The animal stands 
with the limbs apart and the elbows turned out, in order to facilitate 
expansion of the chest. The respirations, although greatly accelerated 
and panting, are shallow in character. In scme cases a frothy nasal 


DISEASES OF THE LUNGS: HORSE 857 


discharge, slightly hemorrhagic, may be observed; also a superficial, 
short, dry cough may be present. The temperature is only slightly 
elevated. | 

Percussion shows a decreased resonance over the entire pulmonary 
area in some cases; in others nothing abnormal can be detected. 

Auscultation reveals the presence of minute crepitations, which may 
be generally diffused, or may be only audible over limited areas. Some 
authorities have observed a rattling sound when hemorrhage from the 
pulmonary capillaries has occurred. 

CoursE AND Proanosis.—In the very acute cases the right side of 
the heart becomes unable to propel the blood through the pulmonary 
capillaries, hence the lungs become engorged, and the animal may die in 
a short space of time from asphyxia and from over-distension of the right 
heart. 

In less severe cases, and with rational treatment, the normal functions 
of the heart and lungs become restored, and recovery ensues in one or two 
days, or the case may develop into pneumonia. 

The prognosis should always be guarded, as even after apparent 
recovery pneumonia may superyene, especially if proper attention is not 
paid to after-treatment, or if the animal is put to work too soon, or 
exposed to chills, etc. 

_ DirFerRentiaL Diagnosis.—The history of the case, and the evidences 
obtained from a physical examination of the chest, also the absence of a 
marked rise in temperature, enable us to differentiate this affection from 
other pulmonary diseases. But in cases not depending on over-exertion, 
and in which the pulmonary congestion constitutes the early stage of 
pneumonia, high fever may accompany the condition. 

From a medico-legal aspect it is of importance to distinguish acute 
pulmonary congestion due to over-exertion from other affections of the 
lungs. Given the history of a horse in unfit condition for severe exertion 
that dies a short time after purchase during a run with hounds, the post- 
mortem appearances of the lungs will enable the practitioner to offer a 
definite opinion as to the nature of the case. 

If the lungs are found gorged with blood and dark in colour, and if 
there be no exudate present in the bronchioles or alveoli, and an absence 
of hepatization and other lesions, the organs floating when placed in 
water, it 1s evident that no previous disease has been in existence. 

Under these circumstances the death of the horse should be ascribed 
to the carelessness or ignorance of the rider, as the animal was not in 
proper condition to undergo the exertion to which he was subjected. 

Another form of acute pulmonary congestion is seen in the horse, 


858 SYSTEM OF VETERINARY MEDICINE 


similar in many ways to the above, but having a slightly different 
origin. , 

In this form the history generally is that the animal has been driven 
an unusually long distance, and is brought back and put in the stable— 
generally a rather stuffy one. About an hour after he is found showing 
similar symptoms to the horse ridden to a standstill, and in addition he 
has a very high temperature, frequently over 105° F. 

Here treatment consists in taking the animal into the fresh air or 
placing in a large airy box, briskly rubbing the surface of the body, 
clothing warmly, and perhaps applying a mustard plaster to the chest, 
and giving internally a diffusible stimulant. 

Under these conditions the patient is generally normal in temperature, 
and on the highroad to recovery by the following day; but if neglected, 
the case may quite easily run on to pneumonia. 

TREATMENT.—If the case occurs in the hunting-field, first-aid treat- 
ment only can be applied, as it is impossible to move him while the urgent 
symptoms last. The girths should be loosed, or, better still, the saddle 
taken off altogether, the head turned towards the breeze, every effort 
made to stimulate the circulation by briskly rubbing the surface of the - 
body, followed by warm clothing. If a diffusible stimulant is available— 
such as 4 pint of whisky suitably diluted—it should be given. A hypo- 
dermic injection of strychnine will assist the heart’s action. 

Many authorities advise venesection to the extent of from 4 to 6 quarts 
of blood in order to relieve the engorged pulmonary vessels and right 
side of the heart. f 

In a comparatively short time—say from half an hour to two or three 
hours—the urgent symptoms pass off, and the horse can be slowly walked 
to a stable. The case should be carefully watched so as to detect any 
symptoms suggestive of the onset of pneumonia. 

The horse should not be put to work too soon, otherwise pneumonia 
is likely to develop. : 

Pulmonary Gdema. 


This is an oedematous or dropsical condition of the lungs. A transu- 
dation of serum takes place from the engorged pulmonary capillaries into 
the air-cells chiefly, also into the alveolar walls. 

It occurs in cases of intense pulmonary congestion, and may also appear | 
during the course of pneumonia, tuberculosis, new growths in the lungs, 
etc. When limited to the vicinity of the primary affection, it is termed 
collateral. | 

General pulmonary cedema may occur under a variety of conditions, 
such as cardiac affections, chronic Bright’s disease, cerebral affections, in 


DISEASES OF THE LUNGS: HORSE 859 


anemia and cachexias, malignant cedema, etc. It may also occur during 
the death struggle.* 

-Morsip Anatomy.—The lung is heavier than normal, and pits on 
pressure. On section a large amount of clear or foamy fluid escapes. 
This, in cases of acute pulmonary congestion, may be hemorrhagic; the 
bronchi may contain a similar fluid. The base of the lung is more fre- 
quently involved, but the entire organ may be affected. 

Two causes are believed to produce the condition—viz., increased 
tension within the pulmonary system, and a diluted blood-plasma. 

Symproms.—In addition to those of the primary disease, marked 
dyspnoea is observed, also cough. A nasal discharge of a foamy, serous, 
or sero-hemorrhagic character may be observed. 

Percussion reveals defective resonance, and on auscultation rales of a 
liquid character may be detected. Insome cases the cedema may advance 
quickly, and prove fatal in a short space of time by inducing asphyxia. 

TREATMENT.—This will depend on the primary affection of which the 
pulmonary cedema is a complication. 

Cardiac tonics are generally indicated, such as digitalin and strychnine, 
also stimulants according to the demands of the case. 


Pulmonary Heemorrhage. 


This term, from a clinical aspect, includes all cases in which heemor- 
rhage arises from the bronchi and pulmonary parenchyma. It may 
occur in two forms—viz.: (A) Broncho-Pulmonary ; (B) Pulmonary 
_ Apoplexy. 

_ (A) Broncho-Pulmonary hemorrhage is also termed Heemoptysis or 
Bronchorrhagia. The condition is not common in animals, but cases 
occur, especially in horses, and may be of a serious nature. The term 
“hemoptysis,” signifying “spitting of blood,” is scarcely applicable 
to horses or cattle, as the blood is usually discharged through the nostrils. 
The lesion may be either acute hyperemia of the bronchial mucosa or 
of the pulmonary tissue, or a perforated vessel may be present. Accord- 


* An instance of this was seen by one of us (Martin) in a mule destroyed for 
‘anemia. The animal was shot with a Greener’s humane killer, and a post-mortem 
examination made within half an hour. The lungs were found enormously distended, 
and white, or very light pink, in colour. They were firm to the touch, heavy, and 
practically airless. On section, a clear fluid oozed all along the line of incision 
Apart from this edematous condition, they appeared normal. There appears to be 
little doubt that in this case the condition occurred during the death struggle, for 
immediately previous to destruction pulse, respiration and temperature were all 
normal. The cause was probably some spasmodic contraction of the left side of the 
heart, that occurred at the time of death, combined with an abnormal condition of 
the blood-plasma. Several other mules were destroyed about that time for the 
same disease (anemia, the result of helminthiasis), but in no other was this 
condition of the lungs found. 


860 SYSTEM OF VETERINARY MEDICINE 


ing to Friedberger and Fréhner, the hemorrhage generally comes from 
the pulmonary tissue. 

EtroLocy.—Broncho-pulmonary hemorrhage may occur under a 
variety of conditions: 

1. Over-exertion, as in racing or hunting. 

2. In certain affections, such as tuberculosis of the lung, Date 
glanders; but it is rare in these conditions. 

3. During the congestive or initial stage of very acute cases of pneu- 
monia. 

4. In purpura hemorrhagica, aneurism of the pulmonary artery, 
anthrax, septicemia, ulcerative new growths in the lung, etc., pulmonary 
hemorrhage may occur. 

Occasionally it is met with in certain cardiac affections, which pro- 
duce passive congestion of the lungs. 

5. Traumatic, due to injuries from fractured ribs, etc., but more 
commonly met with in cattle. 

6. Finally, cases occur in the absence of any appreciable. cause or 
condition. 

Symproms.—These usually appear suddenly. The most character- 
istic are hemorrhage from the nostrils, accelerated respirations, and 
cough. The amount of blood varies according to the nature of the 
case. Thus it may be a slight trickle or appear in a full stream; or its 
presence may not be manifest in cases where the hemorrhage is small, 
as the blood may be absorbed more or less rapidly. 

It may be continuous or intermittent, and is of a bright red colour 
and frothy in character. In severe cases there is marked respiratory 
difficulty, restlessness, an anxious expression of countenance, pallidity 
of the visible mucous membranes, sweating, followed by coldness of the 
extremities, and a weak, thready pulse. When the hemorrhage is 
profuse the animal has imperfect control over his movements and may 
fall. The hemorrhage is increased after coughing and when the head is 
depressed. When extensive in amount, the bronchial tubes may be 
inundated and suffocation results. On auscultation, sounds of a bubbling 
character may be detected in the region of the trachea and bronchi. 

Proenosis.—This should be guarded, as it is difficult to arrive at a 
definite opinion as to the result of a case of this nature. 

DIFFERENTIAL Draanosis.—The only affection with which pulmonary 
hemorrhage is likely to be confounded is epistaxis. 

In epistaxis the blood is not frothy in character; it usually issues from 
one nostril only, and collects in clots around this organ; cough is absent, 
but snorting is present instead. Cases may occur occasionally in which 


DISEASES OF THE LUNGS: HORSE 861 


the source of the hemorrhage is in the pharynx or cesophagus, the blood 
being expelled by the nostrils. 

TREATMENT.—Perfect rest is the first essential in treatment. The 
conditions present depend either on congestion of the bronchial mucosa 
and pulmonary tissue, or on a perforated bloodvessel. 

The value of drugs in the treatment of pulmonary hemorrhage is 
doubtful. Thus ergot, which was believed to exert a beneficial effect, 
is said by some authors to be contra-indicated, as it induces a rise in the 
pulmonary blood-pressure, and thus may increase the hemorrhage from 
the ruptured vessel. Adrenalin is said to be open to similar objections, 
although according to some investigators this drug causes blanching of 
the bronchial mucosa. At any rate, definite clinical information on the 
value of this agent is necessary before we can judge of its utility or 
otherwise. 

As regards the value of agents, such as acetate of lead, mineral acids, 
oil of turpentine, etc., we have no definite knowledge. Probably they 
may prove of some utility in cases where the hemorrhage is not so acute, 
and where it tends to recur at intervals. 

Opium and morphine are relied on by many authorities as the most 
serviceable agents in the treatment of pulmonary hemorrhage. 

In cases of profuse hemorrhage, however, it must be remembered 
that opiates lessen the tendency to cough, and thus the blood tends to 
accumulate in the bronchi instead of reaching the nostrils, and asphyxia 
is induced. 

Atropine is recommended by American practitioners, as it is said to 
possess a marked influence on all forms of internal hemorrhage, probably 
by inducing contraction of the abdominal bloodvessels and dilatation 
of the cutaneous vessels, so that the blood is diverted to the surfac of 
the body. . 

When the cardiac weakness is marked, the subcutaneous injection of 
large amounts of normal saline solution should be carried out. In all 
cases drenching should be avoided. 

When the hemorrhage is controlled, a long rest is essential, as it is 
of importance that the affected animal should not be put to work too 
soon. 

(B) Pulmonary Apoplexy (also termed Pneumorrhagia).—In this con- 
dition the hemorrhage occurs into the air-cells and pulmonary 
tissue. It is met with in very acute cases of pulmonary congestion 
(see p. 856). It may also occur in some cases of chronic cardiac 
disease, and in septic conditions. Hemorrhagic infarction may be one 
of the conditions met with, depending on the presence of a thrombus or 


862 SYSTEM OF VETERINARY MEDICINE 


an embolus in a branch of the pulmonary artery. This may occur in 
chronic cardiac diseases, the thrombus or embolism originating in the 
heart. 

The symptoms of pulmonary apoplexy are not definite. In some 
cases a variable amount of blood may be discharged from the nostrils; 
in others this symptom is absent. When accompanying acute pulmonary 
congestion, the symptoms of both conditions are combined. The treat- 
ment has already been considered under the heading of Acute Pulmonary 
Congestion (see p. 858). When there are evidences of pulmonary heemor- 
rhage present—+.e., the discharge of blood from the nostrils—the treat- 
ment is similar to that already mentioned (see p. 861). 


II, PNEUMONIA (INFLAMMATION OF THE LUNGS). 


General Remarks.—In Vol. I. (Microbial Diseases) we have already 
considered epizoétic pneumonia or pleuro-pneumonia of the horse, termed 
by some writers “contagious pneumonia.” In reality all forms of 
pneumonia depend on the presence of micro-organisms, and should 
properly be placed in the section devoted to infectious diseases. 

In Osler’s “ Practice of Medicine ”’ all types of pneumonia in man, 
with the exception of chronic pneumonia, are described under Specific 
Infectious Diseases, the heading being designated ‘“‘ The Pneumonias 
and Pneumococcic Infections.” 

As, however, little definite is known with reference to the bacteriology 
and pathology of the disease in the horse, we deem it advisable to follow 
the example of other authors, and to consider certain forms of the affection 
in the present section. 

On referring to Epizodtic Pneumonia (see Vol. I.), it will be seen 
that not only is there still much to be learned as regards its bacteriology, 
but also as to the exact pulmonary lesions that are present in the disease. 
We do know that this form may be infectious to a marked extent, may 
be epizodtic in character, and may show various complications. Accord- 
ing to some authorities, epizodtic pneumonia may be either of the lobular 
or lobar type, while others describe special pulmonary lesions for this 
affection. 

The majority of observers recognise a primary or sporadic pneu- 
monia in the horse, which occurs independent of the epizodtic form, ' 
and is met with in isolated instances. The etiology of such cases is 
involved in doubt; exposure to cold and chills is brought forward as a 
cause, but it is impossible to exclude the chances of infection by micro- 
organisms, although we may not be able to point out the source of such 


DISEASES OF THE LUNGS: HORSE 863 


infection. Experience, however, teaches us that such cases are met with, 
and that the symptoms may in some instances be of a mild type; while 
in others they resemble those occurring during the course of epizodtic 
pneumonia. | | 

‘Some authorities, including Cadéac, believe that both sporadic pneu- 
monia and so-called “ contagious pneumonia ”’ originate from a common 
cause, and that under circumstances not clearly understood the former 
type may develop into the latter. According to this view the bacteriology 
of both types is similar, but the micro-organisms of the sporadic form 
acquire an increased virulence by passing through a number of horses, 
and the epizodtic form of the disease is produced. It is admitted that 
the sporadic form is but slightly infectious to healthy animals, but if 
the latter are debilitated from any cause, or suffering from nasal or 
pharyngeal catarrh, etc., they are likely to be attacked. 

Cadéac has observed that a horse suffermg from sporadic pneumonia, 
developed after exposure to chill, etc., may convey the disease to a 
neighbouring horse in the stable, and produce in him a pneumonia having 
all the characters of the contagious or epizoétic type. He has also found 
that typical cases of sporadic and contagious pneumonia may often occur 
together in the same stable, and that the type of the disease depends 
on the degree of virulence of the micro-organisms, on their individuality, 
and on their association with other microbes. Hence he concluded that 
contagious pneumonias are but clinical forms of the sporadic type of the 
disease, and that from the bacteriological and etiological points of view 
there 1s but one pneumonia of the horse.* 

According to Hutyra and Marek (who do not recognise contagious 
pneumonia and influenza as affections distinct from each other), 
‘““We have no proof based upon sufficient bacteriological investigations 
that there exists a separate clinical picture of croupous pneumonia 
occurring in any other way except by localisation of well-known 
infectious diseases.” 

Our own experience leads us to believe that Cadéac is correct in his 
views. We are quite unable to distinguish clinically between sporadic 
and epizodétic pneumonia, and we consider it is only a question of the 
degree of the infectivity. Normally, with healthy mature horses, kept 
under hygienic conditions, especially where ventilation is abundant, 
infectivity is slight; but let the same case occur in a badly ventilated 
stable, with a number of young horses, and especially if there are any 
catarrhal affections or specific diseases such as strangles or influenza 
present, we shall find it will rage in epizodtic form. In the first case 


* << Pathologie Interne.” 


864 SYSTEM OF VETERINARY MEDICINE 


p) 


the disease would probably be termed “sporadic pneumonia,’ and in 


the second undoubtedly “contagious”’ or “epizodtic pneumonia.” It 
is not the disease, however, that is different; it is the conditions. 

We must remember that pneumonia is often observed as a secondary 
affection. Thus it may occur in connection with influenza, strangles, 
purpura hemorrhagica, septic affections, etc. It occasionally accom- 
panies laminitis, and is often seen in cases that for various reasons 
assume the recumbent position for long periods at a time. It may occur 
towards the termination of various diseases as a complication, in which 
case it is designated “* terminal pneumonia.” 

It may also occur as the result of careless drenching, when portion 
of the fluid enters the bronchi (see Inhalation Pneumonia, p. 884). 
This form is also met with as a result of inhalation of smoke from burning 
buildings, or from the passage of blood into the bronchi during opera- 
tions on the pharyngeal or laryngeal regions, or from the passage into 
the bronchi of the nasal and pharyngeal secretions during prolonged 
chloroform anesthesia. | 

Pneumonia is often met with on board ship, and it probably is re- 
sponsible for more than 50 per cent. of the fatalities from disease on a 
voyage. 

Holding the views we do as to the identity of sporadic and epizootic 
pneumonia, it will readily be understood why we do not attempt any 
elaborate classification of the former. Most authorities describe three 
varieties: (1) The croupous or lobar; (2) the catarrhal, lobular, or broncho- 
pneumonic; and (3) the chronic or interstitial. 

We consider this classification very artificial, and it is based more 
on the disease in man than the disease as it actually occurs in the horse. 
True croupous pneumonia as seen in man probably never occurs in horses. 
What often occurs is a pneumonia of a type distinctive to the horse. 
McFadyean* describes the pathology of this type as follows: 

‘“‘The horse is not rarely the subject of a pneumonia that is lobar 
as regards its extent, but when a large piece of the horse’s lung is hepatised 
the solid part lacks the essential character of the classical croupous 
pneumonia—viz., the uniformity of the lesion throughout the whole 
piece. In what usually passes for croupous pneumonia of the horse the 
hepatised lung is, even to the naked eye, obviously not uniform in 
texture; on the contrary, it manifestly comprises a number of different 
centres, and when the microscope 1s brought to the investigation of the 
lesion, it is found that even over small areas the pattern of the structural 
alterations is not the same throughout. At some places the air-cells 


* Journal of Comparative Pathology and Therapeutics, vol. viii., p. 78. 


DISEASES OF THE LUNGS: HORSE 865 


are densely crowded with leucocytes unmixed with either red corpuscles 
or fibrin threads, and at others they are occupied by fibrinous coagula 
or by actual blood.” 

Though we recognise only one true type of pneumonia in the horse, 
we are prepared to admit that when that type results from primary 
bronchial trouble, or from careless drenching, or is secondary to other 
diseases, there will be modifications both in the clinical manifestations 
and in the pathological changes. In such instances the lesions will be 
of a “ mixed ” character, and in general practice this is the type most 
frequently met with post mortem. Owing to the fact that many of the 
so-called sporadic cases recover, we cannot speak definitely as regards 
the lesions that existed. What we find post-mortem is the advanced 
stage, with probably complications, plus the lesions produced by drench- 
ing, when such has been carried out. 

We will now attempt to describe these cases of sporadic pneumonia, | 
or, as they might easily be called, cases of epizodtic pneumonia, with 
a low degree of infectivity. 

Generally speaking, these isolated cases are of a milder type than those 
met with in the regular outbreaks, and there are a correspondingly large 
number of recoveries. We would especially note that the tendency to 
gangrene and necrosis that is so frequently seen in epizodtic outbreaks 
is not nearly so marked; in fact, under good hygienic conditions we meet 
with comparatively few cases in which symptoms of gangrene and necrosis 
are presented, unless such lesions are induced by the careless administra- 
tion of drenches. | 

The most common causes of death in sporadic pneumonia, according 
to our experience, is a toxemia affecting the vasomotor centres, inducing 
lowering of the blood-pressure, also weakness and over-distension of the 
right heart, due to the pulmonary engorgement and cdema of the 
uninvolved parts of the lungs. In some cases death may result from 
gradual asphyxia when the pneumonia is bilateral. 

No doubt environment has an important influence on the production 
of pulmonary gangrene and septic pneumonia, as in ill-ventilated, over- 
crowded stables cases are met with, while under opposite conditions 
and in country districts such terminations are rare, even in instances 
where the disease is very acute and the symptoms severe. 

Errotoey.—As already mentioned, sporadic pneumonia must be 
regarded as depending on the entrance into and development of micro- 
organisms in the body. Formerly it was believed that exposure to cold, 
chills, etc., especially after severe exertion, constituted the chief cause of 
pneumonia. The consensus of opinion in the present day is that exposure 

VOL. Il. : 59 


866 SYSTEM OF VETERINARY MEDICINE 


to cold is but a predisposing cause of the affection. Cold has the effect 
of lessening the normal powers of resistance to microbial invasion. 
According to Cadéac, it enables the micro-organisms which exist in the 
respiratory passages of normal animals to exert a pathogenic action; it 
excites a nervous modification which induces congestion of a pulmonary 
lobe; it interferes with nutrition and with phagocytosis, and prepares 
the way for infection. , 

Minor catarrhal affections of the nasal passages, pharynx and 
larynx, predispose to an attack of pneumonia, as they permit the 
entrance of the micro-organisms to the respiratory mucosa. Impaired 
health from any cause also exerts a predisposing influence. Cases 
are more frequently met with in spring, autumn, and winter than 
in summer. Young horses are more susceptible to the disease than 
adults. More especially is this the case when young horses are brought 
from the country into large city stables for the first time and put to 
hard work. Here we have not only the exposure to contagion, but also 
the change of environment and the lessened vitality due to hard work, 
to which the animals are unaccustomed, and probably the debilitating 
influence of ill-ventilated buildings. 

Any condition productive of a passive congestion of the lungs must 
be considered as strongly predisposing to an attack of pneumonia. We 
have already alluded to the tendency towards this disease shown in cases 
that, for various reasons, assume the recumbent position for long periods. 
We would also note this passive congestion as the chief predisposing cause 
of pneumonia on board ship. Though bad ventilation is usually blamed 
in this connection, it is probably not by any means the chief cause. In 
the Journal of Comparative Pathology, vol. xiv., 1901, p. 343, one of us 
(M.) pointed out that cases of this disease constantly occurred on the 
main and upper decks of a ship where the animal was in the open air, 
and suggested that it was the long continuous standing, without exercise 
or grooming, or other stimulant to the circulation, which produced a 
passive congestion in the lungs strongly predisposing to an infection. 

When pneumonia results from an attack of acute pulmonary conges- 
tion, we must also regard the causation as being microbial in character. 

BacTERIOLOGY.—The micro-organisms which are the essential cause 
of sporadic pneumonia have not yet been satisfactorily determined. 
Similar remarks apply to the bacteriology of epizoétic pneumonia. 
As already mentioned, some authorities are of opinion that all forms of 
pneumonia depend on similar micro-organisms. The epizodtic form 
is said to result when the micro-organisms assume a more virulent 
character by passing through a number of horses. 


DISEASES OF THE LUNGS: HORSE 867 


Amongst the micro-organisms regarded as the cause of pneumonia, 
the most important are the following: 

1. The Streptococcus discovered by Schiitz in 1887 is stated to be 
present in all forms of pneumonia. It is found in the hepatised pul- 
monary tissue, the fibrinous exudate, and the nasal discharge. In the 
epizootic form of the disease the streptococcus occurs as well in the 
pleuritic exudate, the blood, and in various organs of the body. 

2. The Cocco-bacillus of Ligniéres, also known as the Bacillus equi- 
septicus, belongs to the group of Pasteurella. It is found in the nasal 
discharge in cases of pneumonia, and, according to Cadéac, it can be 
associated with the streptococcus, or by the action of its toxins it can 
facilitate the entrance and development of the streptococcus. 

According to some authorities, the micro-organism on which croupous 
pneumonia in man depends may be found in some cases in the exudate 
of pneumonia of the horse. This is the Micrococcus lanceolatus, also 
known as the Pneumococcus or Diplococcus pneumone of Frenkel and 
Weichselbaum. 

In epizoétic pneumonia of a virulent type it is generally admitted 
that a number of other micro-organisms are associated with the strepto- 
coccus. 

Moves oF Inrection.—According to Cadéac, the nasal discharge is 
the chief vehicle of contagion. It contains active micro-organisms not 
only during the course of the disease, but also during convalescence, if 
the discharge continues. Fodder, drinking-water, litter, mangers, buckets, 
halters, etc., become contaminated by it, and thus prove a source of 
contagion; and as the virulence is not affected by desiccation, healthy 
horses placed in stables which have been occupied by subjects of the 
disease are likely to become infected. The micro-organisms have also 
been found in the feces, urine, and cutaneous secretions of affected 
animals, and in the skin and epithelial desquamations. 

Infection can occur by inhalation and by ingestion. 

Preriop oF Incusation.—Nothing definite is known on this point. 
After exposure to infection we are not aware of the period of time that 
elapses before the disease develops. And in sporadic pneumonia we 
do not even know the source or the time of infection in many 
cases. 

Morpip ANATOMy.—One of the characteristics of sporadic pneumonia 
is the comparative freedom from extra-pulmonary localisation as com- 
pared with the epizodtic form of the disease. Another is the rarity of 
necrotic and gangrenous lesions. Usually but one lung is affected, 
double or bilateral pneumonia being uncommon. According to Williams, 


868 SYSTEM OF VETERINARY MEDICINE 


the right lung is more frequently attacked than the left, and this is our 
experience also. 

Authorities recognise three stages as occurring in the affected lung, 
as follows: (1) Congestion or engorgement; (2) red hepatisation; 
(3) grey hepatisation. 

We have adhered to this description of the stages, though we realise 
that they do not give a perfectly accurate picture of the disease in the 
horse, for, as pointed out on page 864, the inflammatory process in this 
animal is of a distinct type; the croupous or fibrinous process appears to 
progress simultaneously and in neighbouring patches to the non-fibrinous 
exudation process, and this naturally alters the picture very consider- 
ably. 

At a post-mortem examination one commonly finds evidences of these 
different processes side by side, so there will be no sharp line of demarca- 
tion between the various stages. 

1. Congestion or Engorgement—According to Hutyra and Marek, the 
affection commences with an active hyperemia in a large continuous 
area, usually of the lower or anterior portion of the lung. It is seldom 
that the lesions are confined to the root of the lung or to the posterior 
or upper portions of the organ. 

The pulmonary tissue is of a deep red colour. On manipulation it 
feels firmer than normal; its elasticity is diminished. When pressed by 
the finger it retains the imprint, and crepitates less distinctly than normal 
when handled. The lung is increased in weight, and may show ecchy- 
moses on its surface; its resistance is considerably reduced. On section 
blood and frothy serum exude freely, and if a portion of the lung be 
excised and placed in water, it will float there. The density, however, 
is higher than that of the normal lung. If the excised portion be thrown 
into a vessel of water from a height, it does not rise quickly to the surface 
like healthy lung, but rises slowly, and floats in the water and not on 
the surface (Cadéac). Microscopical examination shows dilatation and 
engorgement of the capillary vessels. These appear prominent in the 
interior of the alveoli and along their walls. In some of these capillaries 
rupture may have occurred. The alveoli contain an exudate composed 
of a sero-fibrinous fluid, desquamated alveolar epithelium, numerous 
leucocytes, and red blood-corpuscles in lesser amount. The interlobular 
spaces may also be involved, being infiltrated by the exudate and in an’ 
cedematous condition. In this first stage the permeability of the lung to 
air is not interfered with to any extent. 

2. Red Hepatisation.—Coagulation of the exudate marks the transition 
of engorgement to red hepatisation. The lesion starts first in the in- 


DISEASES OF THE LUNGS: HORSE’ 869 


ferior region of the lung, and extends upwards. On opening the thoracic 
cavity the affected lung does not collapse on exposure to the air. The 
colour is a brownish-red tint, the pulmonary tissue is solid, airless, and 
friable. The affected portions sink when placed in water. On section 
the surface is rarely uniform in colour. Dark red patches are found 
surrounded by areas of a greyish-red shade, the latter depending on a 
lessened blood-supply, resulting from pressure of the exudate. The 
cut surface has a granular appearance, due to the coagulated exudate 
in the alveoli forming fibrinous plugs. In some cases numerous circum- 
scribed hemorrhages are present, and mask the granular appearance 
of the lung. 

On microscopical examination the alveoli are found filled and dis- 
tended by the exudate. The latter is composed of coagulated fibrin, 
in the meshes of which are leucocytes in large numbers, red blood-. 
corpuscles, and alveolar epithelium. Infiltration of the alveolar walls 
is also present, and leucocytes are seen in the interlobular tissue. 

3. Grey Hepatisation.—This stage is characterised by an alteration 
in colour to a greyish-red or yellowish tint, by a greater friability of the 
pulmonary tissue, and by a turbid exudate in which the fibrin and red 
corpuscles are largely replaced by leucocytes, which are present in great 
numbers. On section the surface is moist and the granular appearance 
is less marked. In a more advanced stage purulent infiltration occurs, 
evidenced by a softening of the pulmonary tissue and infiltration with a 
purulent fluid. Abscess formation is rare in sporadic pneumonia. 
Resolution —This represents the period of restoration of the lung 
to a normal condition. The exudate undergoes liquefaction, the major 
portion is absorbed by the lymphatics and excreted by the kidneys, a 
minor amount being removed by the nasal discharge. The changes 
in the exudate leading to its resolution are due to an autolytic digestion 
by proteolytic enzymes, which are present much more abundantly in 
grey than in red hepatisation (Osler). 

Resolution may be rapid and complete in some cases, while in others 
the process is slow. It may be incomplete, in which case portion of the 
exudate becomes organised, and thickening of the alveolar walls results, 
this constituting one form of chronic or interstitial pneumonia (see p. 888). 

OTHER PATHOLOGICAL CHANGES IN THE LuNes.—Usually the portions 
of the lung free from the inflammatory action are congested and cedema- 
tous. In some instances the unaffected lung shows congestion, but this 
condition may be hypostatic, and may occur post mortem. 

The Bronchi may show congestion of their mucosa, and fibrinous 
plugs may be present in the bronchioles of the affected region. 


870 SYSTEM OF VETERINARY MEDICINE 


In some cases a serous frothy fluid may be found in the bronchi. 
According to Hutyra and Marek, the bronchi usually contain an abundance 
of a muco-purulent secretion, their mucosa shows catarrhal inflammation, 
and croupous membranes are occasionally found in the smallest bronchioles. 

Pulmonary Gangrene.—This is of rare occurrence in sporadic pneu- 
monia. It may, however, result from careless drenching whereby por- 
tions of medicinal fluids enter the bronchi (see p. 884). As pulmonary 
gangrene is of comparatively frequent occurrence in epizodtic pneumonia, 
a full consideration of it will be found in the secticn devoted to that 
affection (see Vol. I., p. 830). 

Abscess of the Lung and Diffuse Suppuration are rare terminations in 
sporadic pneumonia, but occur in the epizootic type (see Vol. I., p. 831). 
When present in the former, they generally depend on the careless 
administration of drenches. 

LESIONS OF THE PLEURA.—When the inflammatory action is super- 
ficial, the visceral pleura over the affected area usually shows pleurisy, 
which, according to some observers, is of the dry type. Pleurisy of the 
sero-fibrinous type is, by some observers, said to be only occasionally 
met with, but this is not the experience of all practitioners, and a diffuse 
pleurisy with effusion is not uncommon, although not so frequent as in 
epizootic outbreaks. 

LESIONS IN OTHER ORGANS, OCCURRING AS ComPLICATIoNns.—In 
sporadic pneumonia these are seldom met with. They include cardiac, 
renal, digestive, and nervous lesions, and will be found fully described 
under the heading of Epizoétic Pneumonia (see Vol. I., p. 832). In 
plethoric animals laminitis may occur as a complication. 

CHANGES IN THE BLtoop.—According to some observers, alterations 
occur in the blood, suchas a destruction of red corpuscles, and an increase 
in the leucocytes and in the fibrin factors. 

Symproms.—Rigors of varying degrees of intensity may be the initial 
symptom, but unless the case be seen at the commencement, this is not 
observed. The usual symptoms which first attract the notice of the 
attendant are interference with appetite, dulness, and inaptitude for 
exertion. As pointed out by Willams, greatly accelerated respirations 
are not by any means a constant or diagnostic symptom of the early 
stages of pneumonia. No doubt, in over-fed, plethoric animals, when the | 
first stage is marked by severe pulmonary congestion, dyspnoea is an 
early and prominent symptom. 

It will be convenient to consider the symptoms in detail as follows: 

Fever.—Some authorities, including Cadiot, have observed that the 
rise in temperature is gradual and steady. As we seldom get the oppor- 


DISEASES OF THE LUNGS: HORSE 871 


tunity of attending cases in the early stages, we are unable to speak 
definitely on this point. Usually, on our first attendance we find the 
temperature from 104° to 105° F. According to Hutyra and Marek, 
the rise in temperature occurs within half a day, but in older and debili- 
tated animals fever may not be a marked symptom, although the other 
general symptoms may reach an intense degree. The fever is generally 
continuous, with slight morning and evening remissions, for about five 
or six days. About the seventh day a sudden fall in temperature occurs 
(the crisis), and with this we find a marked improvement in the general 
symptoms. In some instances defervescence occurs gradually, with 
remissions in the morning and exacerbations in the evening. Occasion- 
ally the temperature becomes subnormal after the crisis, but soon returns 
to normal. On the occurrence of complications the temperature usually 
rises again. 

Pulse ——In the early stages the pulse may be rapid and full, from 
60 to 80, or 100, per minute. In some cases it may only be moderately 
accelerated at the beginning. Often it shows a soft character. In cases 
where pulmonary congestion is well marked at the outset, the pulse may 
be small and indistinct. The alterations in the pulse during the course 
of the disease will vary according to the severity of the case, the intensity 
of the infection, and the presence or otherwise of complications. When 
the lesions cause considerable interference with the circulation in the 
lungs and with respiration, the pulse becomes small and weak. 

The pulse may be considered as one of the most reliable guides we 
have as to the progress of the case. A sudden drop in the temperature 
may mean the crisis and a general improvement, or it may mean that a 
large quantity of fluid has been poured out into the chest cavity. An 
improvement in the appetite by no means always indicates real improve- 
ment in health. A lower rate of breathing may be equally misleading, 
but if the pulse improves in character and diminishes in frequency, we 
can safely say that the case is making solid improvement. 

Respirations —As already mentioned, greatly accelerated respirations 
do not occur in the early stages of sporadic pneumonia, unless in cases 
characterised by acute congestion. In many instances the alteration 
in the character of the respiration is not sufficient to attract the attention 
of the attendant. On the occurrence of hepatisation the respirations 
become accelerated, the degree of dyspncea depending on the extent of 
the pulmonary lesions. At times expiration is accompanied by a sigh. 

The breathing is of the type known as costal, the nostrils are dilated, 
and the respirations may number from 20 to 60 per minute. If 
pleurisy be present as a complication, the character of the respiration 


’ 


872 SYSTEM OF VETERINARY MEDICINE 


alters to that of the abdominal type. When the respiratory distress is 
well marked, the horse stands with the elbows turned outwards and the 
toes turned inwards, and avoids movement. As a rule he stands per- 
sistently, but exceptions to this are met with. 

The dyspnoea is believed to depend on a combination of factors— 
viz., the toxemia, the fever, and the loss of function in the affected 
pulmonary area. . 

Visible Mucous Membranes.—These are congested, and in some cases 
the conjunctive are of a yellowish colour. 

Nasal Discharge.—A rusty or safiron-coloured discharge is, in our 
experience, a fairly common symptom in pneumonia, although Hutyra 
and Marek state that it is seen only in a minority of cases. It is more 
or less viscid in character, not abundant, and may form a crust around the 
nostrils. In many instances it trickles slowly from the nostrils in a fine 
stream. The colour is said to be due to the presence of blood elements 
in the pulmonary exudate. In some cases the discharge is tinged with 
blood. Asa rule it appears in from twenty-four to forty-eight hours after 
the initial symptoms have been in existence, and it may continue for 
several days. When hepatisation sets in, the discharge disappears, 
probably in consequence of the coagulation of the exudate in the alveoli. 
When the crisis occurs, the discharge generally reappears. It is then usually 
of a greyish colour and mucous in character; but in some cases 1t may be 
of the original rusty appearance. According to Hutyra and Marek, the 
discharge comes on almost always before the commencement of hepatisa- 
ation, and persists either one or two days, or until resolution occurs. 
When it appears later, it usually points to the development of new in- 
filtrations. They regard it as.a very valuable symptom, as in cases of 
central pneumonia (see p. 874), when it may be the only diagnostic 
symptom present. Nasal discharge may be absent altogether in some 
cases of pneumonia. 

Cough.—Cough is not by any means a constant symptom in croupous 
pneumonia. When present, it is of asoft and short type, and usually single, 
and during hepatisation may be of a feeble character. During the crisis 
it tends to become more marked and frequent, but is of an easy and 
moist type. 

Constitutional Symptoms.—The appetite is generally impaired, but — 
seldom entirely lost unless in severe cases and when complications are 
present. Dulness, muscular weakness, and constipation in varying 
degree are observed. The secretion of urine is usually scanty, but it 
rapidly increases during resolution. According to some authorities, the 
urine is usually albuminous, especially during the middle stages of the 


DISEASES OF THE LUNGS: HORSE 873 


disease, its specific gravity is increased, the chlorides are diminished, and 
the amount of urea is increased. 

Puysicau Sians.—According to Hutyra and Marek, auscultation and 
percussion will reveal the presence of lesions in the lung after the fever 
has lasted from 6 hours to two days, and in exceptional cases from three 
to four days. } 

Percusston.—During the stage of engorgement percussion may revea |] 
a tympanitic tone. When hepatisation occurs, the percussion sound is 
dull over the invaded pulmonary area. This dulness is well marked 
when the consolidation of lung tissue is extensive. During resolution, 
tympanitic tones are again revealed by percussion, and the area of dulness 
oradually decreases. 

Hutyra and Marek state that the area of dulness varies in extent. It 
usually extends backwards from the elbow, and reaches to the middle 
or even to the upper third of the thorax. In many instances the upper 
boundary line describes a curve with the convexity above, or descending 
backwards. After three to five days the sound again assumes a tym- 
panitic timbre, later on becoming purely tympanitic, and gradually 
changing to the normal non-tympanitic percussion sound. The above 
authors describe deviations from the ordinary percussion sounds in 
character and in location. When the deeper layers are consolidated in 
such a manner that they are separated from the wall of the thorax by 
considerable portions of normal lung tissue, a tympanitic sound is heard 
during the whole course of the disease, and this changes into the normal 
percussion sound during the stage of resolution. In some cases the area 
of dulness may gradually extend up to the vertebral column and over 
the most posterior and upper portions of the lungs. 

Auscultation.—In the early stage a fine crepitant rale is heard, either 
during or at the end of inspiration. It has been aptly described as a 
series of minute cracklings, and is best heard at the lower portion of the 
affected lung, replacing the normal vesicular murmur. The crepitant 
rale, according to some authorities, is due to separation of adhesive 
exudate in the alveoli and bronchioles, while others regard it as due to a 
fine pleural crepitus. 

The unafiected lung may show the vesicular murmur more marked, 
During the stage of hepatisation the crepitant rales are lost, and tubal 
sounds are heard instead in the consolidated area; these sounds are similar 
to those heard under normal conditions over the larger bronchi. Usually 
at first they are heard with expiration, but later on they are more marked 
and of equal length with inspiration and expiration. They are due, 
according to some authorities, to the absence of vesicular sounds, so that 


874 SYSTEM OF VETERINARY MEDICINE 


the bronchial sounds are rendered more audible; while others state that 
they are laryngeal and tracheal sounds which are transmitted through the 
bronchi and consolidated pulmonary tissue. 

In rare cases the larger bronchi are rendered impervious by excessive 
exudation, and there is complete absence of sound. This is termed 
‘““ massive pneumonia.” 

During the stage of resolution crepitant rales again appear, and take 
the place of the tubal sounds; this change takes place in a gradual manner 
from above downwards through the affected pulmonary area. Finally, 
these rales are succeeded by the normal vesicular murmur. 

Occasionally cases are met with in which the consolidation is deeply 
situated in the lung; and the evidences obtained from a physical examina- 
tion may be so slight that the presence of pneumonia is likely to be over- 
looked. This is termed “ central”? pneumonia. 

CoursE.—In favourable cases the disease usually runs a typical 
course, the various stages succeeding each other at fairly regular intervals. 
From the fifth to the sixth day the constitutional symptoms are generally 
at their height. The seventh day is usually regarded as the period of 
crisis, but this varies considerably. The temperature falls, the respira- 
tions become less rapid, the pulse is lessened in frequency and gains 
in strength, the appetite returns, and the general appearance indicates 
an improvement in the patient. Auscultation and percussion show that 
the affected lung is returning to a normal condition; this process is 
generally a gradual one, and complete recovery may take from eight to 
fourteen days. 

In cases of what are termed “‘ ephemeral,” “ larval,” or “‘ abortive ”’ 
pneumonia, the initial symptoms are presented, but the disease does not 
pass beyond the stage of congestion. Hence recovery may take place in 
such instances in from two to three days. 

Cases occur in which the inflammatory process spreads from the 
original seat of the lesion in a posterior and upward direction, or the 
other lung may be involved (bilateral pneumonia). In such instances the 
course is much prolonged. Again, recurrences are met with in which 
during the stage of resolution fever reappears, and also evidences of 
pulmonary lesions, either in their previous location, or in fresh portions — 
of the lung. | 

In unfavourable cases the respirations become rapid and laboured, 
the pulse is small, irregular, and weak; the cardiac action tumultuous; 
the extremities become cold; the head is held low; the ears droop; the 
anus is dilated; and the nasal mucous membrane is of a dark, bluish-red 
colour. 


DISEASES OF THE LUNGS: HORSE 875 


DEATH may occur from— 

1. Asphyxia, depending on extensive consolidation and general 
cedema of the lungs, or in cases with considerable effusion into the chest. 

2. From failure of the right side of the heart, a progressive weakness 
depending on overwork of the organ in carrying on the circulation through 
the consolidated lung. Degeneration of the myocardium plays an 
important part in this direction when it occurs. 

3. Toxemia.—This is regarded by many authorities as the most 
frequent cause of death in pneumonia. The toxins are believed to act 
on the vasomotor centres and on the walls of the bloodvessels, and to 
produce a progressive lowering of the blood-pressure. 

Occasionally cases are met with which are extremely puzzling and 
annoying to the practitioner. The patient appears to be doing well, 
and all symptoms seem favourable, yet with very little or no warning he 
is found dead. Often the post-mortem examination furnishes very little 
explanation of the sudden death. The affected areas may not appear 
very extensive; there may or may not be a certain amount of effusion 
in the pleural cavities. In fact, there is very little to account for the 
sudden death. In such cases the actual cause of death will be the action 
of the toxins formed in the affected areas, which toxins for some reason 
have been suddenly absorbed. 

TERMINATIONS.—It is not easy to get reliable statistics of the mor- 
tality of this disease, and, as may easily be understood, they are likely 
to be somewhat variable. One of the fullest tables published in this 
country was prepared by F. Smith, and printed in the Journal of Com- 
parative Pathology and Therapeutics, vol. x., p. 121. Smith is one of the 
most reliable clinical workers of our day, and his figures prove a very 
valuable guide. His observations were made on a total of 106 cases, 
which were divided into—Uncomplicated pneumonia, 70 cases; pleuro- 
pneumonia, 24 cases; pleurisy, 12 cases. His mortality from pneumonia 
was 11°4 per cent.; from pleuro-pneumonia, 37°5 per cent.; from pleurisy, 
16°6 per cent.; total mortality, all cases, 18 per cent. 

His mortality strikes one as being rather high. As far as one can 
gather, his observations were made on what are known as sporadic 
cases, for he says: “In my own experience, there is no distinct evidence 
that the disease is infectious.” We may remind the reader that these 
tables were published in 1897, and do not necessarily reflect his present 
opinion. 

It will be noticed in looking into the figures that by far the heaviest 
mortality occurred in the pleuro-pneumonia cases. He says on this 
point: 


876 SYSTEM OF VETERINARY MEDICINE 


“We must bear in mind that in practice pleuro-pneumonia is the 
most common condition in which we meet pleurisy, and, further, it 1s the 
most fatal. The recoveries from uncomplicated pneumonia are numerous, 
from pure pleurisy, so far as we can judge, fairly frequent; but add a 
pleurisy to a pneumonia, and the most fatal chest disease of the horse 
is at once exhibited.’’* 

Resolution.—This is the most favourable termination. The exudate 
undergoes liquefaction and becomes absorbed, and the lung is restored 
to a normal condition. The period of time in which this restoration 
takes place is variable. In some cases resolution is delayed, so that the 
lung does not clear for a considerable period. ) 

Abscess and Diffuse Suppuration—aAs already mentioned, neither 
abscess (circumscribed suppuration) nor diffuse suppuration are common 
in sporadic pneumonia. Both are probably due to secondary infection 
by streptococci or staphylococci. The diagnosis is attended with con- 
siderable difficulty, especially as regards pulmonary abscess. 

The following symptoms may be observed: An increase in the fever, 
marked depression, sunken eyes, slight sweating at irregular intervals, 
complete loss of appetite, a rapid, feeble pulse, and laboured respirations. 

Auscultation reveals a peculiar gurgling sound. A purulent nasal 
discharge, either greyish or in some cases of a reddish tint, is often present, 
and may be foetid in character in some instances. The presence of an 
abscess may be overlooked unless it breaks into a bronchial tube, when 
its contents may be discharged by the nostrils; or it may extend to the 
pleural surface and rupture, bringing about a purulent pleurisy. Ac- 
cording to Johne, a pulmonary abscess may rupture into a bronchus, 
and then heal completely. 

Gangrene.—This is also rarely met with in sporadic pneumonia, 
except as the result of careless drenching. Its advent is marked by an 
ageravation of the existing symptoms; the fever rises rapidly, but tends 
to oscillate, and it is not uncommon to find the temperature subnormal 
as the condition advances. In addition to the evidences of marked 
weakness and depression, we observe a repulsive foetor of the breath and 
a dark-coloured putrid discharge from the nostrils. Such cases usually 
prove fatal. A putrid nasal discharge is not always significant of pul- 


* In the Reports of the Army Veterinary Service for 1911-12 and 1912-13, the - 
mortality from pneumonia is shown as follows : 


SporaDIC PNEUMONIA. 

Number of Cases. Deaths. Destroyed. 
IST AS ee, ee eO 70 1 | 
1912-18 ... en 2G 49 4 


DISEASES OF THE LUNGS: HORSE 877 


monary gangrene, as it may depend on putrefaction of the exudate in 
the dilated bronchioles. For further details, see Epizodtic Pneumonia, 
Vol. I. 

Chronic Pneumonia.—This condition is a very rare termination to 
sporadic pneumonia. Complete resolution does not take place; organisa- 
tion of the unabsorbed exudate occurs, and the alveolar walls become 
thickened by a new growth of connective tissue. Dyspnoea, cough, and 
nasal discharge may persist. The animal remains in a debilitated con- 
dition, and unfit for any exertion (see p. 888). 

Comptications—Pleurisy.—T his is present to a varying degree in 
every case where the inflammation reaches the surface of the lungs. 
When limited in extent, the evidences of its presence are generally over- 
looked. When present, friction sounds may be discovered by ausculta- 
tion in the early stages, followed by evidences of pleural effusion, in 
addition to the physical signs of pneumonia. 

Laminitis —This occurs especially in heavy, high-conditioned horses, 
such as cart-stallions. The symptoms are similar to those met with 
in ordinary cases of laminitis (see works on veterinary surgery). 

For the symptoms of other complications, such as meningitis, endo- 

carditis, etc., see Contagious Pneumonia, Vol. I. 

| Recurrence.—A. difference of opinion exists on this point. Some 
authorities state that one attack predisposes the subject to a recurrence 
of the disease. According to Cadiot, this predisposition does not exist. 
One of us (H.) has seen instances in which two attacks occurred in the 
same year. With this exception, we have not noticed any predisposi- 
tion to recurrence, though relapses, owing to the animal being put to 
work too soon, are not uncommon. In some cases of gangrene, necrotic 
areas become encapsuled for some time, and then they break down and 
start the disease afresh; this, also, is more a relapse than a recurrence. 

Proenosts.— Under favourable surroundings, with early cessation from 
work, and with rational treatment, the prognosis of uncomplicated 
sporadic pneumonia is generally favourable. When occurring under 
opposite conditions to the above, the mortality is likely to be high. 
When the animal is the subject of another disease, and becomes attacked 
by pneumonia, the prognosis is always grave. Cases of bilateral pneu- 
monia are always very serious. 

DIFFERENTIAL D1aGNnosis.—The diagnosis of pneumonia is based on 
the results of a physical examination of the chest and on a consideration 
of the general symptoms presented. As already remarked, cases are met 
with in which the early symptoms are so slight as to be overlooked, while 
in others, unless a careful physical examination of the chest be made, 


878 SYSTEM OF VETERINARY MEDICINE 


the presence of the disease may not be suspected. But in cases of 
* central’? pneumonia (see p. 874), physical signs may either be absent, 
or deferred until the disease reaches the more superficial portions of the 
lung, and an error in diagnosis may be made by even the most careful. 

PRopHYLAxIs.—Holding the views we do as to the identity of all 
pneumonias, it is impossible to come to any other conclusion but that 
cases of this disease should be isolated. It is true that in many cases the 
infectivity appears very slight; still, it should always be recognised. 

In small studs cases should be segregated at once, and the usual dis- 
infectant measures carried out, special attention being paid to anything 
likely to be soiled by the nasal discharge, which is probably the chief 
source of contagion. 7 

Pécus* states that he was able to trace a large number of cases from 
infection at the water-trough, and concludes that this was due to inges- 
tion of the nasal discharge. It is hardly necessary to add that great care 
should be taken of the water-bucket, otherwise it may become a great 
factor in the spread. 

In large studs, such as the army, where young horses are constantly 
being brought into the stable, the possibility of isolating every case, or 
suspected case, is a serious problem. Everyone who has had practical | 
experience of such studs knows that they are very seldom free for any 
length of time from several contagious diseases; and to have one isolation 
ward does not help a great deal when one has to deal simultaneously with 
cases of contagious catarrh, strangles, pneumonia, and ringworm, or other 
skin diseases. We know that to enforce rigid isolation of cases of three or 
four sorts of contagious disease in one isolation ward is very difficult, and, 
on the other hand, it may be impossible to get more isolation wards. In 
such cases a good deal has to be left to the practitioner. Our experience 
is that, where unlimited fresh air is given, the infectivity is slight, and 
we have found that such cases can be kept in proximity to healthy horses, 
or even to cases of catarrhal affections of the respiratory tract, without 
serious danger. 

This statement requires a little explanation, for in the first place our 
idea of unlimited fresh air is, we know, very different from that of many 
practitioners; our ideal isolation ward for all diseases of the respiratory 
system is a shed open on all four sides, and the partitions in this shed 
should be skeleton, in order to permit free circulation of the air. Many — 
think if they see that the upper half of the door of a loose-box is kept 
open, that enough fresh air 1s allowed for any case. We do not think 
so; the box door should be open top and bottom, and there should be a 


* Rev. Gén. de Méd. Vét., December 15, 1907. 


DISEASES OF THE LUNGS: HORSE 879 


good-sized opening on the other side of the box, so that there may be a 
current of air through. This will mean, in common phraseology, that 
there will be a “draught.” We consider that sucha draught is essential 
for the prophylaxis and treatment of pneumonia. This may be an extreme 
view, but we are convinced it is correct. Much harm is done by the 
warning against draughts given in many textbooks. The usual advice is, 
‘‘ Give fresh air, but avoid draughts; our contention is that if draughts 
are entirely avoided, sufficient fresh air cannot be given. 

TREATMENT.—It is now universally recognised that there is no specific 
treatment for pneumonia. In former times the disease was treated by 
heroic measures and promiscuous drugging, with a view to either cut short 
its course or to bring about a favourable termination. Clinical experience 
and a consideration of the pathology of the disease have taught that such 
measures are not only useless, but also prove injurious to the patient and 
prejudice the chances of recovery. 

Of first importance in treatment is attention to hygienic and dietetic 
details. Fresh air is the first essential, and it should be recognised that 
there are very few ordinary stables sufficiently airy for a pneumonia case. 
This, however, does not much matter, for both on the grounds of prophy- 
_ laxis and treatment it is better to move the patient away from his usual 
stable, and we can generally improvise a place when there is no hospital 
at hand. On farms a cart-shed is usually available, and a portion may 
be hurdled off as a loose-box. In towns a coach-house or cart-shed is 
generally to be found—in fact, any place where the air-supply cannot be 
shut off will answer the purpose. Select a place with at least one side 
exposed to the fresh air, and there should be a chance for a current of 
air to blow right through it. Do not let any fetish of avoiding draughts 
interfere with the current of air. This advice holds good no matter what 
the weather may be. 

The food should be of an easily digested nature, and allowed in small 
feeds at a time. Foods of a highly nitrogenous character should be 
avoided, as they are likely to increase the febrile condition and to throw 
extra work on the kidneys. Bran and linseed mashes, oatmeal gruel, 
hay tea, scalded hay, green food if in season, and carrots in moderation, 
should be allowed. Milk is an excellent form of diet, and with a little 
persuasion most horses can be got to drink it. Scrupulous cleanliness 
should be carried out in connection with the feeding utensils, and all un- 
used food should be removed. 

Careful nursing is the sine qué non in treatment, and of this fact every 
practitioner is aware. If the patient’s appetite continues fair, it may 
be assumed that the case is progressing favourably. It is when appetite 


880 SYSTEM OF VETERINARY MEDICINE 


fails and recourse is had to forced feeding and to stimulants that the 
prognosis is unfavourable. 

If the case be seen in the early stages and rigors be present, the ad- 
ministration of a diffusible stimulant is indicated, such as a dose of sweet 
spirits of nitre; but drenching should be avoided as far as possible. 

A plentiful supply of cold water should always be allowed, so that the 
animal can drink at pleasure. In this salines may be dissolved, such as 
small doses of Epsom salt and nitrate of potassium; these assist in re- 
ducing the temperature, and also regulate the action of the excretory 
organs. | 

With reference to the value of drugs in the treatment of pneumonia, 
clinical experience teaches that they have no influence on the course of 
the disease. Provided the appetite is fair and the general condition of 
the animal satisfactory, there is no necessity for the administration of 
active drugs. Above all things, the administration of drenches should 
be avoided, in consequence of the danger of fluids entering the trachea 
and bronchi, and inducing gangrenous pneumonia. When hyperpyrexia 
persists, the question of administering antipyretics must be considered. 
Of these agents, there are a number to choose from, but in our experience 
the time-honoured quinine gives the best results. 

It is preferably administered in the form of electuary, the basis being 
honey. Quinine is best given in moderate doses, repeated at intervals, 
until the temperature is reduced. Some practitioners find antifebrin 
given in the drinking-water useful. We may remark, however, that in 
ordinary cases of sporadic pneumonia, continued hyperpyrexia is not | 
often met with, and the fever tends to disappear spontaneously. 

Of late years nuclein has been largely employed in the treatment of 
pneumonia. It is preferably given by subcutaneous injection, combined 
with normal saline solution, the usual dose being 10 c.c. of each agent, 
once or twice daily. 

With reference to alcoholic stimulants, we think the risks of careless 
drenching by far outweigh any advantage to be gained from their employ- 
ment. The indications for stimulants are cardiac weakness, total loss 
of appetite, and marked depression. 

In our experience the most efficacious cardiac stimulant is the ad- 
ministration of normal saline solution by subcutaneous injection. Quan- 
tities up to a pint can be given by this means, and repeated at proper ' 
intervals. The procedure should be carried out under oo aseptic 
and antiseptic precautions. 

During the stage of resolution many practitioners sash be iodide of 
potassium, and believe that it hastens the process and assists in restoring 


DISEASES OF THE LUNGS: HORSE 881 


the lung to a normal condition. It can be given in the food or in the 
drinking-water. 

In cases where cardiac weakness is a prominent symptom, the hypoder- 
mic injection of digitalin and strychnine may be employed with benefit. 

Some authorities recommend subcutaneous injection of ether, but 
our experience leads us to prefer either the strychnine or normal saline 
injections. Moreover, ether injections may be followed by troublesome 
abscesses. The administration of iodine in bolus has been advocated 
by Malcolm and later* by Smith, but the results do not appear very 
convincing. 

Venesection is seldom employed in the present day in the treatment 
of pneumonia. While it might prove of benefit in the early stages of 
cases in plethoric animals characterised by marked pulmonary engorge- 
ment, clinical evidence of its value is neither clear nor convincing. As 
a routine treatment it is deprecated by all modern practitioners. 

Counter-irritation.—Much difference of opinion exists with reference 
to the value of counter-irritation applied to the thoracic walls in cases 
of pneumonia. Many practitioners have abandoned this therapeutical 
measure, and claim to have as good, if not better, results than those who 
employ it. 

It is not our intention to present the various views in existence on 
the subject, or to attempt an explanation of the manner in which counter- 
irritation is believed to exert beneficial results in these cases. Having 
treated a large number of cases with and without counter-irritation, 
we have arrived at the conclusion that its indiscriminate employment 
is not only unnecessary, but also detrimental. More especially is this 
the case when severe forms of counter-irritation are employed. We 
believe that in the early or congestive stage the application of a mild 
counter-irritant, such as mustard in the form of a paste, is productive of 
good results. When effusion has taken place, we do not consider that 
counter-irritation is of any value. Moreover, it causes distress to the 
patient, and it prevents a proper physical examination of the chest being 
carried out. It also renders tapping slightly more difficult. 

The application of heat to the thoracic walls in the form of blankets 
wrung out of hot water is advised by some practitioners. Whatever be 
the therapeutical effect of such a measure, there are marked difficulties 
in carrying it out, and the danger of chills resulting must be considered. 
If the application of heat be thought advisable, the best manner to employ 
it is by means of a combination of kaolin and glycerine, applied hot 
and in a thick layer to the thoracic walls. 


* Journal of Comparative Pathology and Therapeutics, 1897, p. 118. 


VOL. II. 56 


882 SYSTEM OF VETERINARY MEDICINE 


For further details on the treatment of pneumonia, and of its com- 
plications and sequels, the reader is referred to the section on Epizootic 
or Contagious Pneumonia (see Vol. I.). 

The inhalation of oxygen gas has been found of marked value by some 
practitioners in the treatment of pneumonia. 

With reference to the treatment of cases in which there is total refusal 
of food, artificial feeding per rectum is advised by some authors. _Hutyra 
and Marek advise flour and bran gruels containing 1 to 2 per cent. of 
common salt. The latter is said to induce antiperistaltic movements, 
and transports the food material further forward in the bowel, besides 
favouring its absorption. The contents of the rectum are first removed 
by hand or by enema a quarter or half an hour previously; the food is 
warmed to body temperature and introduced carefully by means of a 
syringe and gum-elastic tube. When nutritive enemata are given daily, 
the rectum should be washed out at proper intervals, so as to remove 
decomposing residue. The amount which may be introduced is from 
2 to 3 quarts. The above authors point out that rectal feeding in horses 
can only be carried out for a limited period, as the rectal mucosa soon 
suffers from a catarrhal condition. 

Operative Treatment—In Smith’s statistical tables (referred to on 
p. 875) ten cases were found on post-mortem to have effusion into the 
pleural cavities, out of a total mortality of nmeteen. Our own experi- 
ence is very similar, and we think most practitioners will agree that the 
proportion of their fatal cases that are found to have effusion will be 
rather more than half, and that in these cases the effusion appears the 
chief cause of death. This being the case, it follows that if we could do 
away with this effusion, we should save half our cases. The first thing 
that occurs to us is to remove it by the operation of tapping the chest; 
but so many of those who have tried tapping find that it has not been 
successful, and so many of the older writers recommend such a large 
number of precautions to be taken, that undoubtedly a prejudice has 
sprung up against it. We think that the reason this prejudice has arisen 
is because the operation has been delayed too long. 

One thing should be made clear before dealing with this question, 
and this is that the veterinary surgeon is at a great disadvantage com- 
pared to the human surgeon in the physical examination of the chest. 
Not only has he to deal with a thick muscular chest covered with hair, 
but he has to conduct his examination in a stable where it is hardly ever 
possible to get even moderate silence, with a patient inclined to be restless, 
and one who is incapable of giving any assistance by showing the seat of 
pain or by taking a deep breath when required. All this means that the 


DISEASES OF THE LUNGS: HORSE 883 


physical examination of the chest in the horse is far more difficult and far 
less accurate than it is in man. 

While we believe that with application and constant practice it is 
possible to get a fairly accurate idea of the changes that are proceeding 
in the chest cavity, we think it is only by close and assiduous practice 
with a greater number of cases than fall to the lot of the average prac- 
titioner that this is done. Thus, while the symptoms of effusion, when 
there is a large quantity of fluid present, are sufficiently diagnostic, we 
think there are very few who can diagnose, with any degree of certainty, 
effusion in its early stages. 

We believe that there is not likely to be any permanent benefit to 
be obtained by tapping cases with large quantities of effusion, especially 
when the condition has lasted some days; but the benefit we have seen 
from tapping in the early stages is surprising. In the Veterinary Record 
of January 25, 1913, p. 450, one of us (M.) pomted out how simple 
the operation was, how absolutely harmless it was, even when con- 
stantly repeated, provided ordinary precautions were taken, and how 
beneficial it was in many cases. Our experience has confirmed these 
observations. We consider that tapping should be a method of diagnosis 
as well as of treatment. We recommend practitioners not to wait until 
by physical examination they have diagnosed fluid, but to constantly 
check their physical examination in the early stages by tapping. We also 
consider that the published results of this method merit a further trial by 
practitioners. In a great number of cases tapped in this way fluid will 
not be found, yet we shall have gained important information, and we 
shall have done no harm. In the occasional case in which it is found, 
great benefit will result. 

The rule should be that whenever in a chest case the symptoms become 
at all urgent, it is advisable to tap, and there is no objectian to this tapping 
being carried out daily. Some who have tried this method say that 
even in those cases in which no fluid is found, the patient usually appears 
better for the tapping, and our own experience appears to support this. 
We hesitate to offer any explanation, but we first put forward the sugges- 
tion that the entrance of a small quantity of air into the pleural cavity 
(which usually occurs when no fluid comes out) has a beneficial effect. 
It will be noted that most of the older textbooks specially warn the opera- 
tor against this entrance of air, but we have found it has no bad effect. 
On the contrary, indeed, it is possible that it does good. 

The operation is simple in the extreme, and it has this reeommenda- 
tion for the lazy man—viz., it can be performed in far less time than it 
takes to make anything like a thorough physical examination of the chest. 


884 SYSTEM OF VETERINARY MEDICINE 


The technique is as follows: The side of the chest about 3 or 4 inches 
behind the point of the elbow is painted with tincture of iodine (after 
clipping if the hair is long); the trocar and cannula, previously sterilised 
by boiling, is introduced between the ribs in the usual way, and the 
trocar is then withdrawn. If fluid is present the whole amount is drawn 
off and the cannula taken out. The right side is usually selected, but 
the left side may be tapped equally well. There is no danger of inter- 
fering with the heart in the position indicated. 

Variations of Type in Pneumonia.— While we admit only one type of 
pneumonia in the horse, we must acknowledge that when it occurs as 
a secondary affection, certain modifications are seen clinically and 
pathologically which have given rise to the separation of a special type 
of pneumonia known as broncho-pneumonia or lobular pneumoma. 

This variation is in reality not a different type, but it results from 
the primary cause of the disease operating through the bronchi. Probably 
every case of this variety commences as a capillary bronchitis, and the 
period at which it verges into a true pneumonia is difficult to determin. 
It is characterised by a circumscribed inflammation of the lung in which 
a varying number of lobules are affected, either connected together or in 
scattered areas. Its features will be found discussed in Vol. I. under 
the heading of the Contagious Pneumonia, and in the present volume 
under the heading of Inhalation Pneumonia (see below). 


Inhalation Pneumonia, Alimentary Pneumonia, Pneumonia Medicamen- 
taria, Pneumonia due to Foreign Bodies. 


Under the above heading are included cases of pneumonia occurring 
as the result of fluids, portions of food, foreign bodies, etc., entering the 
bronchi. The primary effect of such agents is mechanical irritation, 
but as they are also the means of conveying micro-organisms into the 
respiratory passages, the result is the production of pneumonia which 
often presents special characteristics. 

Etiotogy.—This can be most conveniently considered under the 
following heads: 

1. The Careless Admunistration of Drenches, or the Administration of 
the Latter under Conditions that should prohibit this Form of Medication.— 
Under similar conditions foods in the fluid form, forcibly given to cases 
that refuse to take nourishment, come under this heading. This con- 
stitutes a common cause of pneumonia. It may depend on faulty 
methods of administration, such as holding the head too high, pouring in 
too much fluid at a time, drawing out the tongue, closing the nostrils, 
rubbing and pressing the throat with a view to induce swallowing, resulting 


DISEASES OF THE LUNGS: HORSE 885 


in a fit of coughing; administering drenches when the horse is in the 
recumbent position, especially when he struggles, as in cases of colic, 
etc., also giving drenches through the nostril instead of by the mouth. 
Again, in affections such as pharyngitis, laryngitis, etc., fits of coughing 
are easily induced; deglutition is very difficult and painful, and if fluid 
medicines are forced on the patient, a varying amount of these is likely 
to enter the trachea and bronchi. The effects produced depend not only 
on the irritating action of the preparation entering the bronchi, but 
also on the micro-organisms which are carried thereto from the mouth 
and pharynx. Particles of food may also be conveyed from the mouth 
and act as foreign bodies. 

Experiments go to prove that pure water may be introduced into the 
trachea and bronchi in varying amounts without producing broncho- 
pneumonia. According to Cadéac, a certain amount of distilled water 
introduced into the bronchi may cause pneumonia, while the same 
amount of ordinary water may prove harmless. Friedberger and 
Fréhner, however, state that distilled or spring water, and all non-irritant 
drugs in the form of solution, may become absorbed without causing any 
subsequent inflammation. 

It is generally admitted that substances of an irritating nature, such 
as oil of turpentine, solutions of ammonia, chloral hydrate, chloroform, 
etc., are most dangerous. Drenches containing oil are also regarded as 
likely to produce serious results: portions enter the trachea with facility, 
and but little absorption is liable to occur. Some of the most severe 
and rapidly fatal cases may result from the entrance of raw linseed oil 
or of solutions of Epsom salt into the trachea and bronchi. When the 
animal suffers from a respiratory affection prior to the accident in 
drenching, the effects are likely to be far more serious. 

2. Alimentary—In certain diseases there is interference with the 
complete closure of the glottis, and portions of alimentary matters may 
find their way into the trachea and bronchi, such as in cases of tetanus, 
purpura hemorrhagica, affections of the brain, etc. In cases of gastric 
tympany accompanied by regurgitation of fluid ingesta up the cesophagus, 
or attempts at vomiting, the alimentary material may be drawn into 
the trachea and bronchi. 

Injuries to the vagus nerve, such as those resulting from wounds, 
also new growths causing pressure on the nerve, are occasional causes 
of alimentary pneumonia, acting in a similar manner to experimental 
section of this nerve. 

3. Intratracheal Injections may produce broncho-pneumonia, if the 
solutions employed are too concentrated or not aseptic. 


886 SYSTEM OF VETERINARY MEDICINE 


4. Surgical Operations—During prolonged operations hypostatic 
congestion of the lung may be induced, the vital resistance is lowered, 
and pneumonia may result. In such long operations the irritating 
action of the anesthetic on the nasal mucosa often causes a large amount 
of secretion to exude, which accumulates in the region of the naso- 
pharynx, and under deep anesthesia the fluids thus formed may enter 
the trachea and bronchi, and contribute to the result mentioned above. 
In operations in the regions of the nose or throat, blood may enter the 
trachea and bronchi, also during operations on the facial sinuses purulent 
material may enter the lungs while the horse is in the recumbent position. 

If irrigation of the sinuses be carried out while the horse is cast, there 
is grave danger of the fluids gaining entrance to the lungs. After pro- 
longed aneesthesia, if the horse be allowed access to food immediately 
on rising, a portion thereof may enter the bronchi. 

5. Pneumonia of the newly born may result from entrance of portion 
of the amniotic fluid into the lungs. 

6. During operations on the larynx for roaring, blood from the wounds 
and secretions from the mouth and pharynx may pass into the bronchi 
and set up pneumonia. The offensive smell that usually sets in about 
two days after the operation is due to the putrefactive changes taking 
place in these secretions. 

6. The inhalation of irritating fumes, such as smoke from burning 
buildings, may also produce broncho-pneumonia. 

Morsip AnatomMy.—The lesions commence in the bronchi and extend 
to the peribronchial connective tissue and pulmonary parenchyma. 
The exudate is composed of blood-stained serum, leucocytes, red corpuscles, 
and epithelial cells. The tendency to the production of pulmonary 
gangrene is one of the marked characteristics of this form of broncho- 
pneumonia, According to Friedberger and Froéhner, the lesions are a 
combination of catarrhal, croupous, and gangrenous pneumonia. Both 
lungs are generally affected. The lesions are best marked at the anterior 
parts of the lung, and the surface of the organ is irregular. Depressions 
are found amongst the raised portions, these being due to atelectasis of 
the affected lobules. 

On section, centres of hepatisation are observed, at first of a dark 
red colour, changing to a yellow tint; suppurative inflammation gradu- 
ally develops, and abscesses of various sizes are formed. Gangrenous 
foci appear, and ultimately the lung shows all the characteristics of pul- 
monary gangrene. The pleura may also be affected by purulent inflam- 
mation, and pneumothorax or pyo-pneumothorax may occasionally be 
observed. 


DISEASES OF THE LUNGS: HORSE 887 


In cases where a large amount of a drench containing oil enters the 
lungs and proves fatal in a short space of time, portions of the medicament 
may be recognised in the smaller bronchi. This rapid asphyxia seldom 
occurs in the horse, but is not uncommon in cattle. 

BactERIoLoGy.—The micro-organisms found in the affected lung are 
various, and include streptococci, staphylococci, bacillus of necrosis, and 
other organisms of sepsis. 

Symproms.—The gravity of the symptoms depends on the nature 

and on the amount of the fluid which enters the lungs. Immediately 
after the accident in drenching has occurred, marked dyspnoea appears, 
the respiratory movements are laboured, and a distinct interval may 
be observed between inspiration and expiration. Violent fits of coughing 
occur, during which some of the fluid may escape by the nostrils. Rigors 
are also present, and a rise in temperature soon occurs. The pulse is 
greatly accelerated, and tends to assume a weak character. Sweating 
may also be observed. The nasal discharge, at first of a mucous character, 
soon becomes purulent, and in a variable period alters to a brownish tint, 
and becomes foetid. In some cases it is distinctly hemorrhagic. 
As the disease advances there is marked prostration, an anxious 
expression of countenance, the breath assumes the characteristic odour 
of pulmonary gangrene, and the nasal discharge may contain shreds of 
pulmonary tissue, and is of a dark colour. Towards the end the animal 
may assume the recumbent posture, a profuse foetid diarrhoea may set 
in, and all the evidences of general septicaemia are present. 

PuysicaL Signs—Percussion.—Limited areas of dulness are found 
towards the anterior region of both lungs. When cavities are formed a 
tympanitic note may be elicited, provided they are not too deeply situated. 

Auscultation.—At first coarse mucous rales may be heard in the 
upper region of the lung; crepitant and sibilant rales may also be de- 
tected. Later on, when cavities have formed, sounds of a bubbling 
character are present. 

DIFFERENTIAL Diacnosis.—The history of the case is of first import- 
ance. When we have evidence that marked dyspncea, constitutional 
disturbance, violent coughing, and distress follow immediately after the 
administration of a drench, the diagnosis is clear. But we meet with 
cases in which no history of an accident in drenching can be obtained, 
as the attendant who has administered the medicine is desirous of con- 
cealing the fact so as to shield himself from blame. It must also be 
remembered that the accident may occur in horses already suffering from 
a respiratory affection, in which instance there will be a sudden exag- 
geration of the existing symptoms 


888 SYSTEM OF VETERINARY MEDICINE 


The occurrence of pneumonia of a gangrenous type during the course 
of the diseases already mentioned (p. 885) is often suggestive of either 
accidents in drenching or of alimentary matters entering the trachea 
and bronchi. A most characteristic feature of mmhalation pneumonia 
is its sudden development and its rapid progress in a case which previously 
was progressing favourably. 

Proenosis.—This is always grave, especially tte the animal is 
already suffering from bronchitis or pneumonia. Recovery may occur 
when the amount of material entering the lungs is small and not of a 
distinctly irritating nature. 

PRoPHYLAXIS.—Avoid the administration of drenches in respiratory 
affections. Exercise great care in drenching animals in the recumbent 
position. Attendants should be instructed in the careful administra- 
tion of drenches, and the dangers pointed out to them. Attention to 
patients during operations, so as to avoid the dangers already mentioned, 
is of importance. 

TREATMENT.—This is to be carried out on similar lines to those 
advised for cases of ordinary pneumonia. Inhalations of steam medicated 
with antiseptics should be administered at frequent intervals. 

Intratrachea] injections of antiseptic agents are advised by some 
authorities, but are condemned by others. Law advises the intra- 
tracheal injection of a 1 per cent. solution of peroxide of hydrogen. 
Cadéac has found the administration of antiseptics in the form of 
electuary useful. It is generally admitted that when evidences of pul- 
monary gangrene present themselves, recovery is very rarely met with. 


- Traumatic Pneumonia. 


This may occur from the entrance of foreign bodies through the 
thoracic walls, from wounds of this region, from fractured ribs pressing 
inwards, also from crushing or contusion of the thorax, the result of 
accidents, etc. The pneumonia is generally of the same type as that 
described as “inhalation”? or “alimentary ” pneumonia, but is associated 
with septic pleurisy, and the subject more properly comes under the 
domain of surgery. 

Chronic Pneumonia. 


This is also known as chronic interstitial pneumonia, indurative pneu- | 
monia, cirrhosis of the lung, pulmonary sclerosis. 
It may occur as the result of various pulmonary affections and 
diseased conditions, and is characterised by fibroid changes which 
may commence in any part of the pulmonary tissues, such as the peri- 


DISEASES OF THE LUNGS: HORSE 889 


bronchial tissue, the interlobular septa, the alveolar walls, and also in 
the pleura. According to Hutyra and Marek, chronic interstitial pneu- 
monia occurs very rarely in horses as a primary disease. 

Etiotogy—l. As a Sequel to Acute Attacks of Pneumonia.—Croupous 
or sporadic pneumonia is said to be very seldom followed by the inter- 
stitial form. Inhalation pneumonia, and epizodtic or so-called “ con- 
tagious ” pneumonia, lead more frequently to the chronic form, especially 
in aged debilitated horses. 

2. Pleurisy—tThis is usually of the dry type, with adhesions. The 
fibroid change is generally limited to one part of a lobe. It may result 
partly from compression of the lung due to the pleurisy, but in some 
instances there are evidences of the extension of the inflammatory action 
from the pleura to the lung in the form of dense fibrous strands passing _ 
into the pulmonary tissue. 

3. Chronic Bronchitis, also Hydrothoraz.—May be causes of inter- 
stitial pneumonia. 

4. Interstitial pneumonia also occurs in certain infectious diseases 
accompanied by pneumonia, such as strangles, glanders, tuberculosis, - 
botriomycosis, etc. It may also be associated with certain parasitic 
affections, such as hydatid cysts, tumours of the lung, foreign bodies, 
causing abscess, or gangrenous foci, whose course is not rapid. The 
condition has been observed as the result of the inhalation of coal-dust. 
This extends from the bronchi to the interstitial pulmonary tissue, 
producing a poe ee inflammatory gly or occasionally a more 
extensive lesion termed “ pneumoconiosis.’ 

-Morsip Anatomy.—The fibroid change may be tp such as occurs 
in tubercle, abscess, tumours, pleurisy, etc.; or it may be diffuse. When 
occurring in cases of sporadic lobar pneumonia, the lesion results when 
resolution does not take place. The fibrinous exudate in the air-cells 
becomes organised, the alveolar walls are thickened by a new growth 
of connective tissue, and the condition known as grey induration is pro- 
duced. As already mentioned, this form.is rarely met with. 

When the pleura is involved, it undergoes thickening, and extensive 
adhesions may be formed. The pulmonary sclerosis affects chiefly the 
inferior borders of the lung, and fibrous bands from the pleura may 
constrict the lobules; the sclerosis is of a perilobular character. Dilata- 
tion of the right heart and lesions of the liver may be found as com- 
plications. 

A lardaceous pneumonia was described by Dieckerhoff and also by 
Bang. The upper portions of the lungs were of a uniform greyish-white 
or yellowish-grey colour and lardaceous appearance, contained little air, 


890 SYSTEM OF VETERINARY MEDICINE 


and were firm in consistence. Microscopically, proliferation of alveolar 
epithelium, a marked increase of connective tissue, and compression 
of the alveoli, were observed. 

In pneumoconiosis fibro-calcareous nodules or streaky cicatricial 
bands are present, or the lesions are those of a fibrous broncho- 
pneumonia (Hutyra and Marek). 

Symproms.—These are by no means definite or regular. After the 
primary disease has run its ordinary course, the animal does not appear 
to recover, and in addition to evidences of debility, inaptitude and 
unfitness for exertion, symptoms suggestive of pulmonary derangement 
are present, but fever is absent. These symptoms vary in severity accord- 
ing to the extent of the pulmonary lesions. Dyspnoea, in a varying 
degree, is observed, also a cough of a paroxysmal character, and a nasal 
discharge which may be slight or abundant. When the affection follows 
the ordinary type of pneumonia, there is a marked tendency for pul- 
monary emphysema to occur, resulting in the condition known as 
broken wind. Bronchial catarrh is nearly always present. 

In the less severe cases the dyspnoea on exertion, cough, nasal discharge, 
and loss of condition, may continue for an indefinite period, but is likely 
to be aggravated by repeated attacks of bronchial catarrh. In the 
pleuritic form the symptoms may be very obscure and the condition may 
be overlooked. In cases of long standing, complications are likely to 
occur, such as cardiac dilatation, ascites, emaciation, etc. 

In lardaceous pneumonia, a diminished appetite, cough, emaciation, 
unfitness for exertion, and a gradually increasing dyspneea, terminating 
in broken wind, are observed. Fever and constitutional symptoms 
appear after the disease has been a long time in existence, and the course 
of the affection is insidious. After one half to one year the animal becomes 
unfit for work owing to increasing respiratory difficulties. 

Puysicat Sians.—When the lesions are slight, disseminated, or deeply 
seated, a physical examination may prove negative. In other cases 
areas of dulness may be found on both sides of the thorax, especially 
at the end of the inferior borders and anterior portions of the lobes. 
Mucous and sibilant rales may be detected by auscultation, and cavernous 
rales depending on bronchial dilatation and the formation of cavities. 
When pulmonary emphysema occurs, the physical signs of that 
condition will be present (see p. 900). Wid 

DIFFERENTIAL Diagnosts.—The history of the case must be taken 
into consideration. When an animal has suffered from a recent attack 
of pneumonia, and still shows evidences of dyspnoea, debility, and un- 
fitness for exercise, and a physical examination of the chest reveals the 


DISEASES OF THE LUNGS: HORSE 891 


fact that the lungs have not returned to a normal condition, the diagnosis 
is sufficiently clear. The absence of fever is an important diagnostic 
feature. 

Chronic pneumonia may be confounded with pulmonary tuberculosis, 
and the tuberculin test may be necessary in order to arrive at a definite 
diagnosis. From hydrothorax it is differentiated by the dulness on 
percussion in the former affection being limited to the level of the fluid 
in the thorax. From pulmonary emphysema it is distinguished by the 
physical signs and the peculiar character of the breathing in the former 
’ affection. But it is not uncommon to find chronic pneumonia merging 
into pulmonary emphysema, and it is then difficult to draw the border- 
line. 

Proenosis.— Usually the prognosis is unfavourable, as, in spite of 
treatment, pulmonary emphysema occurs and renders the animal useless. 
Besides, other complications are likely to supervene. In less severe 
cases the horse may be fit for slow work. 

TREATMENT.—It is evident that no treatment can exert any effect 
on the fibroid changes which have occurred in the affected lungs. 
| Prevention of the condition is of importance. In cases where resolu- 

tion appears to be delayed, it is believed by many practitioners that the 
administration of potassium iodide favours the absorption and removal 
of the exudate, and prevents organisation of the latter. This agent 
may advantageously be combined with arsenic. In mild cases of the 
affection the above treatment should also be adopted. Tar-water 
sometimes proves useful, and after a time is readily taken by the animal. 
In cases where cough is troublesome and chronic bronchial catarrh a 
prominent symptom, inhalations of steam medicated with terebene are 
indicated. Nerve tonics, such as the arseniate of strychnine, may prove 
of benefit. 

We have seen cases in which the symptoms present would lead one 
to the conclusion that treatment would be hopeless, yet the animals 
recovered sufficiently for moderate work. Hence it is not wise to give 
a definite opinion until we have first: tried the effect of treatment. 

Attention to the surroundings of the animal is of importance, and 
walking exercise should be ordered. Counter-irritation to the thoracic 
wall is advised by some practitioners. In some cases it appears to prove 
beneficial, while in others it is of no value. 

Heroin, even in large doses, has not in our hands exerted any bene- 
ficial action in chronic pneumonia. A combination of arsenic, potassium 
iodide, and strychnine, has occasionally proved of benefit. 


892 SYSTEM OF VETERINARY MEDICINE 


Metastatic or Embolic Pneumonia. 


This form of pneumonia results from the presence of emboli in the 
lung, which originate either from thrombi in the peripheral veins, or from 
endocarditis. Thus it must be regarded as a secondary condition. The 
affections which may be followed by embolic pneumonia are—suppurative 
phlebitis of the umbilical veins or of the vena saphena, suppurative 
arthritis, suppurative mastitis, puerperal metritis, ulcerative endocar- 
ditis, etc. 

The lesions produced include hemorrhagic infarcts, which may undergo 
suppuration, and form abscesses or cavities, or induce pulmonary gangrene 
when the embolus is of a septic character. In the vicinity of the necrotic 
foci fibrinous pleurisy may be present, and empyema results when the 
suppurative focus gains a communication with the pleural cavity. 

The symptoms observed are, in addition to those of the primary 
disease, severe rigors, hyperpyrexia, accelerated respiration, etc. 
Physical examination of the lungs may reveal the presence of cavities. 
When gangrene occurs, the evidences of that condition will be observed. 
Treatment seldom proves of any benefit. 


III. OTHER MORBID CONDITIONS OF THE LUNGS. 


Pulmonary Emphysema. 


This term is employed in a general sense to designate a pulmonary 
condition characterised by an abnormal dilatation of the alveoli, with 
or without structural alterations of the pulmonary parenchyma. The 
following varieties are recognised by Hutyra and Marek: 

1. Acute Alveolar Emphysema, in which there is simple dilatation 
of the air-vesicles without any structural changes of the pulmonary 
parenchyma. 

2. Chronic Alveolar Emphysema, in which there is a permanent 
dilatation of the alveoli accompanied by atrophy of the interalveolar 
and interinfundibular septa and of the vessels contained therein. This 
constitutes the condition on which broken wind commonly depends. 

3. Interstitial Emphysema. —In this form rupture of the alveolar 
walls occurs, and air accumulates in the interstitial connective 
tissue. 

Some authors describe the interstitial variety as one of the forms of 
acute alveolar emphysema, but we consider that the classification 
mentioned above is the most convenient. 


DISEASES OF THE LUNGS: HORSE 893 


Acute Alveolar Emphysema.—This is a secondary affection, and may 
disappear when the disease on which it depends terminates favourably. 
It may occur either in a diffuse or a circumscribed form. 

Et1oLogy.—The condition depends on over-distension of the alveoli 
associated with an excess of residual air therein, owing to certain affec- 
tions of the respiratory passages causing more or less interference with the 
exit of air from the alveoli. The diffuse form may be associated with 
capillary bronchitis, pleurodynia (rheumatism of the intercostal muscles), 
cases where paroxysmal attacks of coughing are a prominent symptom, 
or it may occur during the struggles preceding death. The circum- 
scribed form may be observed in cases where stenosis of the bronchi of 
a certain area occurs. 

Symptoms.—These may be overlooked in consequence of being more 
or less masked by the symptoms of the primary disease. According to 
Hutyra and Marek, in the diffuse form percussion shows an increased 
resonance over the lower and posterior pulmonary margins, and the 
postero-inferior may be displaced backwards, so that it reaches the costal 
arch. If there is obstruction of large pulmonary areas, intensified 
vesicular sounds are heard by auscultation of the emphysematous 
portions. The course of the affection may vary. When the primary 
disease disappears in a rapid manner, the emphysema departs; but 
under opposite conditions the chronic alveolar type of the affection may 
develop, owing to the continued distension of the alveoli decreasing the 
elasticity of the pulmonary tissue. 

TREATMENT.—This must be directed towards the primary disease. 

Chronic Alveolar Emphysema—Synonyms.—Broken wind; Heaves. 

The affection known as broken wind is generally described under 
the heading of Chronic Pulmonary Emphysema. Although a large 
number of cases of broken wind show, on post-mortem examination, the 
lesions of chronic pulmonary emphysema, still it 1s admitted that such 
may be absent in some instances of the former condition. Accord- 
ing to Robertson,* “there seems little doubt that emphysema, par- 
ticularly the vesicular form, does exist in many horses which have not 
at any period exhibited symptoms indicative of the condition known as 
broken wind; also that a very large number of notoriously broken- 
winded animals have, on post-mortem examination, shown in an 
unmistakable manner pulmonary emphysema. Another, not such a 
numerous class, which during life were undoubtedly sufferers from 
this affection, did not, on after-death examination, give evidence of 
either emphysema or other structural pulmonic changes.” This author 


* “ Practice of Equine Medicine.” 


894 SYSTEM OF VETERINARY MEDICINE 


also states that interlobular and vesicular emphysema may be associated 
in cases of broken wind. 

Williams* regarded asthma and broken wind as synonymous, and 
described the condition under the section dealing with dietetic diseases. 
We have already (p. 850) pointed out that asthma should be regarded 
as a disease per se, although admitting that it may terminate im broken 
wind. From a clinical point of view it is desirable to discuss chronic 
pulmonary emphysema and broken wind together, and we may remark 
that, although the condition is one of common occurrence, there is still 
much to be learned with reference to its etiology, pathology, and pre- 
vention. With its symptoms we are only too familiar, and we must 
confess that up to the present time a successful method of treatment 
has not been discovered. The losses incidental to this disease are very 
serious, as horses suffering from it are incapacitated for fast work. 
The affection is generally progressive, and when far advanced, the animals 
become practically useless in spite of treatment. 

As regards the incidence of the disease, we find, on referring to the 
Report of the Army Veterinary Service for 1911-12, that 95 cases were 
recorded, of which 74 were cast, and 10 were destroyed. In the Report 
for 1912-13, 74 cases were admitted for treatment. Of these, 64 were 
cast, and 2 were destroyed. In the Report of the Army Veterinary 
Service in India, 1911-12, 21 cases are recorded, of which 8 were cast, 
3 were destroyed, and 1 died. In the Report for 1912-13, the number 
was 25, of which 10 were cast and 6 were destroyed. Judging by the 
improved methods of hygiene and dietetics employed in connection 
with army horses, it would seem that the definite etiological factors in 
connection with the disease have yet to be discovered. 

From a medico-legal aspect, the affection is also of importance, as in 
the examination of horses as to soundness, great care is necessary in 
order to detect the existence of the malady in its early stages. More- 
over, it is not uncommon for unscrupulous dealers to practise methods 
of deception by means of which the symptoms of the disease are tem- 
porarily arrested, so that unless special precautions are taken, the presence 
of the affection may be overlooked. This matter will be again referred 
to under the heading of Diagnosis (see p. 902). 

Et1oLoay.—Various theories have been advanced to account for the 
- occurrence of broken wind. In instances when the affection follows an 
acute bronchial or pulmonary disease, the explanation offered is at least 
plausible; but in many cases the malady develops in an insidious manner 


* “ Principles and Practice of Veterinary Medicine.” 


DISEASES OF THE LUNGS: HORSE 895 


in the absence of any primary disease, and the etiological factors are by 
no means easily discovered. 

Dilatation of the alveoli, owing to excess of air therein, and occurring 
as the result of long-continued exertion, was suggested as one of the 
causes of the condition. But as the affection is commonly met with in 
animals not subjected to excessive work, either of a heavy or a fast 
character, this mechanical theory per se cannot be accepted. 

Chronic bronchial catarrh must be regarded as an important cause 
of chronic pulmonary emphysema, as owing to the presence of plugs of 
mucus and swelling of the mucosa, the lumen of the smaller bronchi 
becomes narrowed ; the result is that the free passage of air from the alveoli 
is impeded, leading to dilatation of these latter structures. It must, 
however, be pointed out that as emphysema causes interference with the 
circulation in the pulmonary capillaries, 1t may of itself induce chronic 
bronchial catarrh. 

Chronic cough, especially if of a paroxysmal character, tends to pro- 
duce pulmonary emphysema, owing to the deep inspiratory efforts in- 
ducing an increased air-pressure in the alveoli. This pressure is also 
increased during the expiratory effort. 

Broncho-pneumonia is not infrequently followed by broken wind, 
probably owing to degenerative changes in the alveolar epithelium, 
permanent distension of the alveoli, and interference with the blood- 
supply of the latter structures. 

The increased pressure in the alveoli leads to important pathologica] 
changes in the pulmonary parenchyma. The interalveolar and inter- 
infundibular septa, with their capillaries, are compressed, leading to 
interference with the nutrition of the parts; the septa gradually becomes 
thinner, and some of them finally disappear, so that a number of alveoli 
become confluent. The elasticity of the pulmonary tissue becomes 
decreased, hence expiration is performed with difficulty; while owing 
to the interference with the pulmonary capillaries, the respiratory surface 
is decreased in extent, hence dyspnoea results. The pressure in the 
pulmonary artery is increased owing to the changes in the pulmonary 
capillaries. This leads to hypertrophy of the right side of the 
heart. 

Amongst other conditions which are believed to cause broken wind 
may be mentioned interstitial pneumonia, hydrothorax, and pleuritic - 
adhesions. Cadéac and Guinard regard paralysis of the phrenic nerve 
as a cause of chronic emphysema. This lesion is said to reduce the 
respiratory capacity of the lung, to induce dyspnea, and thus to cause 
greatly augmented inspirations. 


896 SYSTEM OF VETERINARY MEDICINE 


Nervous Theory—Some authors state that broken wind originates 
in reflected nervous irritation from the stomach to the lungs. Excessive 
amounts of bulky indigestible foods are believed to produce irritation 
of the gastric nerves, and this irritation is said to be reflected to the 
pulmonary branches of the vagus, the result being a paralysed condition 
of the muscular walls of the smaller bronchi, and well-marked dilatation 
of the pulmonary alveoli. Robertson observed that chopped hay given 
in excess tended to produce broken wind, especially when such fodder 
was in a musty or heated condition. It is well known that many horses 
affected with this disease were, prior to the development of symptoms, 
large feeders, with an inordinate appetite, and a tendency to eat their 
litter at all times. Cobs and ponies in obese condition, getting little 
exercise, are especially subject to the disease, particularly when aged. 
In such instances the symptoms develop insidiously, and often in the 
absence of any primary respiratory affection. It has also been observed 
that horses suffering from broken wind are subject to flatulence of the 
intestines. Taking these points into consideration, 1t would appear as 
if the nervous theory possessed a grain of truth. 

- Hereditary Influences——Many observers believe that a diminished 
resistance of the pulmonary tissue may be congenital or hereditary. 
Bouley and St. Cyr recorded cases of broken wind in young untrained 
horses. Although we have known a large number of instances where 
broken-winded mares were kept for breeding, we have never met with 
any evidence which would point to the hereditary nature of the affection. 

Influence of Breed and Conformation.—In our experience the disease 
is not common in well-bred horses. Occasionally it occurs as the result 
of respiratory affections, but whistling or roaring are far more frequent 
sequele. On the other hand, in horses of a thick-set build—cobs and 
ponies—the affection is very common, even in the absence of any primary 
respiratory disorder. 

Age.—The affection is comparatively rare in young horses, and its 
frequency increases with age. 

Morsip ANAToMy.—As already remarked, Robertson found that in 
the earlier stages of the disease no lesions could be detected in some cases. 
In well-marked cases the lungs are apparently increased in bulk, but are 
lighter in weight, softer, less elastic, and paler in colour than the normal 
organs; also the pericardial sac is covered by the lungs to an increased — 
extent. According to Hutyra and Marek, the pulmonary surfaces 
frequently show the impressions of the ribs. The alterations are most 
marked towards the inferior and posterior borders of the organs. On 
section the pulmonary tissue shows lessened vascularity, only a small 


a 


DISEASES OF THE LUNGS: HORSE 897 


amount of frothy blood issuing from the cut surface. Crepitation is 
absent, and the tendency to collapse is less marked than in the normal 
lung. When bronchial catarrh is present, small drops of pus exude on 
pressure being applied. 

Microscopical Examination.—The histological changes include a 
marked increase in the diameter of the alveoli, attenuation of the inter- 
alveolar septa, narrowing and partial obliteration of the capillaries, 
atrophy of the elastic fibres of the alveolar walls, several alveoli become 
confluent, and fatty degeneration of the alveolar epithelium is also 
observed. 

Some authors describe the interstitial form of emphysema as being 
present in broken wind in some cases. This is characterised by the 
presence of air in the interstitial connective tissue between the lobules 
(see p. 906). 

Carpiac Lrestons.—In well-marked cases hypertrophy of the right 
ventricle is found, owing to interference with the pulmonary circulation 
and increased pressure in the pulmonary artery. In advanced cases 
dilatation of the right heart occurs, with attenuation of the cardiac wall. 
Cadéac states that the right auricle is specially involved. Dilatation of 
the pulmonary artery was observed by Dupuy in one case. 

SymMpPtoMs.—The early symptoms will vary according to the manner 
in which the disease develops. Ina large number of cases the symptoms 
appear in an insidious manner. As already mentioned, cobs and 
ponies that do little work, get into an obese condition, and if allowed 
unlimited amounts of hay, are very commonly affected; they have an 
abnormal appetite, and habitually eat their litter. The affection is not 
common in thoroughbreds or hunters, but many cases are met with 
in farmers’ horses, and in well-kept carriage horses that do only a 
moderate amount of work. The primary symptoms in these insidious 
cases are the presence of cough and an abnormal acceleration of the 
respiratory movements on being subjected to moderate exertion. The 
cough persists in spite of ordinary treatment. It occurs at first in 
paroxysms, with or without a nasal discharge, and is usually termed 
‘chronic cough” in consequence of the length of time it continues 
and its obstinate character. Gradually this cough becomes altered to 
what is known as the “ broken-winded cough,” which we shall describe 
farther on. At the same time the type of respiration which is character- 
istic of broken wind develops (see p. 898). The abnormal appetite 
continues, and except in cases which are subjected to hard work, the fat 
condition is kept up. There is also an increased desire for water, and a 


tendency to the occurrence of flatulence in some instances. 
VOL. IL. 57 


898 SYSTEM OF VETERINARY MEDICINE 


In cases occurring as a sequel to chronic bronchitis, the characteristic 
symptoms of broken wind are also developed gradually, and in many 
instances it is difficult to draw the border-line between the two afiec- 
tions. Chronic bronchitis often has a tendency to disappear during the 
summer, and to recur in the winter months, and during severe attacks 
the symptoms in many respects resemble those of broken wind. This 
will account for the reputed cures of broken wind which are sometimes 
reported as occurring from the administration of certain specifics for the 
disease. Sooner or later, however, repeated attacks of chronic bronchitis 
generally terminate in broken wind. 

Broken wind is not uncommon as a sequel to an attack of broncho- 
pneumonia. In this instance, after the acute symptoms have subsided, 
respiratory distress still continues, and the characteristic symptoms of 
broken wind develop, often in an aggravated form. Those instances 
of the disease which are said to develop almost suddenly are in reality 
cases of asthma. The latter affection, however, generally terminates in 
broken wind. 

When broken wind is fully established, the following symptoms are 
observed : 

1. Dyspnea.—tThis depends not only on diminished elasticity of the 
lungs and distension of the alveoli with air, but also on alterations in 
the pulmonary capillaries so that oxygenation of the blood becomes 
impaired. At first, inspiration, beyond being shorter than normal, is 
not affected to any extent, but expiration is lengthened to a marked 
degree, and is accomplished by a double effort in order to overcome the 
loss of elasticity in the alveoli. When the animal is exercised, the respira- 
tions are accelerated to a marked extent, and a considerable period of 
time elapses before they return to the condition observed during a state 
of rest. The type of respiration is very characteristic in broken wind. 
The expiratory movement is of a double character and accompanied by 
a rapid convulsive heaving of the flanks, which appear to rise and fall. 

Two periods can be recognised in this expiratory movement. The 
first is short, and is succeeded after a brief interval by the second, which 
is longer. As the result of this peculiar action of the abdominal muscles, 
a distinct furrow or groove is observed posterior to the false ribs, which 
by some authors has been termed the “asthmatic furrow.” Some 
authorities believe that in the production of this abnormal type of 
respiration the diaphragm plays an important part, probably depending 
on nervous derangement of this structure. Cadéac points out that the 
two periods of expiration can be demonstrated practically by placing 
one’s hand at a certain distance from the nostrils, when the interruption 


DISEASES OF THE LUNGS: HORSE 899 


in the expired column of air can be felt; or, during frosty weather, the 
broken column in the expired air can be seen. 

As the disease progresses in intensity, the dyspncea and irregular 
respiration are manifested during repose, the nostrils are dilated, the 
alternate rising and falling of the flanks are accompanied by a similar 
action of the muscles of the croup, and by a protrusion and contraction 
of the anus. Im far-advanced cases the inspiratory movement becomes 
irregular, and is sometimes accompanied by two efforts. This irregularity 
is believed to depend on diminished resistance to the entrance of air into 
the alveoli in consequence of the weakened condition of the elastic fibres. 

Cough.—This is by some authors regarded as a symptom of chronic 
bronchitis rather than one of broken wind. As already mentioned, 
cough may be one of the earliest symptoms observed, at which period 
it is paroxysmal in character, dry, and heard especially on leaving the 
stable and when at work. Later on the cough becomes characteristic 
of the disease; it is feeble, jerky, abortive, short and shallow, and not 
followed by sneezing, and is usually single, except when the animal is 
exerted; then a series of these short coughs may ensue. During the 
effort of coughing expulsion of flatus usually occurs per anum, due to 
the flatulent condition of the intestines. The peculiar character of the 
cough depends on weakened expiratory power, as the pulmonary par- 
enchyma is only able to expel an insufficient amount of air at each 
expiration. 

A nasal discharge often occurs after exercise. It is mucous in charac- 
ter, whitish in colour, and not profuse. In some cases it is of a greyish 
tint. It is to be regarded as evidence of the presence of chronic bron- 
chitis, and may be absent in many cases. 

Broken wind is unaccompanied by fever, but according to Richter 
and Schmidt, exercise brings about an elevation of temperature. The 
symptoms may become aggravated at indefinite periods, sometimes 
without apparent cause; at other times depending on a fresh attack of 
bronchial catarrh, or on digestive disturbances due to ingesting large 
amounts of new hay. They are always more marked after feeding on 
bulky food, especially if the animal be put to work shortly afterwards. 
Cardiac palpitation is not uncommon if the animal be subjected to fast 
work or severe exertion. When dilatation of the heart is established, 
the cardiac impulse is weak and irregular, and the pulse accelerated, 
irregular, and feeble. 

Puysicat Stens.—In many instances these are not well marked, and 
in the early stages, unless chronic bronchitis be present, a physical exam- 
ination may reveal nothing abnormal. 


900 SYSTEM OF VETERINARY MEDICINE 


Percussion may reveal increased resonance over the region of the 
emphysematous lung, but unless the lesion is extensive this sign may be 
overlooked. The normal area of cardiac dulness is decreased owing to 
the heart being covered by the lungs, which are enlarged and emphyse- 
matous. 

According to Hutyra and Marek, the increased resonance is particu- 
larly marked over the inferior margin of the lungs. In severe cases the 
posterior boundary of the lungs is shown by percussion to be displaced 
backwards and downwards. 

Auscultation.—T he signs afforded by auscultation are liable to marked 
variations. The vesicular murmur may be feeble or absent over the 
regions where the increased resonance is present. According to Cadéac, 
this depends on the lessened circulation of the air, or on its stagnation 
in the emphysematous parts. Dry, sibilant, whistling, or sonorous rales 
may be heard in various regions of the chest, and sometimes fine mucous 
rales; these are in reality evidences of chronic bronchitis rather than of 
emphysema. Robertson* observed in well-marked cases “a loud, sibi- 
lant, tracheal noise, distinctly heard by standing at the side of the animal 
without placing the ear over the tube.” He also found in nearly all 
cases—(1) ‘‘ A distinct variation in sounds accompanying inspiration 
and expiration, the former a cooing or friction sound, the latter a very 
indistinct and weak murmur or crepitus.” (2) Irregularly distributed 
sibilant or sonorous rales. 

Friedberger and Frohner state that “ percussion and auscultation 
yield nothing positive.” They found “in many cases a distinct diminution 
of heart-sounds,” due to the heart being covered by the enlarged and 
emphysematous lungs. Hutyra and Marek draw attention to the 
presence ofa permanent dilatation of the thorax, the prominent curved 
ribs producing a barrel-shaped thorax, which is very characteristic of the 
disease. 

CouRsE AND Proenosis.—In cases that are not too far advanced 
temporary improvement, depending on attention to dietetic and medicinal 
treatment, is likely to occur. Exacerbations, however, are not un- 
common, due to a fresh attack of bronchial catarrh, improper dieting, 
and too severe work. Usually the affection is progressive, and ultimately 
the animal becomes unfit for even slow work, as cardiac complications 
arise. A guarded prognosis should always be given in the early stages, 
as there may be a difficulty in deciding whether the case is one of chronic 
bronchitis or is proceeding to one of broken wind. According to Hutyra 
and Marek, a sudden exacerbation of the symptoms may arise owing to 


* “ The Practice of Equine Medicine.” 


DISEASES OF THE LUNGS: HORSE 901 


the development of an interstitial emphysema (see p. 906). In far- 
advanced cases the danger incurred by quick work in harness should be 
pointed out to the owners, as death may occur from asphyxia or from 
cardiac failure. When the disease is of long duration, disturbances of 
nutrition may arise, the previously obese animal becoming emaciated. 

DIFFERENTIAL DraGnosis.—In well-marked cases the diagnosis pre- 
sents no difficulty, the clinical history, the character of the cough, and 
the peculiar type of respiration being sufficiently distinctive. The 
absence of fever and of consolidation of the lungs will enable us to 
distinguish the affection from broncho-pneumonia. Certain cardiac 
affections, especially of the right heart, may give rise to symptoms 
simulating those of broken wind, but the peculiar cough of the latter 
affection is not present in the former, and careful auscultation of the heart 
and lungs will decide the question. Robertson was of opinion that, in 
confirmed cases of broken wind, the character of the cough and of the 
respiration were “truly pathognomonic,” and “‘ were not likely to be 
confounded with the cough or respiration of any other diseased condition.” 
Law, however, states that the type of respiration in broken wind—+.e., 
the double expiratory movement—is not peculiar to this disease, “ but 
is also seen in most diseases of the lungs, and even of other organs 
(enteritis, peritonitis) which interfere with the freedom of the respiratory 
act.”* While admitting that a type of apparent double expiratory 
movement may be present in the above affections, we are of opinion 
that the phenomenon is by no means so well defined as in broken wind. 
Hence we must regard this type of respiratory movement, taken in 
conjunction with the peculiar cough, as the most important diagnostic 
feature in broken wind. 7 

It must be remembered that a horse affected with broken wind may 
become attacked by pneumonia, in which instance there will be a com- 
bination of the symptoms of both diseases; the history of the case, the 
presence of fever, and the evidences afforded by a physical examination 
of the chest, will render a diagnosis possible. As already mentioned, all 
cases of chronic emphysema do not exhibit the characteristic symptoms 
of broken wind, but the exceptions are so few that a differential diagnosis 
is not of practical importance. 

To differentiate chronic bronchitis from the early stages of broken 
wind is by no means easy. As remarked by Cadéac, bronchitis can 
precede emphysema, induce it, or complicate it. The presence of the 
physical signs of chronic bronchitis, the absence of the characteristic 
double expiratory movement, and of the peculiar cough, are important 


* “* Veterinary Medicine.” 


902 SYSTEM OF VETERINARY MEDICINE 


alds to diagnosis. The cough in chronic bronchitis occurs in paroxysms, 
but it is of a deep and moist character, and accompanied by a free nasal 
discharge after coughing or following exercise. 

Chronic bronchitis, however, may yield to treatment, but tends to 
recur in cold damp weather. If it persists for any great length of time, 
emphysema and broken wind result; but, as already mentioned, it is 
often very difficult to draw a border-line between the two affections. 
Hence careful consideration is necessary, as an erroneous diagnosis of 
broken wind may be given in a case which afterwards turns out to be one 
of chronic bronchitis that yields to treatment. 

Asthma may be mistaken for broken wind; it may precede the latter 
affection or terminate in it. On the other hand, attacks of a distinctly 
asthmatic character may appear at any time in cases of broken wind. 
Asthma is distinguished from broken wind by its sudden development, 
the spasmodic character of the symptoms, and their sudden disappear- 
ance. Attacks may occur at indefinite periods. The expiratory move- 
ment, although being carried out in a jerky manner, does not show the 
marked double action seen in broken wind. The cough, although short 
and quick, does not exhibit the peculiar characters of the broken-winded 
cough. In asthma the wheezing character of the respiration is more 
marked than in broken wind (see Asthma, p. 851). 

Medico-Legal Aspect of Broken Wind.—In consequence of the 
devices resorted to by unscrupulous dealers to conceal the prominent 
symptoms of broken wind during the period that an affected animal is 
submitted for examination as to soundness, special precautions are 
necessary in order to detect the imposition. The object aimed at by the 
dishonest seller is to prevent the double lifting of the flank and the charac- 
teristic cough. 

Amongst the deceptions practised, we may mention the administra- 
tion on the morning of sale of 1 or 2 pounds of leaden shot, or of bacon 
fat, and keeping the animals short of food and water. Law believes that 
these agents act in a partly mechanical manner, their presence in the 
stomach causing the animal so much inconvenience that he desists as 
much as possible from moving the abdominal organs, the result being that 
the double lifting of the flank is more or less hidden. 

Various sedative agents are also administered to prevent the animal, 
from coughing, such as laudanum, aconite, tartar emetic, hellebore, bella- 
donna, etc. These also tend to prevent the dyspncea and conceal the 
double expiratory movement. 

Hutyra and Marek point out that horse-dealers often administer the 
roots, leaves, or seeds of belladonna, henbane, or stramonium, in order 


DISEASES OF THE LUNGS: HORSE 903 


to conceal the symptoms of broken wind. The experiments of Raitsits 
made at the Budapest clinic have shown that the agents named reduce 
the frequency of respiration, abolish the double expiratory movement, 
and render the breathing perfectly normal even in advanced cases. The 
effect is produced within fifteen minutes, and may last for a whole day; 
but after the effect has passed off the dyspnoea becomes more intense than 
previously. Hypodermic injections of atropine have the same effect; this, 
however, comes on within a few minutes, and lasts only for one to three hours, 

In order to detect imposition, the horse should be properly tested by 
subjecting him to exertion, and when he cools down the character of the 
respirations must be carefully observed. In the case of grass-fed horses, 
care must be taken not to mistake the heaving of the flanks, due to want 
of condition, for anything abnormal. By pressing the larynx and causing 
the animal to cough, the character of the cough can be noted. Asa 
rule in cases of broken wind, cough is easily induced in this manner. 
Although this test causes a certain amount of laryngeal irritation,we are 
not aware of any other means by which we can detect the presence of 
the characteristic cough of broken wind—a most important symptom, 
and one that cannot be altered by deceptive measures. It is, however, 
cases in the early stages that are most likely to be overlooked, as the 
character of the cough may not be so well marked. Whenever any sus- 
picion exists, such as a greater acceleration of the respirations than is 
normal after exertion, and dilatation of the nostrils, the horse should be 
kept under observation for a sufficient time after he has cooled down, 
and should be allowed cold water and a feed of hay. If affected with 
broken wind, the diagnostic symptoms will now appear in spite of the 
deceptions practised. King, of Kansas City Stockyards, has found the 
intravenous injection of adrenalin useful in the detection of slight cases 
of broken wind. He injects 30 minims of the drug with 4 ounce of normal 
saline solution. In healthy horses the respirations become accelerated 
for a minute or so, but if broken wind be present, the double expiratory 
movement is produced, and the symptoms continue for several minutes. 
Judging by the successful manner in which horse-copers are able to 
conceal the evidences of this disease, it is necessary for the practitioner 
to be on his guard and to adopt the precautions mentioned ; otherwise he 
may overlook the presence of the affection, and be liable to a charge of 
negligence. Law has observed that “ mares advanced in pregnancy often 
show no double action of the flank, though decidedly broken winded.” 
This is an important matter, as animals in this condition cannot be 
subjected to exertion; the character of the cough is the only point we 
can rely on in such instances. 


904 SYSTEM OF VETERINARY MEDICINE 


As regards those cases of broken wind which are said to come on 
suddenly, we are of opinion that such are in reality asthma, and the prac- 
titioner should not be held responsible for failing to detect an intermittent 
affection. Another point of importance, in connection with the examina- 
tion of horses as to soundness, is that the presence of a cough should never 
be regarded lightly, especially if no evidences of simple catarrh are 
present to account for it. A persistent cough may turn out to be a very 
serious matter, and may be the precursor of broken wind. 

TREATMENT.— When the disease is established it is incurable. Pallia- 
tive measures, such as attention to hygienic and dietetic details and suit- 
able therapeutic measures, will succeed in rendering cases that are not 
too far advanced suitable for moderate harness work. The amount of 
hay should be limited, and the animal should be prevented from eating 
his bedding. The addition of treacle to each feed is advised by some 
authorities. The horse should be fed about two hours prior to being 
worked, and should not be forced at a quick pace, especially up hills. 
Occasional doses of Epsom salt, with bicarbonate of soda, assist in keep- 
ing the digestive organs in a healthy condition. Various drugs are ad- 
vised as exerting a beneficial effect on the disease. Of these, arsenic is 
most largely employed, although some authorities are doubtful as to its 
value. To be of any use, it must be administered in gradually increasing 
doses, and continued for a long period. Continental authors prescribe 
this drug in large doses. Thus, Cadéac advises that 8 grains of arsenious 
acid be given in the food twice daily, and after some days the dose may 
be increased to 11 grains; or after a time about 30 grains per day can be 
administered. It must be temporarily discontinued when any of the 
physiological effects of the drug are manifested. Fowler’s solution of 
arsenic in equivalent doses may be given by preference. In cases where 
there are evidences of chronic bronchitis we find that a combination of 
Fowler’s solution, extract of belladonna, and iodide of potassium exert 
a favourable influence. Digitalis 1s said by some authors to give good 
results, especially when there are evidences of cardiac disturbance. Nerve 
tonics are indicated in the disease, and although the beneficial effect of 
arsenic must be attributed to its action on the nervous system, it is found 
that a combination of agents proves of greater value. Probably nerve 
tonics may restore to the walls of the pulmonary alveoli and the bron- — 
chioles some, at least, of their lost contractile power. With this object 
in view, strychnine is combined with the arsenic, or the arseniate of 
strychnine may be given. Cagny advises the administration of vera- 
trine with ergot. Veratrine is said to act beneficially on the weakened 
muscular walls of the bronchioles, also on the bronchial secretions and 


DISEASES OF THE LUNGS: HORSE 905 


on the circulation, and thus to cause expulsion of retained bronchial dis- 
charges. It is given in a dose of 10 centigrammes (about 14 grains) once 
daily. Ergot is believed to relieve bronchial congestion and to restore 
contractile power to the bronchioles, and also assists in expelling the 
retained secretions. 

It is difficult to draw conclusions as to the real value of these various 
agents; we often find that what proves useful in one case fails in another. 
Aconite appears to give good results in some instances, relieving the 
cough and the dyspneea. Antimony potassium tartrate is also believed 
to exert a beneficial effect. We have found the following combination 
useful: Antimony potassium tartrate, Z11.; pulv. extract of aconite, gr. v.; 
arsenious acid, gr. x.; strychnine sulphate, gr. ss.; veratrine, gr.i.ss., given 
in the food every evening. 

Tar-water should be allowed for the animal to drink, and a bucket 
containing it is preferably fixed in the stall, so that it can be taken at 
pleasure. Chopped gorse, in lieu of hay, often proves useful. 

In cases of sudden exacerbations of the disease with symptoms of 
bronchial catarrh, inhalations of steam medicated with terebene prove 
useful. 

Hutyra and Marek point out that drugs such as eserine, arecoline, or 
chloride of barium, should be used with extreme caution in horses suffering 
from broken wind, as, in consequence of the contraction of the muscular 
fibres of the bronchi produced by these agents, extreme dyspnoea, even 
leading to asphyxia, may result. This was demonstrated by the experi- 
ments carried out by Raitsits. 

PROPHYLAXIS.—Obviously, one of the most important points in con- 
nection with the prevention of broken wind is proper attention to the 
feeding of horses. Animals doing little work and allowed unlimited 
amounts of hay are the class most frequently affected; an abnormal 
appetite develops, and they eat whenever opportunity offers. 

Hence the importance of daily exercise for such animals, of the limita- 
tion of bulky food, and the prevention of the pernicious habit of eating 
their bedding. The evil effects of an obese condition should also be 
pointed out, as horses under the circumstances above mentioned usually 
become over-fat,-a bodily state which predisposes to pulmonary emphy- 
sema. Any evidences of gastric derangement should receive early 
attention. 

A neglected cough is often the starting-point of the disease; hence 
this symptom should always receive due attention and treatment. A 
persistent cough occurring in a fat, highly fed horse doing little work is 
often reflex in character, and proceeds from gastric irritation. Hence 


906 SYSTEM OF VETERINARY MEDICINE 


treatment should be directed to the source of the symptom, and suitable 
remedies prescribed, together with attention to diet. In many instances . 
full doses of bicarbonate of soda produce good results, and in persistent 
cases gastric sedatives such as belladonna should be added. Many cases 
of broken wind could be prevented if the presence of the early symptoms 
were observed by the owners, and professional advice sought in time. 
Chronic bronchial catarrh should also be treated early, as it is a frequent 
precursor of broken wind. 


Interstitial Emphysema. 


SynonyM.—Interlobular emphysema. 

In this condition rupture of the alveolar walls takes place, and air 
enters the interstitial connective tissue. It is a more frequent and a 
more important affection in cattle than in horses (see p. 953). 

Et1oLogy.—The lesion is believed to depend on the sudden increase 
of air-pressure in the alveoli; thus it may occur under a variety of condi- 
tions, as follows: Certain pulmonary diseases—e.g., broncho-pneumonia, 
in which the affected regions of the lungs are unable to perform their 
function, and the portions permeable to air are subjected to increased 
pressure, owing to the forced inspirations made by the patient in order to 
supplement the respiratory deficiency—over-exertion, falls, struggling 
during accidents, traumatic injuries to the thoracic walls, foreign bodies 
accidentally entering the air-passages, careless drenching, especially 
when the medicament contains irritants. 

Cases have been recorded in which the lesion resulted from an obstruc- 
tion to the respiratory passages, such as polypi in the naso-pharynx, en- 
largement of the retropharyngeal glands, etc. Interstitial emphysema 
may also occur as a sequel to chronic alveolar emphysema. Heme 
it occurs during the death struggle. 

Morpip Anatomy.—Raised sacs of various sizes containing air are 
found beneath the pleura (subpleural emphysema) and in the pulmonary 
parenchyma. Occasionally the air may extend from the subpleural space 
to the root of the lung, and reach the mediastinum, and from thence gain 
entrance to the loose connective tissue at the lower end of the neck, 
causing diffuse subcutaneous emphysema; but this is more often met 
with in cattle (see p. 953). | 

Symptoms.—The air which has gained entrance to the interstitial 
connective tissue compresses the alveoli in the vicinity; hence sudden 
dyspnoea, marked distress, an anxious expression of countenance, and in 
some instances subcutaneous emphysema—especially in the cervical 
region—are observed. Percussion may give a tympanitic sound, which 


DISEASES OF THE LUNGS: HORSE 907 


is especially well marked in subpleural emphysema. Auscultation may 
reveal crepitant sounds, or a diminished respiratory murmur over the 
anterior borders and the inferior and posterior regions of the pulmonary 
lobes. The course varies; it may be very acute, terminating in death in 
from twenty-four to thirty-six hours, or in less severe cases recovery may 
take place in a variable period of time. 

A definite diagnosis can only be made when subcutaneous emphysema 
is associated with the respiratory disturbance. 

TREATMENT.— Perfect rest is essential, as movement tends to increase 
the escape of air into the pulmonary parenchyma and subcutaneous 
tissue. If cough be a prominent symptom, it should be relieved by the 
administration of belladonna or heroin. 


Parasitic Affections of the Lungs. 


See the section on Parasites. 


Tumours of the Lung. 


These include carcinomata, sarcomata, etc., and are usually secondary. 
They are of more interest from a pathological than a clinical point of view, 
as their presence is seldom recognised during life, the symptoms pre- 
sented being by no means diagnostic, while treatment proves useless. 
Amongst the symptoms recorded in cases of carcinomata were: Difficult 
breathing, or asphyxia, when the animal was exercised; a painful deep 
cough; sometimes a discharge of blood from the nostrils; when the 
tumour pressed on the bronchi a roaring sound was heard; dulness on 
percussion and loss of respiratory murmurs over the affected region were 
also observed. 

Pressure of the tumour on the heart or vessels causes symptoms of 
circulatory disturbance, and when the branches of the pulmonary artery 
are involved by the neoplasm evidences of asphyxia appear. 

The presence of external tumours on the body will assist in the diag- 
nosis. Treatment is, of course, out of the question. 


908 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE PLEURA. 


PLEURISY—PLEURITIS—INFLAMMATION OF THE PLEURA. 


General Remarks.—Although it is generally admitted that pleurisy 
usually occurs as a secondary affection, yet cases are met with in which 
the disease develops in the absence of any appreciable cause. Again, we 
are aware that a primary pleuritis may follow exposure to chills, especially 
when horses are subjected to fatigue, and the clinical history may give 
no evidence of a pulmonary complication. As we shall point out farther 
on, the influence of cold, chills, etc., is in the present day regarded as a 
predisposing cause of the disease, the actual etiological factor being the 
invasion of the pleura by micro-organisms, in the same manner as 
microbial agents produce peritonitis or meningitis. There are many 
instances in which it is not easy to explain how a closed sac like the 
pleural cavity can become invaded by bacteria; on the other hand, when 
pleurisy is associated with or follows pneumonia, or depends on a per- 
forating wound of the thorax, the source of infection is sufficiently clear. 

According to the course of the disease, the following divisions are 
recognised: (A) Acute. (B) Chronic. | 


(A) Acute Pleurisy. 


This will be described under the following headings, representing the 
various forms of the disease: (1) Acute Sero-Fibrinous Pleurisy. 
(2) Purulent Pleurisy, also known as Empyema. (3) Fibrinous, Plastic, 
or Dry Pleurisy. 

1, Acute Sero-Fibrinous Pleurisy is characterised by the presence of 
a sero-fibrinous effusion, and is the form most frequently met with in 
the horse. The disease may be unilateral or bilateral, and authorities — 
differ as to the relative frequency of these types. Cadéac, Delafond, 
and Bouley (junior) have found that both sides of the thoracic cavity 
are most commonly affected. Friedberg»r and Fréhner, Law, Williams, 
and many others, on the other hand, state that unilateral pleurisy is more 
frequently met with. In our experience, the bilateral form is most 
common. The affection commences in one pleural sac, and tends to 
invade that of the opposite side. As already remarked, pleurisy may 
occur as a primary or as a secondary affection, the latter being far more 
common. 

Et1oLocy.—Ezposure to Cold and Chills, especially after exertion, 
when animals are perspiring. This etiological feature is still regarded 


DISEASES OF THE PLEURA: HORSE 909 


by many clinicians as an important one in the production of primary 
pleurisy. Pathological investigations, however, as in the case of pneu- 
monia, tend to indicate that the disease is microbial in origin, the exposure 
to cold and chills acting only as a predisposing cause, by lowering the vital 
powers of resistance. The connection between pleurisy and rheumatism 
is by no means easy to expiain, although the occurrence of cases in which 
both affections are combined is not uncommon, especially in young 
horses kept under unfavourable conditions. As, however, what has been 
termed “rheumatic” pleurisy has also been observed in young horses 
not exposed to cold or chills, it is probable that a “‘ rheumatic ” tendency 
exists in these animals. In our present state of knowledge concerning the 
bacteriology of rheumatism and of pleurisy, it is not possible to explain 
in a satisfactory manner the relation between the two affections. 
Laborde and Trasbot injected very small amounts of the serous exudate 
from cases of rheumatic pleuritis into the pleural cavity of healthy horses, 
and succeeded in producing pleurisy in the latter; on the other hand, 
the injection of pure fluid gave negative results. 

The “ metastatic” theory, according to which it is believed that the 
inflammation changes its seat from the pleura to the ligamentous or 
tendinous structures of the extremities, and that cold er se is the etio- 
logical factor, cannot be accepted in the present day. 

The microbial origin of pleurisy, if not definitely proved as regards 
’ primary cases of the disease, has at any rate much evidence to support 
it. The experiments carried out by Delafond tend to prove that exposure 
to cold per se is not capable of producing the disease. According to 
Cadéac, if a small amount of pleuritic effusion be taken from the thorax 
of a horse which has just died from an attack of ordinary acute pleurisy, 
and injected with all due precautions into the pleural sac of a norma] 
horse, a generalised pleurisy will result. Thesame material, when injected 
subcutaneously into the dog and guinea-pig, causes septicemia, pneu- 
monia, or pulmonary cedema, and deathin one ortwodays. Similarexperi- 
ments carried out with the liquid obtained from a case of hydrothorax 
show that the fluid in this instance does not possess pathogenic properties. 

Here we may remark that some authors confuse hydrothorax with 
pleural effusion. As we shall point out later on (see p. 927), hydro- 
thorax signifies a transudation of simple non-inflammatory fluid into the 
pleural cavities, and occurs as a secondary process in many affections, 
quite independent of pleurisy. 

The micro-organisms found in the pleural exudate include strepto- 
cocci, staphylococci, and various microbes, depending on the nature 
of the primary disease. 


910 SYSTEM OF VETERINARY MEDICINE 


Secondary Pleurisy.—Pleurisy is very frequently associated with pneu- 
monia. It is also common in influenza, and may occur in connection with 
strangles, tuberculosis, chronic glanders, acute articular rheumatism, 
pyxemia, septicemia, inhalation broncho-pneumonia, pulmonary abscess, 
pulmonary gangrene, pericarditis, endocarditis, new growths in connection 
with the lung or pleura, etc. 

Infection of the pleura from. pneumonia is believed to occur either 
by the micro-organisms reaching the pleural surface by way of the lymph 
current, or by continuity. Rupture of a pulmonary abscess, or of an 
abscess in the mediastinum due to strangles, is followed by direct infec- 
tion and septic pleurisy. 

Sero-fibrinous peritonitis may be followed by pleurisy, the micro- 
organisms being carried to the pleura by means of the lymphatics of the 
diaphragm. : 

Traumatic Causes—Traumatic pleurisy may arise from _pene- 
trating wounds of the thorax, compound fractures of the ribs, severe con- 
tusions of the thoracic walls, rupture of the esophagus in its thoracic 
portion, foreign bodies passing from the bronchi to the pleura, etc. 

As occasional causes may be mentioned suppurative diseases of the 
sternum, ribs, and vertebral column. Cadéac has observed pleurisy to 
follow operation wounds resulting from the excision of extensive indura- 
tions of the skin. 

Morsip AnAatomy.—In well-marked cases the most characteristic 
pathological alterations present are a sero-fibrinous effusion, a pseudo- 
membranous exudate (false membranes), and pulmonary atelectasis 
when the effusion is extensive. 

In the early stages congestion of the pleura is present. The dilated 
vessels in the subpleural tissue produce the following alterations in the 
aspect of the pleura: A spotted or ecchymotic appearance, or a streaky or 
uniform red tint; it also assumes an opaque aspect. This is known as 
the “dry stage” of the disease. The endothelial cells proliferate and 
become detached, and the pleural surface becomes dry and rough. The 
congestion is followed by inflammation, and, as a result, exudation of 
lymph and serous effusion occur. ) 

The false membranes consist of coagulated fibrin, which becomes 
attached to the altered surfaces of the pleura in the form of layers or 
shreds. Their composition, in addition to fibrin, includes desquamated 
endothelial cells, leucocytes, red blood-corpuscles, and embryonic cells. 

They may cover the pleura in a uniform manner or in the form of 
irregular patches, or may hang in shreds resembling cobwebs, or may 
occur as bands, one extremity of which floats in the effusion; or these 


DISEASES OF THE PLEURA: HORSE 911 


bands may extend between two points in the pleura, causing the forma- 
tion of an adhesion. Their colour is generally a pale yellow, but in some 
cases it varies from a greyish to a reddish tint. In consistence, they are 
soft, infiltrated with serum, easily torn, and removed with facility when 
recent. In the early stages and in mild attacks they are thin, but in 
severe cases of about a week’s duration they become comparatively thick. 
After a time, if absorption does not take place, organisation of the false 
membranes occurs; they become permanent, adhesions between the 
visceral and parietal pleure result, and chronic pleurisy is produced 
(see p. 924). | 

From a medico-legal aspect, it is of importance to ascertain the 
average period of time in which false membranes may be formed. 
W. Williams found that after the injection of irritants into the pleural 
cavity of healthy horses a false membrane presenting some degree of 
organisation was formed in twenty-four hours. According to Cadéac, 
false membranes are formed in ordinary cases of the disease in three or 
four days. St. Cyr found in experimental cases that congestion and 
swelling of the pleura occurred in a few hours, and was speedily followed 
by the formation of soft, friable, pulpy false membranes, fully adherent 
to the pleura, accumulating rapidly, so that in three or four days the 
entire surface of one or both sides may be covered. From the sixth to 
the ninth day the false membranes commenced to become vascular, and 
from the tenth to the fourteenth day organisation was established. 

But it must not be assumed that the course of events as regards the 
period of development of the lesions is exactly similar in experimental 
cases and in those occurring in the ordinary manner. 

PLEURAL Errusion.—This varies in amount and in general character- 
istics in different cases. 

Colour and Appearance.—It may be lemon-coloured and clear, or it 
may be turbid, reddish, brownish, dark-coloured, or blood-stained. In 
severe and recent cases the red colour depends on the presence of red 
corpuscles, arising from very acute inflammation and from rupture of 
newly-formed vessels in the false membranes. The colour of the effusion 
gives some indication as to its probable age. According to the observa- 
tions of St. Cyr, the effusion from the first to the seventh day is generally 
of a dark red or of a sero-sanguineous appearance; it begins to get clear 
towards the end of the second week, and becomes clear after the twenty- 
fifth to the thirtieth day. According to Cadéac, a clear tint of the effusion 
corresponds to a slight degree of inflammatory action, dating at least 
from seven days. Dark red effusions become clear, limpid, or of a 
yellowish tint from the eighth to the thirtieth day in the course of acute 


912 SYSTEM OF VETERINARY MEDICINE 


pleurisy. A dark red hue does not, however, always indicate recent 
effusion, as a relapse may occur during the course of the disease, and 
cause a reappearance of the original dark red colour. Fibrin may be 
found in the effusion in the form of flocculi scattered through it, or as 
whitish, curd-like masses in the dependent part of the fluid. In subacute 
cases, or in those which have an insidious development, the effusion 
clears more quickly than under opposite conditions. In cases of some 
standing it may become turbid and of a greyish or light greenish colour. 
In empyema it becomes purulent, and may be foetid (see p. 922). 

Judging from our own experiences in tapping cases of pleurisy and 
pleuro-pneumonia, we would hesitate to lay down any rule as to the 
colour of the effusion. We have found that most cases of effusion, when 
tapped in the early stages, yield a pale amber-coloured fluid; exception- 
ally one finds a reddish-coloured fluid. 

It will be noted that our experience differs very considerably from 
that of St. Cyr. 

Amount.—This is variable, and, according to some authors, is usually 
larger when the inflammation is moderate in degree and slow in its course. 
Hutyra and Marek, however, state that in cases with a very rapid course 
the amount of fluid exudate usually predominates, while in protracted 
cases the amount of fibrin is most in evidence. From 2 gallons up’to 
9 gallons or more may be present. The fluid is generally found in both 
sides of the chest cavity in the horse, as a communication exists by means 
of the cribriform or lace-like character of the posterior thediastinum of 
this animal. Some authorities question whether the usual bilateral 
nature of the effusion is entirely due to this communication, and F. Smith 
says on this point:* “ Once this opening is reached by a fluid in one sac, 
the material must be able to find its way into its fellow; in this waya 
single-sided pleurisy might become double. I am bound to confess that, 
in my experience, such an extension of the disease does not apparently 
occur; in fact, pleurisies are from the first almost invariably double, and 
the foramina in the mediastinum are hardly likely to assist in extension, 
as they are blocked with lymph early in the attack.” 

Composition.—A chemical and microscopical examination of the exu- 
date shows that its composition resembles to some extent that of the 
blood-serum. It contains fibrin, albumin, leucocytes, a variable number of © 
red corpuscles, shreds of fibrillated fibrin, sometimes swollen cells probably 
derived from the pleural endothelium, salts, and water. The amount 
of fibrin present depends on the intensity of the inflammation, and the 
power of coagulation possessed by the effusion corresponds to the propor- 


* Journal of Comparative Pathology and Therapeutics, vol. x., p. 98. 


DISEASES OF THE PLEURA: HORSE 913 


tion of fibrin therein. The proportion of albumin present is always 
high. 

PuLtmonaRy Lestons.—When the pleural effusion is extensive, the 
lungs are displaced in an upward direction towards the vertebral column, 
and are also compressed. Compression of these organs is also produced 
by the organisation and contraction of the false membranes by which they 
are enveloped. As a result, atelectasis is produced; the organs are dark 
red in colour, diminished in volume, tough in texture, airless in parts, 
and contain little blood. By means of insufflation through the bronchi, 
the lungs can be inflated. The portions unaffected by atelectasis may be 
hyperemic or emphysematous. In some cases interstitial pneumonia 
(pulmonary sclerosis) is produced. 

EFFECTS ON OTHER OrcGANS.—In extensive pleural effusion the heart 
becomes displaced, and, in consequence of interference with the pulmonary 
circulation, the right side of the heart suffers from dilatation. The large 
veins in the thoracic cavity are compressed, and as a result passive con- 
gestion of the liver, kidneys, etc., occurs, also oedema beneath the sternum, 
and serous effusion in the pericardium and peritoneum. The diaphragm 
is displaced to a varying extent, being forced backwards by the effusion. 

Heemorrhagic Pleurisy may result from severity of the inflammation, 
rupture of newly formed vessels, tuberculosis, carcinoma, etc. 

Mediastinal Pleurisy is rarely met with. According to Cadéae, “the 
effusion accumulates between the two layers of the mediastinum, and 
occupies the upper region of the chest, producing unequal compression 
on the two pulmonary lobes, and causing atelectasis of the superior 
borders of one or both lobes. The cavity of the mediastinum is filled 
with exudates and false membranes.” 

Diaphragmatic Pleurisy generally occurs in the dry form of the 
disease, but is met with occasionally in the sero-fibrinous variety. It is 
rarely found limited to the diaphragmatic surface, and may be in the form 
of a diverticulum composed of false membranes and filled with effusion, 
situated between the posterior aspect of the lung and the anterior aspect 
of the diaphragm. 

Encysted or Multilocular Pleurisy occurs when false membranes 
divide the chest cavity into several pockets or loculi, which may or may 
not communicate with each other. The fluid in these divisions may vary 
in character, being clear in some, and turbid or sero-sanguineous in others. 
This form is not uncommon in empyema. 

Pleurisy may terminate in a complete recovery, or enter on a chronic 
course, or end in death. In some instances the exudate becomes puru- 
lent (see p. 922). In cases of recovery the effusion becomes absorbed ; 

VOL. I. 58 


914 SYSTEM OF VETERINARY MEDICINE 


the false membranes undergo fatty degeneration, and are also absorbed, 
but in a less rapid manner. For a description of the lesions of chronic 
pleurisy, see p. 924. 

Symptoms.—lIf the case be seen early, the following symptoms are 
often observed—viz., Pain and Rigors. 

Pain.—This varies in intensity from slight uneasiness to symptoms 
resembling those met with in spasmodic colic, such as pawing, lying down 
at intervals, and rolling, and turning the head towards the sides; in some 
instances slight sweating in patches may be observed. In fact, it is not 
uncommon for cases of pleurisy presenting these symptoms to be mis- 
taken for spasmodic colic, and treated as such. The pain is probably 
due to the commencing inflammation in the pleura, but it is possible that, 
as in pleurisy in man, pain may be referred to the abdominal muscles. 
These evidences of pain are of short duration, and are succeeded by stiff- 
ness and a distinct groan or grunt if the animal be made to move, or if 
percussion be applied to the thoracic walls. 

Rigors.—These vary in degree from a slight chill, evidenced by a 
staring coat and coldness of the surface of the body and extremities, to 
actual shivering fits, which are usually of short duration, but may recur. 
Trasbot states that occasionally fibrillary trembling of the intercostal 
muscles can be detected by placing the hand on the thorax. The rigors 
are succeeded by a dry, hot condition of the skin on the surface of the 
body, but the limbs are generally cold, and the ears alternately hot and 
cold. In primary pleurisy the onset of the disease is generally sudden, 
but in the secondary form symptoms characteristic of the primary 
affection are first in evidence. 

When the disease is developed, the following phenomena are ob- 
served: 

Fever.—T he temperature may be high at the commencement, ranging 
from 105° to 106° F. It is often of an irregular and intermittent 
character, and its duration is usually about seven or eight days. 

The Pulse is quick—from 60 to 80 per minute—and has a hard, wiry 
character. Later on, when effusion occurs, it assumes a soft character, 
and when the amount of fluid is extensive it becomes more rapid, small, 
weak, may be intermittent, and in fata] cases it becomes imperceptible. 

Respiratory Phenomena.—These are very important, and also charac- 
teristic. The respirations are accelerated, and the type of respiration in 
this disease is that known as the “abdominal,” the ribs being moved as 
little as possible, while the movement of the abdominal muscles is greatly 
increased. This type of respiration results from the fact that the ordinary 
movements of the thoracic walls cause pain in consequence of the inflamed 


DISEASES OF THE PLEURA: HORSE 915 


condition of the pleura, hence the ribs are fixed as much as possible. 
A hollow line extends along the inferior border of the false ribs, from the 
sternum across the flank to the anterior spine of the ilium. What is 
known as the “ pleuritic ridge” is thus formed. According to Hutyra 
and Marek, in exceptional cases, especially in inflammation of that 
portion of the pleura which hes near the upper surface of the diaphragm, 
the breathing may be of the costal type. 

The respirations may number from forty to fifty per minute; they 
are short and painful, and the nostrils are dilated. Unlike pneumonia, 
the air expired is not much hotter than normal, as it does not remain long 
in the lungs; the visible mucous membranes are not injected to the same 
extent, and in uncomplicated pleurisy there is no nasal discharge. In- 
spiration is difficult and painful, and is carried on by a series of jerky 
movements. Expiration may not show any marked difference from 
normal; in some cases it may be slow and prolonged. 

Cough is not a prominent symptom; it may be absent in the early 
stages or throughout the entire course; it is dry, short, painful, and sup- 
pressed, not occurring in paroxysms, and generally assumes a stronger 
character when effusion appears. It is readily produced by percussion 
of the thorax. 

On the occurrence of extensive effusion, other respiratory phenomena 
appear. The respirations become quick and laboured, accessory muscles 
are called into play, the anus and the abdominal organs are alternately 
drawn forward and pushed backwards, and the tail is moved upwards 
and downwards with each respiratory movement; this is termed the 
‘‘pumping”’ type of respiration, and it also occurs in cases of broken 
wind. 

In some cases the sphincter of the anus becomes paralysed, and the 
anal opening is dilated, air being alternately drawn in and expelled. 
This phenomenon, however, is also met with in other affections. 

The thorax may assume an appearance of increased circumference ; 
the intercostal spaces may. become flattened or may bulge. 

Cardiac Phenomena.—aAt first the cardiac impulse may be less strong 
than in the normal condition. When effusion occurs, the impulse may be 
imperceptible on the left side; the cardiac sounds become feeble, and 
may be detected on the right as well as on the left side. Occasionally 
there is a reduplication of the first sound of the heart, due to increased 
work on the part of the right ventricle, which generally becomes weakened. 
An cedematous swelling appears on the sternum, and may extend over the 
dependent parts of the abdominal region, and in some cases may affect 
the limbs. 


916 SYSTEM OF VETERINARY MEDICINE 


Attitude and General Appearance—Any movement causes pain, and 
the animal generally stands with the back arched. If forced to move, he 
does so in a rigid manner; the general appearance is that of dejection. 
After the occurrence of effusion, this marked stiffness relaxes to a certain 
extent, and a temporary improvement in the general appearance may be 
manifested. When the effusion is extensive, unfavourable symptoms 
develop; the patient generally stands persistently ; the elbows are turned 
out; the countenance is haggard; the eyes are dull, but in cases of threaten- 
ing asphyxia they stare and project; the head may be protruded, or may 
hang in a listless manner. 

General constitutional symptoms, such as occur in all febrile affec- 
tions, are present—viz., loss of appetite, constipation, thirst, a dry, 
pasty condition of the mouth, etc. The urine becomes scanty as 
effusion extends; it is also high-coloured, and shows an absence of 
chlorides. 

PuysicaL S1ians—Percussion.—In the early stages, beyond marked 
tenderness of the thoracic walls, percussion gives little or no evidence of 
morbid changes. But, in judging of the degree of tenderness on per- 
cussion, one must bear in mind that some healthy horses, when percussed, 
exhibit marked sensibility of the thoracic walls. In some cases, when a 
small amount of effusion is present, which to a certain extent diminishes 
the elasticity of the lung, a tympanitic percussion note may occasionally 
be detected. Clinically it is found that an effusion may exist in the lower 
third of the thoracic cavity, without any evidence of its presence being 
detected by percussion. As pointed out by Friedberger and Fréhner, 
this is accounted for by the muscular covering of the chest wall, while on 
the left side the normal area of cardiac dulness may be sufficient to 
obscure the presence of slight effusion. 

Later on, when effusion is advanced, dulness on percussion is well 
marked; its upper limit corresponds to the height to which the fluid has 
risen in the thoracic cavity. It rises to the same level in both sides of 
the chest, when the pleurisy is bilateral, except in those cases where the 
communication at the posterior mediastinum is rendered imperforate by 
false membranes. 

The dulness has a resistent “ wooden” quality, and its upper limit 
may vary according to the position assumed by the animal. Owing to. 
the pressure exerted on the lungs by the effusion in an upward direction, 
a tympanitic percussion note may sometimes be detected above the 
horizontal line of dulness. 

AvuscuLtation.—In the early stages the following phenomena may be 
detected: 


DISEASES OF ‘THE PLEURA: HORSE 917 


Friction Sound.—This is of a dry, rubbing character, and may be 
heard during inspiration and expiration, or during one of these acts only. 
It is due to the dryness of the pleural surfaces, and also to the irregularities 
on these surfaces resulting from the exudate thereon. The friction sound 
is also heard during the later stages when the effusion has receded. 
When occurring at the outset of pleurisy, it may be of very short duration, 
and hence is easily overlooked. According to Cadéac, it is more marked 
after resolution has occurred. As a diagnostic feature, its value is often 
exaggerated, although Hutyra and Marek state that it is the only pathog- 
nomonic sign in pure fibrinous pleurisy. 

Weakness of the Respiratory Murmur results from the act of inspiration 
being carried out in a short, jerky manner. 

When effusion occurs, the friction sound disappears; the respiratory 
murmur becomes still more weakened, and has a distant character, due 
to the effusion pressing the lung in an upward direction, and also causing 
it to recede from the thoracic wall. In a short period the respiratory 
murmur disappears over an area corresponding to the extent of the 
effusion; both sides of the chest are usually involved, and the fluid 
rises to the same level in each side. When the lung is but moderately 
compressed, a tubular breathing-sound may be detected. 

Above the line of dulness this tubular sound may sometimes be heard, 
and the respiratory murmur may be harsh and exaggerated. According 
to Friedberger and Froéhner, the line of dulness “ rarely rises higher than 
two-thirds the height of the chest, and the entire pleural cavity is never 
filled by the effusion.” 

Mathis and Labat (quoted by Cadéac) draw attention to a friction 
sound caused by the movements of the heart and accompanying 
cases of pleurisy. It is a dry, rough sound resembling the ‘“ creaking 
of new leather,” occurring during inspiration and expiration, syn- 
chronous with the cardiac beats, and lasting from half a day to three 
days. 

CouRSsE AND TERMINATION.—The duration of the different stages in 
pleurisy cannot be determined with accuracy. Some authors state that 
effusion commences after a period of two or three days; others in four days; 
while others, again, have found that the symptoms indicative of the 
early stages may last from four to six days before evidences of effusion 
can be detected. The severity of the inflammation probably exerts some 
influence on the duration of the dry stage, while a certain amount of effu- 
sion must be present before its existence can be determined. The effusion 
may gradually increase in a regular manner, or there may be irregular 
intervals during which the process ceases. 


918 SYSTEM OF VETERINARY MEDICINE 


Generally speaking, the course of pleurisy is slow, protracted, and 
subject to relapses. 

The terminations are—(1) Resolution; (2) Death; (3) Chronic 
Pleurisy. ; 

1. Resolution.—This occurs in cases which terminate favourably; the 
effusion and false membranes are removed by absorption, the general 
appearance of the patient improves, the urine is increased in amount, and 
the respirations become regular. Physical examination shows that the 
effusion is gradually being removed; the friction sound reappears, and 
the respiratory murmurs are re-established. Favourable cases are gener- 
ally those in which the effusion is not extensive. Convalescence is slow, 
generally lasting from two to three weeks, but relapses may occur. Per- 
manent lesions may remain, such as chronic thickening of the pleura, 
adhesions, and a varying degree of loss of elasticity of the lung. 

2. Death.—This result may occur in a rather sudden manner under the 
following conditions: 

(1) Asphyxia.—Due to extensive effusion, which interferes with the 
pulmonary functions, or depending on sudden congestion or cedema of 
the lungs consecutive to compression, or to atelectasis of a large portion 
of these organs. It is evidenced by convulsive dilatation of the nostrils, 
irregularity of the respiratory movements, heaving of the flanks, and a 
cyanotic appearance of the visible mucous membranes. 

(2) Cardiac Complications.—T hese include displacements of the heart, 
compression of the right auricle, cardiac degenerations, myocarditis, 
endocarditis, pericarditis. 

Death may occur slowly from exhaustion, depending on total loss of 
appetite, interference with the oxygenation of the blood, or from general 
septicemia following on a septic or purulent effusion. 

3. Chronic Pleurisy.—See p. 924. 

Latent Pleurisy.—In this variety of pleurisy the course is considerably 
modified. The disease is of a subacute character, and the symptoms 
are by no means well marked, so that, even with a careful physical ex- 
amination of the chest, the existence of the affection is likely to be over- 
looked, unless evidences of extensive effusion present themselves. Such 
cases often prove very deceptive, and it may happen that until a post- 
mortem examination is held the real nature of the illness is not discovered. . 

A capricious appetite, loss of condition, respiratory distress on slight 
exertion, and a cough of obscure origin, are the symptoms that may be 
observed. Urgent symptoms of dyspnoea may appear at any time, with 
evidences of effusion in the thoracic cavity. In some instances the 
affection may continue for a long period. 


DISEASES OF THE PLEURA: HORSE 919 


Unilateral Pleurisy.—The course of this form of pleurisy resembles 
that of the bilateral variety. The dyspnoea is less marked, and the 
vesicular murmur heard on auscultation of the unaffected side is intensi- 
fied, while the resonance on percussion is normal. 

DIFFERENTIAL DiaGnosis.—T he diagnosis of pleurisy is based on the 
history of the case and on careful attention to the physical examination 
of the chest. We must admit, however, that, in spite of all the sugges- 
tions advanced for the differential diagnosis of the affection, errors are 
by no means uncommon, especially with reference to the detection of 
pleural effusion when of moderate extent. The practice of verifying the 
diagnosis by frequently employing the trocar and cannula is becoming 
more recognised every day, and we cannot too strongly recommend this 

method. 
| The principal diagnostic symptoms in the early stages are the friction 
sound, the abdominal type of respiration and the presence of the pleuritic 
ridge, the attitude of the patient, the tenderness evinced by percussion 
of the thorax, and, when effusion occurs, the horizontal line of dulness, 
symmetrical on both sides when the disease is bilateral, and the loss of 
respiratory sounds up to the level of the effusion. 

The following conditions may be confounded with pleurisy: 

Acute Pulmonary Congestion.—This is distinguished by the history 
of the case, by its sudden appearance and early marked dyspnoea, by 
the character of the respirations, and by a physical examination of the 
chest. 

Pneumonia.—The differential diagnosis is based on the physical signs 
and on the observation of certain symptoms peculiar to each disease. 
In cases of double pneumonia of a massive character the dulness and 
loss of respiratory sounds may simulate pleurisy with effusion. The 
cough in pneumonia is of a soft and deep character; in pleurisy it is hard, 
short, suppressed, and painful. The character of the respirations in the 
two affections differs. In pneumonia inspiration is performed without 
difficulty, expiration is irregular, interrupted, and may be accompanied 
by asigh or moan. In pleurisy the respiration is of the abdominal type, 
inspiration is difficult and painful, expiration is either normal or slow 
and prolonged. The nasal discharge in pneumonia is of a rusty or 
orange-coloured tint. In uncomplicated pleurisy nasal discharge 1s 
absent. The physical signs of pleurisy, which have already been 
described, will assist in the differential diagnosis. The horizontal line 
of dulness in pleural effusion is of importance in distinguishing this con- 
dition from dulness due to pulmonary hepatisation. In the latter the 
line is irregular and varies its position. 


920 SYSTEM OF VETERINARY MEDICINE 


Pleuro-Pneumonia.—At the outset it may be impossible to arrive 
at a definite diagnosis, as the symptoms of both affections are combined. 
Later on, when effusion appears, the physical signs and the symptoms 
of this condition become manifest, and the diagnosis of pleurisy can be 
made in addition to that of pneumonia (see Epizoétic Pleuro- Pneumonia, 
Vol. [.). When the symptoms of pneumonia are those first in evidence, 
the diagnosis is rendered far less difficult. | 

Pericarditis with Effusion—This condition may be associated with 
pleurisy, and a differential diagnosis presents great difficulty. In 
uncomplicated pericarditis with effusion the region of dulness corresponds 
to the cardiac area. ‘The feebleness of the cardiac sounds is more marked 
in pericarditis. Attention to the history of the case and to the physical 
signs will give valuable assistance in the differential diagnosis, but in 
many instances the employment of the aspirating needle will be 
necessary. 

Hydrothorax.—The symptoms are similar to those met with in pleural 
effusion, and the diagnosis must be based on an examination of the fluid 
removed by means of the aspirator. In hydrothorax the fluid is clear, 
and contains no flocculi of fibrin. Moreover, the condition is generally 
met with in connection with cardiac or renal diseases, or with general 
dropsy. 

Proenosis.—Pleurisy with extensive effusion often proves fatal. 
In milder attacks, with a limited degree of effusion, the prognosis is 
favourable; but a guarded opinion should always be given in consequence 
of the dangers incidental to’ relapses. Imperfect recoveries associated 
with the formation of permanent adhesions are not uncommon. In 
pleurisy associated with pneumonia the prognosis is always very grave. 

TREATMENT.—In the early stages, if colicky pains be present, relief 
should be afforded by the administration of chloral hydrate; from 
4 ounce to 1 ounce, according to the size of the horse, should be given in 
the form of bolus. This agent is far preferable to opium in any form, 
as it does not induce nausea, nor interfere with the peristaltic action of 
the intestines. 

If rigors be present, a diffusible stimulant is indicated, such as sweet 
spirits of nitre with solution of acetate of ammonia. The body should 
also be warmly clothed, and cotton-wool with bandages applied to the | 
limbs. 

The value of counter-irritants applied to the thoracic walls is a vexed 
question. Moderate counter-irritation by means of mustard paste, 
applied before the stage of effusion, may have some benefit, but it cer- 
tainly has drawbacks in increasing the difficulties of auscultation and 


DISEASES OF THE PLEURA: HORSE 921 


percussion, and the operation of tapping. After effusion has taken 
place, we think counter-irritation is harmful. 

Attention to diet and to surroundings is as necessary in pleurisy as 
in pneumonia. When the body temperature runs high, the question 
of administering antipyretics has to be considered. Drenching should 
be avoided for reasons already mentioned when dealing with pneumonia. 
Quinine can be given in the form of electuary, the basis being preferably 
of honey and treacle. Such a preparation can be readily administered. 
In cases of a rheumatic type, salicylate of soda may take the place of the 
quinine with advantage. Salines, such as Epsom salt and potassium 
nitrate, may be given in the drinking-water. These exert a febrifuge 
action, and induce a favourable diuresis. 

When effusion occurs, diuretics are often prescribed, such as potassium 
nitrate or potassium acetate, combined with small doses of colchicum. The 
object of administering diuretics in this condition is to assist in the 
removal of the effusion, through the medium of the kidneys. Digitalis 
is advised by some authorities for this purpose, but in consequence of its 
tendency to interfere with appetite we cannot recommend it. Potassium 
iodide is frequently prescribed to promote absorption of the effusion. 

The removal of the fluid by the operation of “‘ paracentesis thoracis,” 
or, as 1t is popularly called, “ tapping,” has been recommended by many. 
Some difference of opinion exists as to what time it should be removed, 
but nowadays the majority of observers recommend early operation. 
One of us (Martin), in the Veterinary Record of January 25, 1913, p. 450, 
strongly advocates the operation as a means of diagnosis, and advises 
practitioners not to wait until the diagnostic symptoms of effusion have 
developed. We recommend that cases should be tapped immediately 
the symptoms of pneumonia or pleurisy become well marked, and that 
they should be tapped daily, or every second day, until those symptoms 
improve. The advantage of this method is that no large amount of 
fluid is allowed to collect. Tapping may be repeated as often as is required, 
and, provided the simple precautions of boiling the instruments and 
disinfecting the skin with tincture of iodine are carried out, no harm 
ensues. 

Another feature is that in almost all cases, both of pneumonia and 
pleuro-pneumonia, a marked improvement in the condition of the patient 
is seen after the operation, even when no fluid is found. There is usually 
a marked drop in the temperature, and the other constitutional symptoms 
are improved. The site for the operation recommended is the intercostal 
space about 4 inches behind the point of the elbow when the horse stands 
with both forelegs level. In this position there is no risk of injuring 


922 SYSTEM OF VETERINARY MEDICINE 


the heart either on the right or left side, and there will be no danger of 
entering the intestines and so causing infection, which might occur a 
few inches farther back. 

It is by most observers considered advisable to withdraw only a 
portion of the fluid at one tapping, and while this may be true in those 
cases where very large quantities have been allowed to collect, we do not 
think it necessary in ordinary cases that are tapped early. We have seen 
a good recovery from a case in which seven gallons were removed at one 
tapping, and we make it a general rule to remove as much as we can at 
each tapping. 

In our opinion no precautions against the admittance of air need be 
taken ; it is probable that a little air is beneficial. 

Subcutaneous injections of normal saline solution are advised by some 
Continental authorities, in conjunction with the operation of paracentesis 
thoracis, in order to compensate for the loss of fluid from the system, 
and also to sustain the heart’s action. Brocherion advises that 1 litre 
of the solution be slowly injected into the cellular tissue behind the upper 
region of the shoulder. This is carried out by fixing a vessel containing 
3 or 4 litres of the solution at a suitable height on the wall, and by means 
of a regulating tap the fluid enters the tube and injecting needle at the 
rate of about 1 litre per hour. Almy advises the administration of a 
similar fluid by intravenous injection into the jugular vein in amounts 
of from 2 to 3 litres. 

During convalescence from pleurisy the administration of potassium 
iodide is indicated in order to assist in the removal of false membranes. 
This may be combined with preparations of iron. Good food and nursing 
are important essentials to recovery, also proper hygienic surroundings. 

2. Purulent Pleurisy (Empyema).—In this form of the disease the 
effusion’ is of a purulent character. It may follow an ordinary sero- 
fibrinous pleurisy, or may result from a variety of conditions, all of which 
favour the entrance of pyogenic organisms to the pleural cavity. These 
conditions include strangles, septic foci in cases of lobar or lobular 
pheumonia, abscesses in the intercostal or phrenic regions, rupture of 
mediastinal abscesses in cases of strangles, and of pulmonary abscesses, 
rupture of the cesophagus occurring in its thoracic course as the result of 
accident in passing the probang in cases of choking. Penetrating wounds 
of the thoracic cavity, fracture of a rib resulting in penetration of the 
pleura, and necrosis of ribs or of the sternum forming fistule, may also 
produce empyema. Lastly, a simple effusion may be converted into a 
purulent one by neglect of aseptic precautions when performing the 
operation of paracentesis thoracis. The micro-organisms found in the 


DISEASES OF THE PLEURA: HORSE 923 


purulent effusion are of a varied character. The elfusion may be feetid 
or otherwise. When of the former character, it often contains gases, 
and the condition is known as “ pyo-pneumothorax” (see p. 925). It 
varies in colour from dirty white to reddish-brown, or may be of a 
greenish tint. Often the effusion separates into a clear greenish-yellow 
serum above and a thick cream-like pus below. In some cases it is slightly 
turbid, and contains flocculi of fibrin. The pleura is thickened, and its 
surface may be of a greenish hue. 

Symptoms.—These may arise during the course of the primary 
affection, of which empyema is a complication. They include high 
fever of an irregular character, repeated rigors, marked constitutional 
disturbance, great prostration, rapid emaciation, and evidences of general 
collapse. 

The course is often rapid, but in some cases the affection comes on 
insidiously with obscure symptoms. The termination is generally fatal. 
A correct diagnosis can only be made by an exploratory puncture by 
means of a trocar and cannula. The nature of the effusion can then be 
ascertained. 

TREATMENT.—Although the majority of cases prove fatal, operative 
measures should be adopted so as to give the patient a chance if the animal 
be a valuable one or a favourite. It is generally agreed that the employ- 
ment of the trocar and cannula, or the aspirator, is not serviceable for 
this purpose. A proper incision should be made so as to afford efficient 
drainage, and permit of thorough disinfection of the pleural cavity. 

Attention to surgical cleanliness is absolutely necessary. The in- 
cision is made at the anterior aspect of the ninth rib close to its inferior 
extremity. After evacuation of the fluid the pleural cavity should be 
carefully irrigated with a non-irritating antiseptic solution, and the 
wound covered with double cyanide gauze, antiseptic wool, and a broad 
bandage. 

Friedberger and Fréhner, Cadéac, Poinot, and others state that 
excision of portion of a rib may be carried out in these cases. 

For further details of these operations consult works on veterinary 
surgery. . 

3. Fibrinous or Plastic Pleurisy (also known as “ Dry,”’ ‘‘ Adhesive ”’ 
Pleurisy).—T his is a special variety of pleurisy in which there is no appre- 
ciable effusion. An acute and a chronic form are described, but very 
frequently the symptoms are so slight or so obscure that not only is the 
differentiation impossible, but even the affection itself is likely to be 
overlooked. 

As a primary or independent affection, dry pleurisy may arise from 


924 SYSTEM OF VETERINARY MEDICINE 


similar causes to those mentioned under the etiology of the sero-fibrinous 
variety. As a secondary process, it may occur in connection with 
pneumonia; the latter affection is always accompanied by this form of 
pleurisy to a varying extent. It is also met with in cases of pulmonary 
abscess or gangrene, and in cancer when the surface of the lung is involved, 
and may also be associated with tuberculosis and chronic pneumonia. 

Mors Anatomy.—The lesions are very frequently found as a 
surprise at post-mortem examinations; they are especially common in 
aged horses. The pleura may present a turbid, granular appearance due 
to being covered by a sheeting of lymph of variable thickness, or fibrin 
may be deposited on the pleural membrane in distinct layers. Lesions 
of the chronic form are far more commonly met with; in some instances 
these are circumscribed. The pleura is thickened in patches of various 
sizes. These patches are of a glistening white appearance; they render 
the membrane firm and resistant, and are chiefly found on the superior 
borders and external aspect of the lung, very rarely on the parietal 
pleura. | 

Adhesions of varying degrees of thickness and of firmness unite the 
lung to the thoracic wall or to the diaphragm. They are usually limited 
to certain regions, and the pleura beyond these may be normal. The 
adhesions may take the form of bands of various lengths and sizes, so 
that in some instances a certain amount of movement between the 
visceral and parietal pleure is permitted; or they may rupture, and one 
of their extremities remains free in the thoracic cavity. 

Symptoms.—lIt is generally admitted by clinicians that owing to the 
absence of diagnostic symptoms, dry pleurisy cannot be recognised during 
life. When the lung is firmly adherent to the thoracic wall, its expansile 
movement and its functions are interfered with, and symptoms identical 
with those occurring in pulmonary emphysema are observed, such as 
irregular respiration and a double expiratory movement. When the 
adhesions are less extensive and the action of the lung not interfered with 
to any extent, no symptoms may be presented. 

As regards treatment, when firm adhesions are formed, no medicinal 
agent can prove of service, even if a diagnosis were possible. 


(B) Chronic Pleurisy. 


This may occur as a sequel to acute sero-fibrinous pleurisy, or it may 
develop insidiously. In some instances it may resemble dry pleurisy, 
because, as the effusion becomes absorbed, the layers of the pleura enclose 
a variable amount of fibrinous material, which gradually becomes 
organised into a layer of firm connective tissue. In the ordinary form 


DISEASES OF THE PLEURA: HORSE 925 


following the sero-fibrinous variety, the effusion may persist for long 
periods without undergoing much alteration or becoming purulent. 

The common result of chronic pleurisy is the formation of adhesions 
which unite the pulmonary to the costal pleura, so that the lung becomes 
firmly attached to the thoracic wall, and its expansile movement is 
interfered with. Recurring attacks of pleurisy are not uncommon in 
the subjects of the chronic form of the disease. 

Symproms.—These vary according to the extent of the lesions. When 
the effusion is of sufficient extent, its presence can be recognised by the 
physical signs already mentioned. In cases of extensive adhesions, 
irregular respiration and symptoms resembling those of pulmonary 
emphysema may be present. Many cases are likely to be overlooked in 
the absence of a correct history of the case, or if a physical examination of 
the chest be neglected. 

It is not uncommon to find cases of chronic pleurisy, with a varying 
degree of effusion, which present obscure symptoms, and their real 
nature is not discovered until after death. 

From a medico-legal point of view, it is important to remember that 
pleural adhesions may exist in a horse, and that their presence cannot be 
determined by an examination as to soundness. 

TREATMENT.—Beyond attention to hygienic and dietetic details, and 
the administration of potassium iodide combined with tonics, little can 
be done to benefit cases of chronic pleurisy. If the effusion be sufficiently 
extensive to warrant paracentesis thoracis, this should be carried out. 


PNEUMOTHORAX—HYDRO-PNEUMOTHORAX— 
PYO-PNEUMOTHORAX. 


Pneumothorax signifies the presence of air in the pleural cavity. As an 
affection per seit is very rarely met with, being generally found associated 
with either the presence of a serous fluid, when the condition is termed 
hydro-pneumothorax, or with pus, when it is known as pyo-pneumothoraz. 

ErttoLogy—l. Perforation of the Lwng.—This may occur from rupture 
of a pulmonary abscess into the pleural cavity, or as the result of gan- 
grenous foci in cases of epizodtic pneumonia, and in inhalation broncho- 
pneumonia. The usual effect is the communication of a bronchus with 
the pleural cavity (pleuro-bronchial fistula) and the production of pyo- 
pneumothorax, generally of a putrid character. 

2. Perforating Wounds of the Thoracic Walls, also fracture of a rib, 
when one of the sharp ends penetrates the pleural cavity or the lung 
itself. If the wound forms a valvular orifice, air is drawn inwards during 


926 SYSTEM OF VETERINARY MEDICINE 


inspiration, but cannot be expelled during expiration. When the amount 
of air is extensive, collapse of the lung results. Local subcutaneous 
emphysema is generally present. 

3. Rupture of the Hsophagus in its Thoracic Portion —This occurs in 
cases of “‘ choking” when the probang is carelessly manipulated during 
the efforts made to dislodge the foreign body. Gases and ele fluid 
matters enter the pleural cavity. 

Amongst other causes may be mentioned abscess of the thoracic wall 
in the vicinity of the sternum, communicating with the interior of the 
chest and also with the external air; gases generated from a purulent 
effusion, the pleural cavity being intact. 

In the horse true pneumothorax is very seldom met with, as inter- 
lobular emphysema generally distends the visceral pleura instead of 
rupturing it, such as occurs in cattle (see p. 953). Occasionally, when 
rupture of the pleura does occur in the horse, it may, according to Cadéac, 
produce a limited pneumothorax by means of complete adhesion of the 
lung to the parietal pleura at the point of rupture. 

Morsip ANAToMy.—On opening the thoracic cavity there is a free 
discharge of gas. In pyo-pneumothorax the gases consist of sulphuretted 
hydrogen and carburetted hydrogen. The lungs are compressed in 
proportion to the extent of the effusion and gases, the heart is displaced, 
and the diaphragm pressed backwards. The usual lesions of empyema 
are present, and the effusion may contain bubbles of gas. The false 
membranes may be very extensive, and the disease may be limited to one 
side of the chest. 

It may be difficult to discover the perforation in the eee ; the pleuro- 
bronchial fistula is generally single, but in the case of inhalation broncho- 
pneumonia there may be several fistule present. 

Symptoms.—When occurring during the course of a pulmonary 
affection, sudden dyspnoea, a marked rise in temperature, a rapid and 
feeble pulse, lividity of the visible mucous membranes, and an anxious 
expression of countenance, are the symptoms observed. Cough of a 
suppressed character may be present, followed by a brownish-coloured, 
foetid nasal discharge in cases depending on perforation of the lung. In 
instances depending on penetrating wounds of the thorax and pleural 
cavity, subcutaneous emphysema and hernia of the lung may be observed. 

Puysicat Siens.—When the amount of gas present is extensive and 
unilateral, the affected half of the thorax is prominent. 

Percussion.—T he resonance is tympanitic at the superior part of the 
chest, while dulness is present in the inferior region owing to the effusion. 
The sound varies according to the degree of intra-pleural pressure; thus 


DISEASES OF THE PLEURA: HORSE 927 


percussion may reveal what is known as the “ cracked-pot ”’ sound, or it 
may be of a metallic character. 

Auscultation.—T he vesicular murmur is suppressed in the affected side, 
and may be exaggerated in the opposite side. Rdales may be present, 
which possess a peculiar metallic quality. When the effusion is extensive 
a gurgling sound may be heard, attributable to the bubbles of gas which 
come to the surface of the fluid. The usual evidences of pleural effusion 
are present. 

In some cases the physical signs are very obscure and by no means 
diagnostic. . 

TREATMENT.—The operation of paracentesis thoracis may be tried by 
means of a trocar and cannula, so as to permit the gas to escape. But 
Hutyra and Marek point out that it is advisable to employ a trocar 
provided witha stopcock, or preferably an aspirator, so as to prevent any 
air from entering the thorax. In an emergency a rubber tube, with a 
clamp, may be attached to the ordinary trocar. In cases of pyo-pneumo- 
thorax, the treatment advised for empyema is indicated, but the affection 
is generally fatal in spite of all therapeutical measures. In traumatic 
cases the wound should be treated according to modern surgical principles, 
special attention being paid to efficient drainage and plugging of the 
opening with antiseptic gauze, so as to prevent ingress of air. 


HYDROTHORAX (DROPSY OF THE PLEURA). 


As already mentioned (p. 909), hydrothorax is a condition character- 
ised by the transudation of a non-inflammatory fluid into the pleural 
cavities. It occurs quite independently of pleurisy; the fluid is clear, 
yellowish, or slightly reddish in colour, and contains no fibrin; the pleure 
are smooth, and no false membranes are present. It may occur under 
the following conditions: Chronic affections of the heart and of the 
kidneys, chronic lesions of the lungs, pulmonary and pleural tumours, 
general dropsy, and certain diseases of the blood. The amount of fluid 
present is rarely so extensive as in the case of pleural effusion. 

The affection is generally bilateral. Diagnosis is based on the history 
of the case and the absence of fever. The physical signs resemble those 
met with in moderate cases of pleural effusion, but an examination of the 
fluid withdrawn by aspiration will enable us to differentiate the two 
conditions. 

The symptoms are complicated with those of the associated disease. 

TREATMENT.—This is to be conducted on similar lines to those 
advised for pleural effusion. Of course, the disease with which hydro- 


928 SYSTEM OF VETERINARY MEDICINE 


_ thorax is associated must receive attention. Unfortunately, such affec- 
tions are generally chronic and resist treatment, and the withdrawal of the 
fluid is soon followed by its reappearance. 


TUMOURS OF THE PLEURA. 


These are of comparatively rare occurrence. They include sarcomata, 
carcinomata, epitheliomata—this latter being more often recorded. 
The lesions are generally disseminated on the surface of the pleura. 
Tuberculosis has been mistaken for carcinoma of the pleura. 

F. Smith* recorded a case of carcinoma of the pleura. The horse was 
admitted to the infirmary, and showed the ordinary symptoms of pleurisy 
with effusion. The case ran the usual course, and tapping was performed 
several times. The animal lived for twenty-two days, and then death 
occurred somewhat suddenly. The autopsy showed the thoracic cavity 
full of a clear, yellow, inodorous serum. The entire pleural surface, both 
costal and pulmonary, was covered by grape-like growths, which extended 
to the diaphragm. The growths were pink in colour and of a pearly lustre, 
and the largest were found on the anterior ribs. Attached to the first 
ribs were growths of a very considerable size. On section they resembled 
lymphatic glands. The lesions in the lungs were almost confined to the 
anterior lobes and lower borders. The pleura, but not the lung tissue, 
was involved, and the deposits were suspended from the edge of the lung. 
The pericardium was very much enlarged and lobulated on its surface 
from the presence of pink pearl-like growths, but the interior of the sac 
was normal. The entire mass of growths weighed several pounds, and 
they extended into and implicated the mediastinum. The lesions 
resembled those of tuberculosis, but on microscopical examination they 
proved to be carcinoma. 

Symptoms.—There are no characteristic symptoms. When the 
tumours attain a sufficient size, evidences of pleurisy with effusion may 
be present. Pressure may be exerted on the large vessels at the base 
of the heart, resulting in cedematous swellings on the dependent parts 
of the body. Death occurs from gradual exhaustion and asphyxia. 

TREATMENT.—Nothing can be done in the way of treatment. The 
case will probably be treated for ordinary pleurisy without any benefit — 
resulting, and the real state of affairs will not be disclosed until the 
autopsy is made. 


* Journal of Comparative Pathology and Therapeutics, vol. ix., p. 37. 


VACCINE THERAPY AS APPLIED TO 
DISEASES OF THE RESPIRATORY 
ORGANS IN THE HORSE 


By W. M. SCOTT, F.R.C.V.S., F.R.M.S., BripgwatER 
Consulting Veterinary Surgeon for the County of Somerset. 


A BACTERIAL vaccine may be defined as an albuminous substance com- 
posed of devitalised bacteria held in suspension, which, when introduced 
into the animal body, stimulates the tissues capable of elaborating anti- 
bodies, these antibodies laying hold of and bringing about the annihila- 
tion of the corresponding bacteria. 

In considering bacterial invasions of the respiratory organs, one must 
remember that all atmospheres are charged with disease-producing 
organisms more or less, and consequently the respiratory mucose are 
continually coming in contact with bacteria, many of which are very 
virulent in character, others only virulent under certain circumstances, 
while, again, others are quite non-pathogenic. Nature has made special 
provision to protect the respiratory organs of members of the animal 
kingdom from the destructive ravages of pathogenic bacteria, and, indeed, 
it is upon this protective fabric, speaking generally, that the science 
of vaccine therapy is largely built. 

The nasal cavity, in-addition to acting as a hot-air chamber, serves a 
much more important function as a bacterial filter, and we find as a con- 
sequence, in health, while the nasal mucosa harbours myriads of bacteria, 
the deeper pulmonary structures are sterile, or nearly so. 

To increase the utility of this bacterial trap, the nasal mucosa is 
covered with a sticky mucus, to which bacteria entering with the inhaled 
air become glued, and their progress intercepted. Moreover, the bac- 
teria inhabiting the nasal cavity are being continually washed away 
with the outward flow of mucus. Micro-organisms passing the nasal 
barrier and entering the larynx and trachea are immediately acted upon 
by the epithelial cells, which possess great phagocytic powers, and as a 
rule their destruction here is assured. The foregoing may be defined as 
the first line of defence, and being called daily into requisition, is in itself 

VOL, Il. 929 59 


930 SYSTEM OF VETERINARY MEDICINE 


usually sufficient to protect the healthy respiratory apparatus from 
bacterial invasion. 

Should, however, the bacterial attack be of such a character as to 
paralyse the first line of defence, the second line is brought into requisi- 
tion. This consists of polynuclear leucocytes, lymphoid cells, and im- 
mune bodies. If these forces are capable of keeping at bay and destroying 
the invading bacteria, a restoration to normal health follows. Should 
they fail, however, a general invasion follows, and a systemic paralysis 
may take place, which often leads to dissolution. 

When these bacteria have thwarted the first line of defence, and are 
waging war against the second, the time has arrived for the vaccine 
therapist to increase the activity of this second line by the administra- 
tion of suitable vaccines—if, indeed, he has not done so before. 

I think we may take it as a sine qud non from what has been said 
that the animal body possesses all the protective elements necessary to 
wage war against bacterial invasions. Unfortunately, however, there are 
circumstances which mitigate against the successful fulfilment of the 
respective functions of these elements. The following are the principal: 

1. The bacteria and their products may be so virulent as to paralyse 
the protective bodies from the outset. 

2. The antibodies themselves may be exceedingly deficient in quality 
and quantity, consequent upon a previous debilitating disease, or it may 
be some hereditary defect. 

3. The antibodies may be in abundance, but, being unable to reach 
the focus of infection, their bacteriotrophic functions remain passive— 
as, for example, in hepatisation of the lungs. 

In the case of No. 1, when a general toxemia is in evidence, anti- 
toxic and antibactericidal sera are indicated. When the intoxication is 
local, antitoxins may be roused into activity by suitable vaccines. 

As regards No. 2, the exhibition of vaccines is indicated, and pre- 
ferably autogenous vaccines, for here it is clear the body cells require 
rousing to elaborate suitable antibodies. 

In the case of No. 3, where the antibodies cannot reach the focus of 
infection owing to pronounced coagulation of the blood, the internal 
administration of citrate of soda is indicated. 

When the clinician desires to make a bacteriological examination of 
the respiratory tract to ascertain what causative organisms are present, 
or to isolate them with the view of making a so-called autogenous vaccine, 
the following procedure should be adopted: 

The materies morbi in these cases usually consist of the discharges 
from the nasal cavity. It is of great importance here, however, to point 


VACCINE THERAPY IN RESPIRATORY DISEASES: HORSE 931 


out that material taken from the anterior nares may not give a definite 
indication of the bacterial flora causing the true pulmonary lesions. It 
is most essential to secure the material as far back in the nasal cavity as 
possible, and for this purpose I use a small instrument for taking “ nasal 
swabs.” This consists of a piece of stiff metal wire 15 to 18 inches long, 
at the end of which can be hooked sterile cotton-wool, a large test-tube 
12 inches long, with an inch diameter, and a rubber cork to act as a 
plug, through which the metal wire passes. Needless to add, all the parts 
of this instrument should be sterilised before use. By swabbing out the 
nasal cavity—or, better still, irrigating it with normal saline solution, 
added to which 1s potassium permanganate—this superfluous nasal dis- 
charge 1s washed away. The animal is then made to cough, when a 
fresh supply of discharge direct from the trachea and the larynx will 
come within reach of the swab, which is now inserted as far up the nostril 
as possible. The swab is then placed in the test-tube for future examina- 
tion. Smears are made from it, and prepared in the usual way, stained 
by Leishmann’s, Gram’s, or other methods, examined microscopically, 
and a general working knowledge of the causative bacteria obtained. 

Agar, blood-agar, gelatine, slope, and stab tubes are then innoculated 
to obtain bacterial growths for identification purposes. 

Plate cultures are also carried out, and the necessary vaccines made.* 

In studying diseases of the respiratory organs from a clinical and 
therapeutical point of view, they may be conveniently divided into two 
classes: 
1. Diseases of the upper respiratory apparatus. 
2. Diseases of the lower respiratory apparatus. 


In the former I include the nasal chambers, larynx, and trachea; 
in the latter the bronchial tubes (large and small) and the pulmonary 
parenchyma. 

Catarrh of the Upper Air-Passages.—T his condition is most commonly 
seen in young horses, often running concurrently with the dentition period, 
the apparent reason being that at that period a systemic debility is greatly 
in evidence. The opsonic index is low, and the animal is consequently 
more susceptible to any bacterial infection it is subjected to; hence it 
follows that horses exposed at fairs, shows, or travelling by sea or rail, and 
coming under the influence of infection, are hable to suffer from catarrhal 
conditions. These catarrhs are never in themselves serious enough to war- 
rant the necessity of vaccine treatment, but we know, if such cases are 


* For further details on these points, the reader is referred to my work, 
“ Clinical Bacteriology and Vaccine-'Therapy for Veterinary Surgeons.”’ 


932 SYSTEM OF VETERINARY MEDICINE 


neglected, serious sequele, such as bronchitis, pneumonia, etc., may follow. 
I am also confident that, if prophylactic and in the early stages curative 
vaccine therapy were carried out in the catarrhal conditions seen in young 
hunters and blood stock, we should meet with fewer cases of whistling and 
roaring in practice. As soon as an animal is exposed to infection, a stock 
vaccine—or, better still, an autogenous vaccine—obtained from the first 
case in the stud to be attacked by the infection should be injected; and 
as streptococel are present in nearly every case, the vaccine should be 
combined with a polyvalent antistreptococcal serum. Unfortunately, 
however, as far as the latter is concerned, there exists so many strains 
of streptococci, some of which are very benign, and others very patho- 
genic in character, that unless a serum 1s prepared from a similar strain, 
the beneficial effects are very small indeed. 

Bronchitis.—From the vaccine therapist’s point of view, I consider 
it unnecessary to differentiate between acute and chronic bronchitis, 
bronchitis proper, and capillary bronchitis, or the more serious and 
advanced condition of bronchitis with pneumonic lesions. The prog- 
nosis in each of these cases may and does vary considerably, but the prin- 
ciples upon which the therapeutical law of vaccines depend are identical. 
Whether the disease affects a single animal or a number, or at whatever 
stage of infection a bacteriological examination is made, I have never 
seen a single case where the bacterial flora was not mixed. I have also 
noticed at certain phases one kind of bacteria appeared to hold sway, 
and at a later period their place is taken by another kind. Rightly or 
wrongly, I consider this phenomena is due to the specific efforts of the 
tissue cells elaborating their own specific antibodies. These antibodies 
lay hold of the bacteria, retard their development, and even determine 
their ultimate destruction. If there is one specific bacterial infection 
more than another where autogenous vaccines are indicated, it is in 
bronchitis, for here we find in nearly every instance such a variety of 
bacteria present. Bronchitis is pre-eminently suited for treatment by 
vaccine therapy, there being no interference with the free transmission 
of the fluids carrying antibodies (unless pneumonic lesions predominate), 
and the phagocytic action of the epithelial cells of the bronchial mucose 
is called early into requisition, and continues throughout more or less 
active, if the virulence of the invading bacteria is not too great, in which 
case cellular paralysis and destruction follows. The most common bac- 
teria met with in practice are—streptococci, diplococci which appear to 
resemble the pneumococci of man, and a Gram-negative coccus resem- 
bling the Micrococcus catarrhalis of man. In equine bronchitis I have 
never seen staphylococci, but I have isolated this organism in bovine 


VACCINE THERAPY IN RESPIRATORY DISEASES: HORSE 933 


bronchitis with tubercular complications, and also in verminous bron- 
chitis in calves. 

Clinical Phenomena following a Suitable Dose of Vaccine.— W hether 
the immunisator is treating a superficial condition, such as poll evil, or 
a deep-seated and visceral disease, such as bronchitis or pneumonia, a 
focal reaction follows the administration of a suitable vaccine, and this 
reaction is looked for and required if good results are to be anticipated. 
In the case of pulmonary disease I divide the chest wall into twelve 
imaginary squares, each square being carefully examined with the stetho- 
scope, and the rales noted on a duplicate chart.* 

If the case is seen in the early stages, there may be no more than 
dry vesicular murmurs detectable. As the secretion increases, moist 
rales develop, followed by wheezing, crackling, crepitous sounds of various 
degrees and intensity. At whatever stage the patient is examined, these 
various sounds and impressions should be carefully noted on the chart 
previous to injection. | 

From twelve to twenty-four hours after the administration of a 
vaccine an aggravation of the focal conditions should take place, the 
respiratory movements will be hurried, and the inspiration will be more 
superficial. Dyspnoea increases, the cough becomes more irritable, the 
respiratory murmurs are exaggerated, the pulse-beat may be increased 
10 to 20 per minute, and there may be a slight rise in the temperature. 

There is at the outset a fall in the opsonic index, due, it is presumed, 
to the gathering together of opsonins consequent upon the injection of 
the vaccines. This condition is known as the negative phase. It is 
followed by a rise of the opsonic index, and a consequent improvement 
of the clinical signs—z.c., the positive phase. This latter phase merges 
into the phase of increased resistance, during which a steady improve- 
ment is taking place in the focal condition—i.e., a freer expectora- 
tion, deeper respiratory movements, and a slower, stronger, and more 
steady pulse. The temperature falls, and the whole constitutional 
tone of the animal shows marked improvement. In five to seven 
days, dated from the time of injection, the improvement is maintained, 
after which the condition of the patient may become stationary or even 
retrogressive. This indicates the administration of another and larger 
dose of vaccine. 

Should these clinical phenomena fail to show themselves as promi- 
nently as described, the dose of vaccine is either too small, or there is an 
error in the technique, or perhaps the responsive powers of the tissue 


* Direct auscultation in such cases is too inaccurate, and is worse than useless ; 
for it is often misleading, and should be altogether discarded. 


934 SYSTEM OF VETERINARY MEDICINE 


cells are so far destroyed as to be beyond restoration. If the dose is too 
small, a larger dose should be administered forthwith; and if the tech- 
nique is defective, the process should be gone over again with more care. 

Pneumonia.—As with bronchitis, the term ‘‘ pneumonia” is used in 
its broadest sense, and as such it may be defined as an acute febrile 
disease involving the vital structures of the lung parenchyma, running 
as a rule a rapid course; but sometimes an insidious one, characterised by 
consolidation of the lung, and terminating in eight to twelve days by 
crisis or lysis. | 

I venture to think clinicians will agree that specific diseases in general 
run a certain and more or less definite course, and probably there is no 
disease more pronounced in this way than pneumonia. I do not know 
of a single drug or combination of drugs capable of cutting short an 
established case of pneumonia, but I have seen several instances where 
vaccine therapy has been applied fairly early, the various resolution 
phenomena taking place two, three, or five days earlier than under the 
old régime of drug therapy. To those who are sceptical of the value of 
vaccine therapy, this fact should alone be convincing, and carry great 
weight. | 

The pathological changes which take place in pneumonia are of the 
greatest importance to the vaccine therapist, which warrants my re- 
counting them here. 

The irritation set up by the various bacteria and their products deter- 
mines a pronounced capillary congestion, the pulmonary vessels become 
gorged with blood, which is extremely rich in leucocytes, but deficient in 
antibodies. As the result of this circulatory tension, serous effusion 
occurs in the lung parenchyma, taking the place of the air in the vesicles. 
Solidification becomes established through coagulation, and entangled in 

he meshes of the fibrin are red and white blood-corpuscles, cast-off 
epithelial cells, and dead and living bacteria. This condition is known 
as ‘‘red hepatisation.’” At this stage the circulation is much interfered 
with. The red corpuscles now lose their hemoglobin, an increased 
number of leucocytes invade the lung tissue, with a consequent diminu- 
tion of their number in the free circulation. Grey hepatisation has now 
set jn, and is the first step towards resolution. An animal suffering from 
pneumonia clearly indicates that the phagocytes and immune bodies are 
incompetent to resist the bacterial invasion. There may be other forces 
existing to complete the immune role, but of these two we are certain. 
We know of no reliable agent capable of stimulating phagocytosis, but we 
do know that vaccines stimulate animal tissue cells, with the consequent 
production of immune bodies. To obtain the maximum benefit from 


VACCINE THERAPY IN RESPIRATORY DISEASES: HORSE 935 


vaccine therapy, the vaccine should be administered in the early stages, 
in which case the course of the disease will be shortened. In other words, 
it should be administered before consolidation has set in. When hepatisa- 
tion has become established, the hepatised area is largely cut off from the 
free circulation, the bacteria are enclosed in the fibrinous meshes, and 
the bacteriotrophic fluids already coming in contact with them are 
deprived of any bactericidal power they may possess. In this condition 
the body fluids may be very rich in antibodies, but, owing to the inability 
of the latter to reach the bacterial foci, their beneficial influence remains 
in temporary abeyance. As soon, however, as cellular degeneration 
takes place, and resolution sets in, the immune bodies can reach the 
isolated areas, and restoration will be all the more rapid when the tissue 
cells are stimulated by vaccines. In those cases where the “ crisis’ is 
delayed, the administration of a full dose of vaccine hastens the process. 
The vaccine therapist has two primary objects in view: 

1. The annihilation of invading bacteria. This, we have seen, is 
brought about by stimulating the tissue cells with suitable vaccines, an | 
so increasing the supply of such antibodies as opsonins, agglutinins, bac- 
tericidins, and bacteriolysins in the circulating fluids. 

2. The neutralisation of free toxins circulating in the blood. Vac- 
cines in themselves are only slightly antitoxic. It is therefore clear that 
in.a typical case of toxemia, such a large dose of vaccine would require 
to be given before any pronounced antitoxic effect was produced, that 
Nature would be unable to assimilate such a large dose, so to speak, and 
the negative phase would be so pronounced with consequent extreme de- 
pression that Nature’s vital forces would be so impaired as to lead to 
irreparable destruction. Theoretically speaking, antitoxic sera are here 
indicated. The difficulty, however, in practice is to obtain a serum derived 
from the same strain as the causative bacteria. Where, however, there is 
reason to believe that the toxemia proceeds from streptococcal intoxica- 
tion, a polyvalent antistreptococcal serum should be administered in 
conjunction with suitable vaccines, and I have found that such combina- 
tions have given me better results than I would otherwise have obtained 
by using vaccines alone. 

The bacteriological investigation in pneumonia must be carried out 
on the same lines as in bronchitis, and here also a similar variety of bac- 
terla are in evidence. In two or three cases, however, in the latter stages 
of the disease I have encountered the Bacilli coli communis. If there is 
difficulty in obtaining materies morbi in the early stages of the disease— 
this difficulty I often find present in practice—puncture of the lung should 
be practised, which in itself is a very simple operation. 


936 SYSTEM OF VETERINARY MEDICINE 


Lung Puncture.—The chest should be carefully percussed and aus- 
cultated, and the area showing the most pronounced lesions noted. Over 
this area the skin should be sterilised with strong tincture of iodine. For 
the purpose of puncture I use an ordinary serum syringe of 25 c.c 
capacity, provided with an extra long needle. This instrument is sterilised 
with hot salad oil,* after which 3 to 5.c. sterile broth is taken up. The 
needle is boldly thrust between the ribs (taking care to avoid the costal 
artery) direct into the lung tissue, and the broth slowly expelled, and then 
gently aspirated and the needle withdrawn. The fluid so obtained should 
be carefully examined microscopically, and at the same time culture tubes 
inoculated. In this way one is at least assured of securing the causative 
bacteria without risk of contamination. 

Pneumonia differs from bronchitis in running a more rapid course 
and is in itself a more fatal disease, owing to the fact that toxemia is 
more pronounced, and the respiratory and cardiac centres, as well as the 
heart muscle itself, soon become actively poisoned. Moreover, conse- 
quent upon hepatisative changes rapidly taking place, death by suffocation 
may occur. It therefore follows that the clinician must adopt energetic 
measures. As soon as the case is seen, a polyvalent stock vaccine, and 
if considered advisable, combined with a polyvalent serum, should be 
injected at once. This will prepare the way for an autogenous vaccine, 
which should be made forthwith. In pneumonia it is advisable to begin 
with a moderately small dose, inasmuch as it is desirable here to have as 
slight a negative phase as possible. If there is no clinical improvement 
in twenty-four to thirty hours, the dose should be repeated. After 
another thirty hours, should there be no distinct response, a double 
dose should be administered, and every three or four days after gradually 
increasing doses should be given until complete restoration has taken 
place. Needless to add, in all pulmonary cases the hygienic surroundings 
should be carefully attended to, abundance of fresh air should be allowed, 
and the patient comfortably but not oppressively clothed. Other 
details, such as the administration of strychnine, normal saline solution, 
etc., as cardiac stimulants, must receive attention when the indications 
for their employment are present (see p. 880). 


* Vide ‘‘ Clinical Bacteriology and Vaccine Therapy,” p. 77. 


DISEASES OF THE RESPIRATORY ORGANS 
IN CATTLE 


By E. WALLIS HOARE, F.R.C.V.S. 


INTRODUCTORY REMARKS. 


RESPIRATORY diseases do not occupy so important a position in cattle 
as in horses, so far as adult animals are concerned. In ordinary practice 
it is found that the majority of cases of pulmonary affections depend 
either on the effects of careless drenching or on tuberculosis. Tn calves, 
however, very serious outbreaks of bronchial and pulmonary affections 
occur, while parasitic bronchitis is a common and important condition. 
On the Continent, where cattle are employed for working, respiratory 
diseases appear to be more frequently met with. 

In the physical examination of the chest of the ox, owing to anatomical 
peculiarities, there are certain points which merit consideration. 

In percussion of the left side, applied over the fourth, fifth, and sixth 
ribs, a resonant sound is elicited, owing to the heart being surrounded by 
lung tissue in this region. 

When the rumen is very full of ingesta, it increases the anterior con- 
vexity of the diaphragm, and tends to compress the lungs into the 
anterior part of the thorax. Under such conditions percussion elicits 
dulness, which may be mistaken for consolidation of the lung. Auscul- 
tation may show well-marked normal sounds that can be mistaken for 
evidences of disease. Thus Law draws attention to crepitation or a fine 
crackling sound, due to a dryness of the subcutaneous areolar tissue. A 
fine crepitation is also heard on the left side due to the bursting of myriads 
of minute bubbles of air generated among the contents of the rumen 
during the process of digestion; this sound is especially marked after the 
animal has been fed on green food or potatoes. A well-marked friction 
sound may be heard over the left side after the animal has fed, and 
depends on the movements of the rumen during contraction; it is not 
synchronous with the respiratory acts, and thus can be differentiated 
from the friction sounds of pleurisy. 

Accelerated respirations are not always to be regarded as evidence 

937 


938 SYSTEM OF VETERINARY MEDICINE 


of respiratory disorders in cattle, as this phenomenon is common in 
bovines after feeding, more especially in stall-fed animals, and in cattle 
driven to fairs and markets in hot weather. It is also observed when 
cattle are caught for examination, or when they become excited on the 
approach of a stranger. 


DISEASES OF THE NASAL CAVITIES. 
ACUTE CORYZA (ACUTE NASAL CATARRH). 


This is of rare occurrence in cattle, as compared with the analogous 
condition in equines. In addition to the simple or catarrhal coryza, 
Continental authors recognise a croupous form; this will receive a separate 
consideration. Simple coryza is said to be a common affection in 
working oxen. In ordinary practice in the British Isles it 1s by no means 
frequently met with. The usual causes recognised are exposure to chills, 
wounds of the muzzle, injuries of the base of the horns, unskilful dis- 
horning, etc. In very acute cases the inflammation may extend to the 
facial sinuses (see p. 940). Cadéac describes an infectious coryza 
occurring as an enzootic in calves either at the time of birth or up to 
fifteen days old. The symptoms of simple coryza resemble those met 
with in the horse, but the nasal discharge may be overlooked in conse- 
quence of the animal licking it from the nostrils. When occurring as a 
secondary condition in cases of unskilful dishorning, serious symptoms 
may be associated with it, such as those of septiceemia, septic inflam- 
mation of the sinus, and meningitis. 

The treatment is similar to that advised for the analogous affection 
in the horse. In obstinate cases irrigation of the nasal passages with a 
weak solution of tincture of iodine (1 per cent.) is advised, but care should 
be taken that the fluid does not enter the trachea. 


CROUPOUS RHINITIS (NASAL CROUP). 


This is recognised on the Continent, but so far as we are aware it has 
not been described by British authors. According to Hutyra and Marek, 
it is rare in cattle as compared with its frequency in equines. Although 
‘croup’ is described by W. Wilhams,* he does not mention the nasal 


* ** Principles and Practice of Veterinary Medicine.”’ 


DISEASES OF THE NASAL CAVITIES: CATTLE 939 


form of the affection. The disease occurred in epidemic form in Copen- 
hagen, and was studied by various investigators. Bang regarded the 
affection as closely allied to malignant catarrh. It is described as an 
infectious malady characterised by the formation of false membranes on 
the mucosa of the nasal passages, and in only 30 per cent. of the cases 
occurring as a localised affection. Various complications occur in the 
majority of instances, such as extension of the morbid process to the 
remainder of the respiratory passages, to the digestive and ocular mucosa, 
and to the genital mucosa. The bacteriology of the disease has not been 
determined. The animals attacked are adult cattle, especially cows that 
have recently calved; the affection is rarely seen in calves. It has 
been observed by Wysmann as a secondary condition in connection with 
parenchymatous mammitis in the cow; also ina calf that had been suckled 
by a cow suffering from pseudo-membranous vaginitis. It has also been 
observed in connection with a pseudo-aphthous stomatitis, and the lesions 
can extend from the mouth to the nasal passages, and vice versa. Accord- 
ing to Bang, the nasal phenomena, as well as the complications, should 
be regarded as secondary. 

The period of incubation is short, and in many instances does not 
extend beyond ten days. | : 

Symproms.—In addition to well-marked constitutional disturbance 
and fever of an intermittent character, false membranes are found on the 
nasal mucose, especially in the septum, and ale of the nostrils. These 
false membranes may be of a whitish, yellowish, or greyish colour, and 
may be confluent. When they become detached, ulcers may result. 
They may form and disappear very rapidly, but generally, after several 
days, they become detached owing to suppuration taking place. A more 
or less sero-sanguinolent, foetid nasal discharge is present, which becomes 
purulent, and contains shreds of false membranes. The animal shows 
oral breathing, which is accompanied by a “roaring” sound. The 
majority of cases present complications, of which broncho-pneumonia 1s 
the most frequently met with. Pulmonary emphysema is also observed, 
with subcutaneous emphysema in some instances. Intestinal complica- 
tions consist of a croupous enteritis, associated with diarrhoea, the feces 
being very foetid, and containing blood-clots and shreds of false mem- 
branes. Ocular phenomena occur in about 8 per cent. of the cases, and 
consist of a purulent conjunctivitis. In cows, metritis, vaginitis, or 
metro-peritonitis may be observed. 

The prognosis is grave, as about 40 per cent. prove fatal, while in 
those associated with complications the mortality may reach 78 per cent. 

The disease is distinguished from malignant catarrh (see Vol. I.) by 


940 SYSTEM OF VETERINARY MEDICINE 


the constant presence of ocular phenomena in the latter affection, and 
their comparative rarity in the former. Again, in malignant catarrh the 
constitutional disturbance and the nervous symptoms are more marked. 

TREATMENT.—Local treatment is said to be the most important. 
The application of a solution of iodine to the nasal passages is advised by 
means of a soft brush. Nasal injections of a 1 or 2 per cent. of sodium 
carbonate also prove useful. The affected animals should be isolated. 
The complications should be treated according to the indications 
presented. 


CHRONIC NASAL CATARRH. 


This seldom occurs in cattle, and the existence of a chronic discharge 
from the nostrils is generally to be attributed to disease of the sinuses. 


EPISTAXIS. 


Hemorrhage from the nostrils may occur in cattle, and depends on 
similar causes to those mentioned for the analogous condition in equines. 
Treatment is to be adopted on similar lines. 


NEOPLASMS OF THE NASAL CAVITIES. 


These include polypi, tuberculous growths, and more rarely malignant 
tumours, such as carcinomata and sarcomata. Mucous cysts have also 
been observed, and very rarely actinomycotic growths “in the form of 
strawberry-like masses in the lower portions of the nasal cavities” 
(Hutyra and Marek). The symptoms are similar to those observed in 
equines. 


CATARRH AND EMPYEMA OF THE MAXILLARY AND 
FRONTAL SINUSES. 


In cattle the maxillary sinus 1s rarely involved by catarrh, and when 
the affection is met with the frontal sinus is the seat of the lesion. The 
chronic form is that more commonly met with, but some authors describe 
an acute catarrh of the frontal and maxillary sinuses. The frontal sinus 
in cattle is very extensive, and communicates with the core of the horn 
cavity. | 

Acute Form.—When the frontal sinus is involved, the commonest 


DISEASES OF THE FRONTAL SINUS: CATTLE 94] 


causes are injuries such as those occurring from animals fighting each 
other, from evulsion or fracture of horns, and from unskilful dishorning. 
In working oxen (on the Continent) injuries received from a badly-fitting 
‘‘yoke ”’ may induce the condition. 

In the case of acute catarrh of the maxillary sinus, the etiological 
factors may be the presence of diseased molar teeth, also injuries to the 
maxillary region. All the sinuses may be involved in general infectious 
diseases, such as malignant catarrh. An infectious form of catarrh of the 
sinuses occurring in a large number of newly-born calves has been met 
with by Continental observers. 

Symptoms.—In catarrh of the frontal sinus, when the affection depends 
on traumatic causes, epistaxis may first be observed; this is followed by 
a nasal discharge from one or both nostrils. The head is held low, and 
in unilateral cases is directed towards the unaffected side. When the 
core of the horn cavity is involved, the base of the horn is hot, and tender 
to percussion. In severe cases constitutional disturbance is present. 

When the maxillary sinus is involved, snorting, snuffling, or snoring 
sounds accompany respiration, the nasal passages may be partly occluded, 
and muco-purulent material, with perhaps clots of blood, may be expelled 
from the nostril. The discharge is generally unilateral. In some cases, 
after the expulsion of the above material, temporary relief may occur. 

The symptoms may disappear in about two weeks, and recovery may 
result, or the affection may become chronic. Complications may occur, 
such as a septic condition depending on putrefaction of blood-clots, and 
meningitis may result. A high mortality has been observed in young 
calves in some districts. 

TREATMENT.—When the frontal sinus is involved, surgical measures 
are advised, such as trephining the affected sinus and irrigating with 
antiseptic solutions. 

When the maxillary sinus is affected, medicated inhalations of steam 
or irrigations with antiseptic solutions may prove successful, as in the 
chronic form of the disease. 

Chronic Form.—Chronic catarrh and empyema of the frontal sinus 
may depend on similar causes to those mentioned in connection with the 
acute form. Depressed fractures of the frontal bone, or the presence of a 
tumour in the sinus, may also be etiological factors. 

Symptoms.—A chronic nasal discharge, glairy or purulent, inodorous 
or foetid, and of a yellowish, whitish, or greyish colour, is observed; this 
is increased in amount when the animal coughs or when the head is 
lowered. The eyelids are closed, the head is carried low in bilateral 
cases, or if in a stall the animal rests it on the manger. In unilateral 


942 SYSTEM OF VETERINARY MEDICINE 


cases the head is held in an oblique manner. The region of the frontal 
sinus is tender to percussion, and on applying this test dulness is occasion- 
ally observed. In severe cases the core of the horn cavity and the 
maxillary sinus are involved, and the disease may become bilateral. The 
animal is unable to raise the head, and can only feed from the ground. 
The disease may extend to the lachrymal canal and lachrymal sac, and 
ocular symptoms develop, such as conjunctivitis and infiltration of the 
cornea. Meningeal complications may ensue, the infection being carried 
to the meninges either by the lymphatics or through the cribriform plate 
of the ethmoid, owing to necrosis of this structure. Marked prostration 
is present, or nervous phenomena may predominate, such as vertigo, 
incodrdination of movements; the head is pushed against the wall or 
surrounding objects, paralysis of the hind limbs and coma complete the 
scene. According to Moussu, bulging of the internal bone-plate of the 
frontal into the cranial cavity may cause pressure on the brain and 
cerebral symptoms. 

In chronic catarrh and empyema of the mazillary sinus, the symptoms 
observed are frequent sneezing, accelerated respirations accompanied by 
snoring, violent movements of the head, a unilateral muco-purulent nasal 
discharge, which may be sanguinolent, and may sometimes contain 
fibrinous flocculi. Percussion may not reveal dulness in some cases for 
similar reasons to those already mentioned in the case of equines (see 
p. 809). The region of the maxillary sinus is tender to pressure, and in 
some cases the bone may show deformity. 

TREATMENT.—In cases of chronic catarrh of the maxillary sinus, 
especially when occurring as a sequel to rhinitis, medical treatment should 
first be given a trial, such as irrigations with antiseptic and astringent 
solutions by way of the nasal passages. When these fail, the operation 
of trephining the sinus must be carried out. 

When the frontal sinus is involved, trephining should be performed 
without delay. In adult animals the openings should be made in the 
core of the horn cavity, and also in the inferior aspect of the frontal sinus. 
In cattle under three years of age Moussu advises that, as the cavities at 
the base of the horns are not well developed, the opening should be made 
in the upper region of the frontal sinus, midway between the median line 
and the base of the horn. For the technique of these operations the’ 
reader 1s referred to Moussu and Dollar (“‘ Diseases of Cattle, Sheep, and 
Pigs ”’), also to Cadéac (“ Pathologie Interne ’’). 


DISEASES OF THE LARYNX: CATTLE 943 


DISEASES OF THE LARYNX. 


ACUTE LARYNGITIS. 


Acute inflammation of the larynx is a comparatively rare affection in 
cattle, but is said to occur more frequently in countries where oxen are 
used for draught purposes. 

Et1oLoay.—The following causes are recognised: Exposure to chills; 
the inhalation of irritant vapours, such as smoke from burning buildings; 
injuries resulting from the careless use of the probang in cases of choking 
when the foreign body is situated in the upper region of the gullet. A 
pharyngo-laryngitis may occur from extension of the inflammatory 
process in cases of acute coryza. Instances are recorded in which cattle 
fattened on distillery mash developed acute laryngitis; the alcohol con- 
tained in this feeding was suggested as the exciting cause. In South 
Germany, also in Bavaria, enzodtics of laryngo-tracheitis have been 
observed, and are regarded as microbial in character, and some authors 
describe them as “ cattle distemper or influenza.” 

Symptoms.—The symptoms resemble those met with in the analogous 
condition in equines. In severe cases the respirations are of a wheezing 
character, and may be accompanied by a roaring sound, especially when 
the animal attempts to swallow food or is forced to walk. <A frequent, 
dry, painful cough is present, the head is extended, the mouth is half 
open, and the tongue is protruded. Deglutition is difficult; stringy saliva 
hangs from the mouth, and a glairy or muco-purulent nasal discharge 
may be present. When cedema of the larynx occurs, oral breathing and 
dyspnoea are observed. In uncomplicated cases recovery may be rapid. 
The disease may assume the croupous type, or chronic laryngitis may 
result. ; | 

TREATMENT.—The principles of treatment are similar to those advised 

or acute laryngitis in the horse. 


CROUPOUS LARYNGITIS (PSEUDO-MEMBRANOUS 
LARYNGITIS). 


This condition is believed to depend on various micro-organisms. 
The bacillus of necrosis is stated by some authors to be the chief etiological 
factor. As a secondary affection it may be associated with malignant: 
catarrh, and may occur as a complication of nasal or bronchial croup. 
According to Hutyra and Marek, it is a rare disease, although more often 


94.4 SYSTEM OF VETERINARY MEDICINE 


met with in cattle and sheep than in other animals. The symptoms 
resemble those of an aggravated case of acute cedematous laryngitis. The 
pharyngo-laryngeal region is swollen, and the nasal discharge may be 
sanious, and may contain débris of false membranes. Constitutional 
disturbance is well marked, fever is present, the conjunctive are con- 
gested, and evidences of asphyxia may appear. The disease may extend 
to the pharynx, trachea, and bronchi, and even to the gastro-intestinal 
mucose. The course is rapid, and death may occur from asphyxia in 
forty-eight hours. Some cases may recover in about eight days. 

As regards treatment, if there are evidences of impending asphyxia, 
tracheotomy should be performed. Inhalations of steam, medicated 
with antiseptic agents, are indicated. If ulceration occurs after the false 
membranes have been detached, it is advised to make an opening in the 
upper region of the trachea, and to apply a solution of iodine to the ulcers 
by means of a tampon of gauze held by a forceps. 


CHRONIC LARYNGITIS. 


According to Cadéac, this condition is rare as a sequel to the acute 
form, and in the majority of instances it is associated with tuberculosis 
of the larynx. It may also be associated with actinomycosis and neo- 
plasms of the organ, especially those having a tendency to ulcerate. The 
symptoms observed are cough of a short wheezing character, which occurs 
especially during deglutition of dry food, or while drinking cold water. 
When the condition depends on the presence of a tumour, a roaring 
sound may accompany respiration. The disease proves very obstinate to 
treatment. Obviously, in the case of neoplasms therapeutical measures 
are useless, while if the condition depends on tuberculosis treatment is 
not advisable. If these causes can be excluded, similar treatment to that 
advised for the analogous condition in horses may be tried. 


G2DEMA OF THE LARYNX. 


This may be associated with acute or croupous laryngitis, or with 
neoplasms of the larynx. It is also met with in acute infectious diseases, 
such as malignant catarrh, anthrax, and hemorrhagic septicemia. The 
condition may occur in connection with urticaria, the laryngeal oedema 
being associated with swelling of the eyelids, head, and facial region. The 
symptoms resemble those described as present in the analogous condition 
in equines, and treatment is to be conducted on similar lines. Hutyra 
and Marek state that palpation of the interior of the larynx, with the 


DISEASES OF THE LARYNX: CATTLE 945 


hand introduced per os, is a valuable aid to the differential diagnosis of 
the condition, provided it can be carried out in the presence of the existing 
dyspneea. 


PARALYSIS OF THE RECURRENT NERVE (ROARING). 


A roaring sound accompanying respiration is a common symptom of 
certain pharyngeal and laryngeal diseases in cattle. Probably it occurs 
most frequently in connection with pharyngeal abscesses of tubercular or 
actinomycotic origin (see p. 325). But cases of roaring due to paralysis 
of the recurrent nerve are recorded by Vitz, Ollmann, Besnoit, and 
Prietsch, the lesion depending on enlargement of the peribronchial 
lymphatic glands. According to Ott, the roaring is intensified when the 
head is turned towards the right side, but is lessened when the head is 
inclined in the opposite direction, the explanation being that the paralysed 
arytenoid cartilage, owing to its weight, alters its position according to 
the direction in which the head is turned. According to Cadéac, rapid 
recovery has occurred in some cases under the influence of arsenical 
treatment; hence the correctness of the diagnosis may be open to doubt. 


NEOPLASMS OF THE LARYNX. 


These include tuberculous and actinomycotic growths, and in rare 
instances fibromata, carcinomata, etc. In the case of sessile growths, the 
symptoms are difficulty in breathing and a roaring sound when the animal 
is subjected to movement, or is confined in a warm building. When a 
neoplasm arises from the epiglottis, it causes not only difficulty in respira- 
tion, but also in deglutition. Pedunculated tumours cause intermittent 
attacks of dyspneea, accompanied by spasm of the glottis, and may bring 
about asphyxia. A nasal discharge, which may be streaked with blood, 
is sometimes observed. Moussu met with cases in which mucous cysts 
were found in the larynx. 

The diagnosis of tumours of the larynx is based on an internal 
examination of the organ, but this procedure is very difficult, and may 
be impossible in many instances. An exploratory laryngotomy should 
then be carried out, and in the case of pedunculated tumours surgical 
measures for their removal may be attempted, if considered desirable. 


VOL, II. 60 


946 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE BRONCHI. 
ACUTE BRONCHITIS. 


This affection is not so commonly met with in cattle as in horses, if we 
except the parasitic bronchitis of young animals. It is said to occur 
more frequently in countries where oxen are employed for draught pur- 
poses. Similar etiological factors to those mentioned in connection with 
the disease in the horse may induce bronchitis in cattle. We have 
observed enzoétics of a mild form of bronchial catarrh in dairy cows, 
especially in damp, foggy weather; the prominent symptoms were a 
hacking cough and slight nasal discharge, but the latter in most instances 
was removed by the tongue from the nasalale. Constitutional symptoms 
were absent, and spontaneous recovery resulted on the appearance of more 
favourable weather. 

Severe cases are sometimes met with, accompanied by fever, consti- 
tutional disturbance, accelerated respirations, and a paroxysmal, hacking 
cough. Such cases, if neglected, or if subjected to careless drenching, 
terminate in capillary bronchitis. 

The physical signs are similar to those met with in the ina 


CAPILLARY BRONCHITIS. 


See Broncho-Pneumonia, p. 950. 


BRONCHIAL CROUP. 


This is also known as croupous bronchitis and pseudo-membranous 
bronchitis. Under the heading of croup, W. Williams described a pseudo- 
membranous inflammation of the pharynx, larynx, trachea, and bronchial 
mucosa. The disease occurred in young cattle, varying from a few 
weeks to a few months old, especially in those kept on low damp pastures _ 
in the autumn. The cause of the disease was said to be the bacillus of 
necrosis. Continental authors describe bronchial croup as occurring in 
cattle under the same conditions which induce laryngeal croup, or it may | 
be secondary to the latter condition or to nasal croup. The majority of 
the bronchi are covered by tubular masses of false membranes, which 
cause occlusion of the smaller tubes. Law met with the disease in a 
valley in Central New York, only a few cattle being attacked in a herd. 
Some Continental observers describe nasal, laryngeal, and bronchial 


DISEASES OF THE BRONCHI: CATTLE 947 


croup under one heading—viz., Croup. Grunth investigated the enzodtic 
outbreaks of the affection, and arrived at the conclusion that it was pro- 
duced by an unknown infectious agent, which probably weakened the 
resisting powers of the body, and thus rendered the mucose susceptible 
to secondary infections. According to Cadéac, bronchial croup may occur 
from the inhalation of irritant fumes, and also from the entrance of fluid 
medicaments into the bronchi as the result of careless drenching. It 
may also complicate various infectious maladies of the bronchi and lungs. 
The false membranes are at first found in the trachea and in the larger 
bronchi; they are formed of concentric layers, are readily detached, and 
interfere with the passage of air to the smaller bronchial canals. They 
are composed of fibrin, which encloses in its meshes degenerated epithelial 
cells, leucocytes more or less altered, mucin, and a large number of 
micrococci. In some cases the false membranes may be moulded to a 
large bronchial tube, and extend into its branches, the fibrinous mass 
being arborescent in appearance. 

The symptoms are those of a severe bronchitis with intense dyspnea. 
During paroxsyms of coughing portions of false membranes are expec- 
torated, and appear in the nasal discharge. In some of the cases ob- 
served by Williams swellings occurred in the parotid and submaxillary 
regions. Judging by the description given by this author, the disease 
does not appear to have been of so fatal a nature as in the enzodtics 
recorded by Continental writers. The latter found that when the smaller 
bronchi were invaded and partially obliterated, death frequently occurred 
in less than three days, and that a fatal termination was the rule in young 
animals. In cases that tended to recover, the false membranes were 
expectorated, and the symptoms of asphyxia were relieved. Diagnosis 
was based on the presence of false membranes in the nasal discharge. 

Treatment should be directed to bring about expulsion of the false 
membranes. Inhalations of steam medicated with antiseptic agents are 
advised. When asphyxia seems imminent, tracheotomy is advised; but 
we fail to see the value of this procedure when the bronchi are obstructed. 
The large majority of severe cases succumb. In milder cases the treat- 
ment suggested for ordinary bronchitis should be adopted. 


CHRONIC BRONCHITIS. 


This may occur in cattle as the sequel to an attack of acute bronchial 
catarrh. It is not uncommon in aged debilitated cattle, but in the 
majority of instances it is associated with other diseased conditions. 
The prominent symptom is the presence of a chronic cough, which occurs 


948 SYSTEM OF VETERINARY MEDICINE 


in paroxysms when the animal is forced to move quickly, or is housed 
ina warm, ill-ventilated building. A nasal discharge of a white flocculent 
character may be observed, but in many cases it is absent. Auscultation 
reveals the presence of sonorous or sibilant rales, and also of mucous 
rales. The affection can only be differentiated from tuberculosis by 
adopting the tuberculin test. Many cows suffer from a persistent bron- 
chial cough during damp, cold, foggy weather, and appear to recover 
completely in spring and summer. 

Hutyra and Marek describe a form of bronchial catarrh which they 
consider is probably due to infection with the Bacillus pyocyaneus. The 
wheezing, whistling, and purring sounds are said to be best heard at the 
portions of lung covered by the shoulders. 


BRONCHIAL ASTHMA. 


Although pulmonary emphysema jis occasionally met with in cattle 
(see p. 953), we have only come across one reference to bronchial asthma 
in this species—viz., two cases in young cows recorded by Boer, quoted 
by Hutyra and Marek. A sharp whistling or hissing sound was heard 
during the attack, but the authors mentioned remark that the presence 
of pediculated tumours (tuberculous) in the larynx or its vicinity had not 
been entirely excluded in these cases. 


PARASITIC BRONCHITIS. 


See the section on Parasites. 


DISEASES OF THE LUNGS. 
ACUTE PULMONARY CONGESTION. 


This is seldom met with in the British Isles, but is said to be more 
common in countries where oxen are employed for draught purposes. 
Cases are recorded in which cattle chased by dogs showed evidences of | 
pulmonary congestion. As a secondary condition it may occur in con- 
nection with certain infectious diseases. 

Symproms.—These will depend on the severity of the case and the 
extent of pulmonary cedema present. In peracute cases dyspnoea is 
extreme, and blood in small amount may issue from the nostrils. The 


DISEASES OF THE LUNGS: CATTLE 949 


animal has an anxious expression of countenance, and shows muscular 
tremblings, the head is extended, the nostrils dilated, and sweating may 
be observed. Heemoptysis may occur in some cases. Death results 
from asphyxia. In other instances pneumonia may supervene. In less 
severe cases the symptoms of respiratory distress gradually subside and 
recovery follows. | 
TREATMENT.— Venesection is advised, especially in the case of plethoric 
animals. Counter-irritation of the thoracic walls is also employed with 
benefit. Diffusible stimulants are indicated, but the risks of fluids 
entering the respiratory passages must be taken into consideration. 


THE PNEUMONIAS OF CATTLE. 


Apart from contagious bovine pleuro-pneumonia, cattle suffer from 
ordinary pneumonia, which, in the large majority of cases, is either a 
secondary affection, or depends on the entrance of fluids into the respira- 
tory passages as the result of careless administration of drenches. All 
authors describe various types of the disease; but after a perusal of the 
views expressed, we are forced to the conclusion that definite knowledge 
on the subject is still wanting, and, like the analogous affection in equines, 
it is not possible to draw the border-line between croupous pneumonia 
and broncho-pneumonia. We admit that croupous pneumonia may 
occur, and that animals so affected may recover; but in our experience 
the lesions found at autopsies have always been those of broncho-pneu- 
monia. Some practitioners, however, have found typical lesions of 
croupous pneumonia on post-mortem examination. 

The methods of diagnosis in pulmonary affections are anything but 
satisfactory in the horse, but the difficulties are greatly increased in the 
case of bovines. The differential diagnosis between the various types of 
pneumonia, although described with facility, 1s quite another matter 
when we proceed to carry it out clinically. Pulmonary gangrene is, in 
our experience, very rare in cattle, even in cases of inhalation pneumonia. 
This is also the experience of other practitioners. 

Croupous or Lobar Pneumonia is recognised by Continental authors, 
and appears to be of more common occurrence in countries where oxen 
are employed for purposes of draught. It tends to run a regular course, 
and the prognosis is favourable in many instances. Nothing definite is 
known as regards its etiology or bacteriology. The lesions resemble 
those described as occurring in the analogous condition in equines, but 
in consequence of the large amount of interlobular connective tissue 
present normally in the lungs of cattle, a marbled aspect is produced, 


950 SYSTEM OF VETERINARY MEDICINE 


owing to the infiltration of this tissue. This condition was at one time 
considered as a special feature in contagious pleuro-pneumonia, and no 
doubt is more clearly marked in that affection (see Contagious Bovine 
Pleuro-Pneumonia, Vol. I.), but there is nothing specific in the lesion. 

According to Hutyra and Marek, the following characteristics are 
observed in the symptoms of croupous pneumonia of cattle as compared 
with the analogous affection in horses: (1) Elevation of temperature does 
not occur so rapidly; (2) acceleration of respiration is more marked; 
(3) a weak, painful cough is frequently present; (4) the rusty-coloured 
nasal discharge is absent, but a whitish mucoid nasal secretion may be 
observed; (5) bronchial breathing is heard more rarely, and vesicular 
breathing over the affected portions of the lung in the initial stages is more 
commonly weak or completely absent; (6) the duration of the disease is 
longer. 

According to Cadéac, abscess of the lung or gangrene 1s seldom or 
never met with, and neither pleurisy nor pleural effusion is present. 

For the differential diagnosis of croupous pneumonia and contagious 
bovine pleuro-pneumonia, see Vol. I. under the latter heading. 

Broncho-Pneumonia (also known as “lobular pneumonia’’) is the 
usual form of the disease met with in cattle. As already remarked, it is 
generally a secondary affection, and is encountered under the following 
conditions: It may occur as a sequel to acute bronchitis; it may be asso- 
clated with septic metritis, suppurative mammitis, suppurative arthritis, | 
etc. Animals when suffering from various affections, in which they tend 
to assume the recumbent position for long periods, are very apt to develop 
broncho-pneumonia; thus it is one of the most serious and fatal complica- 
tions in cases of milk fever that run a slow course. In such instances it 
results from regurgitated ingesta finding its way into the trachea and 
bronchi (see Inhalation Pneumonia, p. 951). 

Broncho-pneumonia is a common complication of tuberculosis of the 
lung (see Tuberculosis, Vol. I.). Exposure to cold, chills, etc., acts as a 
predisposing cause of broncho-pneumonia; this is more especially the case 
in cows that have recently calved. Of course, the affection really depends 
on microbial infection, but the source of this infection cannot always be 
determined. It is not uncommon to find that an apparently healthy 
cow, when exposed to cold, wet weather, shortly after calving, develops 
well-marked evidences of broncho-pneumonia, followed by rapid emacia- 
tion, and the autopsy reveals the presence of pulmonary tuberculosis. 
In such cases the tubercular lesions have been lying latent, but are 
roused to activity by the exposure, assisted by the debilitating effect of 
parturition. 


DISEASES OF THE LUNGS: CATTLE 951 


The bacteriology of bovine broncho-pneumonia is not definitely de- 
termined ; various micro-organisms have been found in the affected organs, 
but the specific cause has yet to be discovered. The lesions and symp- 
toms resemble those met with in the horse, but in cattle it not infrequently 
happens that owing to the manner in which these animals rest when lying 
down—viz., on the sternum—they can assume the recumbent position 
even when suffering from dyspneea. 

TREATMENT OF PNEUMONIA.—This is to be conducted on similar lines 
to those advised for the treatment of the affection in equines. 


INHALATION PNEUMONIA, OR BRONCHO-PNEUMONIA DUE TO 
FOREIGN BODIES. 


This affection is met with in cattle under similar conditions to those 
mentioned under the heading of inhalation pneumonia in the horse; but 
there are, in addition, certain factors which render the condition of more 
common occurrence in bovines than in equines. Careless drenching 1s 
the usual cause, and many animals are lost through ignorance in this 
respect. The facility with which the act of coughing is produced in 
the ox renders the accident liable to occur if large amounts of fluid are 
forced on the animal, especially when the head is held too high or turned 
to one side, as a sudden deep inspiration during coughing will draw 
a portion of the drench into the trachea and bronchi. Certain diseases 
predispose to the accident. Tympany of the rumen causes accelerated 
respirations, and also obstructs the free flow of fluids into the rumen, so 
that they tend to regurgitate to the pharynx, and so may enter the 
larynx and trachea. Affections accompanied by paralysis of the pharynx, 
such as milk fever, are especially liable to suffer from inhalation pneu- 
monia if drenching be attempted. 

Prolonged decubitus, such as may occur in milk fever, paralysis of 
the hind-limbs, etc., is usually accompanied by arrest of the normal 
movements of the rumen; fermentation of the ingesta and tympany 
occur, and regurgitation of portion of the gastric contents is likely to 
ensue, with the result that some of the latter gains entrance to the trachea 
and bronchi. Moreover, prolonged decubitus tends to produce hypo- 
static congestion of the lungs, which favours the occurrence of pneumonia. 
Foreign bodies, such as portions of straw, chaff, etc., may gain an entrance 
to the lung and induce pneumonia. Again, a sharp-pointed foreign body 
may reach the lung from the reticulum, and cause pneumonia, while 
penetrating wounds of the thorax have a similar effect. 


952 SYSTEM OF VETERINARY MEDICINE 


Morsip Anatomy.—The lesions of inhalation pneumonia are chiefly 
found in the inferior regions of the anterior pulmonary lobes. They are 
similar to those described as occurring in the inhalation pneumonia of 
the horse, with the exception that pulmonary gangrene is of very rare 
occurrence. 

Symproms.—When portion of a drench enters the larynx and trachea, 
the first symptom is a violent fit of coughing, followed by greatly ac- 
celerated respiratory movements, and a collection of froth around the 
lips. The violence of the symptoms depends on the amount of fluid 
which gains entrance to the bronchi and on the nature of this fluid. 
When a large amount enters, asphyxia may be rapidly produced, the 
animal dying in the space of a few minutes; in fact, so quick may be the 
fatal termination that the owner may think he has administered some 
toxic agent inthe drench. In some cases the preliminary symptoms may 
subside, and in a period of from twenty-four to forty-eight hours evidences 
of broncho-pneumonia present themselves. Instances are met with in 
which the initial symptoms are slight. In others, symptoms of broncho- 
pneumonia appear early, and for a few days may not be severe. Dyspnoea 
occurs at intervals, but the animal feeds fairly well and ruminates 
regularly; in a variable period, however, urgent dyspnoea and marked 
constitutional symptoms are manifested, with extreme cardiac palpita- 
tion, weakness, and total loss of appetite. 

The respirations are short, laboured, and irregular, and expiration is 
accompanied by a moan or grunt. Even when marked dyspnea is 
present, the animal may lie down for long intervals. The temperature 
is subject to variations, and may range from 104° to 107° F. A nasal 
discharge may or may not be present. Footor of the breath is very 
rarely observed. 

As the disease progresses, the dyspnoea becomes more urgent, and 
death occurs in a variable period from asphyxia or from cardiac failure; 
or, in the case of pulmonary gangrene, the fatal termination is due to 
general septicemia. When the course of the disease is slow, extreme 
emaciation occurs. The evidences obtained from a physical examination 
of the chest are similar to those met with in the horse. 

Diagnosis is based on the history of the case and the sudden appear- 
ance of the symptoms after a drench has been administered. 

Prognosis must always be guarded, as the patient may appear to 
progress favourably for some days and then develop unfavourable symp- 
toms. Theaffection must be regarded as a very serious and often fatal’one. 

TREATMENT.—T his 1s to be carried out on similar lines to those advised 
for the affection in the horse. Although in many cases stimulants may 


DISEASES OF THE LUNGS: CATTLE 953 


be indicated, it is generally found impossible to administer them in 
consequence of the fits of coughing which are induced by the process. 
Medicines should be prescribed in the form of electuary. 


SEPTIC OR INFECTIOUS PNEUMONIA IN CALVES. 
See Vol. I. under this heading. 


CHRONIC PNEUMONIA. 


This condition may follow the various forms of pneumonia, and also 
accompanies parasitic affections of the lungs. The lesions resemble 
those occurring in the horse. 

The symptoms generally observed are delayed convalescence after 
an attack of pneumonia, a persistent dry cough, loss of condition, de- 
pression, sometimes digestive disturbances evidenced by recurring attacks 
of slight tympanites after feeding, constipation, or diarrhcea. 

In order to distinguish the affection from tuberculosis, the tuberculin 
test must be applied. Treatment of any kind is useless, once the lesions 
are established. 

Under the heading of “ Entéqué’’ Cadéac describes a chronic affection 
of the lung, characterised by ossification or calcification of the inter- 
vesicular or interlobular connective tissue, and progressive emaciation 
of the animal. 

It occurs amongst Argentine cattle, and is accompanied by digestive 
disturbances, evidenced by a persistent diarrhoea and a tendency to 
ingest foreign bodies of all kinds. The course is slow, and many cases 
become paralysed in the later stages. 

The etiology is not known. Some authors regard the affection as a 
form of pasteurellosis. 


PULMONARY EMPHYSEMA. 


The acute form is the one usually met with. The affection is not 
common in the British Isles, but is observed more frequently on the 
Continent, where the ox is employed for purposes of draught. It may 
be produced by violent exertions while at work, such as drawing heavy 
loads. Amongst other causes may be mentioned the violent struggles 
that occur when the animal falls into a drain, and endeavours to extricate 
itself; loud and prolonged bellowing; broncho-pneumonia as the result of 
the presence of foreign bodies in the lung; tuberculosis when accompanied 
by constrictions or dilatations of the bronchi; affections of the stomach 


954 SYSTEM OF VETERINARY MEDICINE 


accompanied by tympanites, which induce dyspncea from pressure on 
the diaphragm and displacement of this structure. The emphysema 
may become subpleural and subcutaneous, and extend up the neck or 
become generalised. Friedberger and Fréhner explain the phenomenon 
as follows: The air penetrates from the subpleural space towards the root 
of the lung and between the layers of the mediastinum, and finally attains 
the anterior aperture of the chest, and reaches the loose connective tissue 
about the neck, from whence it becomes generalised. 

The condition has also been observed in cases of difficult parturition 
in cows, and is then due to violent labour pains. 

The symptoms resemble those already described as occurring in the 
horse. It must be remembered that subcutaneous emphysema of the 
head and neck may occur in cases of rupture of the cesophagus due to 
careless or awkward manipulation of the probang when employed in cases 
of choking; in this instance the emphysema is due to regurgitation of 
gases from the rumen and their entrance through the wound in the ceso- 
phagus to the subcutaneous tissue. 

Small punctured wounds in the region of the elbow, breast, or lower 
region of the neck, may also cause subcutaneous emphysema, due to the 
entrance of air into the cellular tissue. 

The course of the affection varies according to its cause. In some 
cases the emphysema disappears quickly. When accompanying broncho- 
pneumonia it adds to the gravity of this condition. 

Treatment is to be carried out on similar lines to those advised for 
this affection in the horse. 

In the swampy districts of the Netherlands an enzoétic form of 
emphysema has been observed in cattle, the causes of which are not 
definitely known. Belgian veterinary surgeons report its occurrence 
amongst cattle kept in stalls for fattening purposes. The lesions found 
were those of vesicular, interlobular, and subpleural emphysema. The 
affection has been termed “* Pneumatosis.” Cadéac ascribes it to diges- 
tive disturbances and attacks of tympanites. 

Snarry of York has met with several cases of subcutaneous emphy- 
sema in cattle, depending on pulmonary emphysema.* The etiology 
of the condition was obscure. The affection has also been recorded by 
other British practitioners. 


* See Williams’s “‘ Veterinary Medicine,”’ 


DISEASES OF THE PLEURA: CATTLE 955 


CHRONIC PULMONARY EMPHYSEMA. 


This must be rarely met with if we are to judge by the literature on 
the subject. We have never observed a case of the affection amongst 
bovines. Moussu states that chronic pulmonary emphysema may occur 
in the ox in connection with chronic bronchitis, or as a sequel to broncho- 
pneumonia; also that cases resembling broken wind in horses may be 
met with, but are rare. 


DISEASES OF THE PLEURA. 
PLEURISY. 


Acute Sero-Fibrinous Pleurisy.—As a primary affection this is rarely 
met with in cattle. According to Moussu, most cases of the disease 
attributed to the effects of cold and chills are in reality pneumonia. 
Other authors, however, recognise a primary sero-fibrinous pleurisy, in 
which exposure to cold is a predisposing etiological factor, especially in 
oxen used for purposes of draught. As a secondary disease sero-fibrinous 
pleurisy is met with under a variety of conditions, such as the different 
forms of broncho-pneumonia, inhalation pneumonia, traumatic peri- 
carditis, septic metritis, contagious pleuro-pneumonia, and penetrating 
wounds of the thoracic walls. The effusion may assume a septic or 
purulent nature, according to the character of the disease with which 
the pleurisy is associated. 

Tubercular pleurisy is generally of a dry or plastic character, but 
under the influence of chills, etc., it may assume a sero-fibrinous nature, 
the effusion, however, is usually small in amount. 

Morsip ANAtoMy.—The lesions are similar to those described as 
occurring in the horse. In consequence of the posterior mediastinum 
not being perforated as in the horse, the effusion is confined to one side 
of the thoracic cavity when the disease is unilateral. When the affection 
is bilateral, the effusion does not rise to the same level on each side, or 
the dry form may be present on one side, and effusion may exist in the 
other. 

Symproms.—Generally speaking, the symptoms are similar to those 
met with in the horse. 

The initial rigors may first be observed in the thoracic region, and then 


956 SYSTEM OF VETERINARY MEDICINE 


extend over the body. Pain is evidenced by frequent change of attitude, 
grinding of the teeth, moaning, and in some instances by colicky symp- 
toms, such as lying down and rising at intervals. In some cases fever is 
not well marked. Amongst other symptoms may be noted congested — 
conjunctive, an anxious expression of countenance, half-closed eyelids, 
the head is slightly lowered, and there is loss of appetite and cessation of 
rumination. Digestive disturbances may occur, evidenced by slight 
recurring attacks of tympanites; constipation is also present. ‘The 
animal may lie down, but rarely for long periods at a time. Cidema of 
the dewlap may be present; occasionally this becomes extensive and 
spreads upwards, so as to cause compression of the jugular veins. 

The Prysican Sians resemble those met with in the horse. 

The CouRsE may be rapid or insidious, and emaciation soon occurs. 
Resolution may occur, but more commonly permanent adhesions and 
chronic pleurisy result. 

Driacgnosis.—In order to ascertain the nature of the effusion an ex- 
ploratory puncture with a trocar and cannula must be made. The fluid 
can then be examined bacteriologically for evidences of tuberculosis. As 
already mentioned, tubercular pleurisy is rarely accompanied by much 
effusion. 

In cases of pleurisy depending on the presence of a foreign body 
leading to traumatic pericarditis, the special symptoms of this condition 
must be looked for. 

TREATMENT.—This is to be conducted on similar lines to those advised 
for pleurisy in the horse. 


EMPYEMA OR PURULENT PLEURISY. 


This occurs in cattle under similar conditions to those mentioned in 
connection with the disease in the horse. 

An additional cause in cattle 1s found during the migration of a 
foreign body from the reticulum towards the heart. 

Treatment in any form of empyema in cattle is very rarely successful. 


DRY OR ADHESIVE PLEURISY. 


This is of frequent occurrence in aged cattle. It may depend on 
parasitic causes, such as the presence of strongyles or ecchinococci in the 
lungs; also as the result of the passage of a foreign body from the reticu- 
lum, through the pleural cavity to the heart or lung. The condition 
most commonly associated with dry pleurisy is tuberculosis. Injuries 


DISEASES OF THE PLEURA: CATTLE 957 


to the thoracic walls from animals horning each other are also believed 
to be a cause of dry pleurisy. 

Dracnosis.—This is attended with considerable difficulty, and in 
order to ascertain whether the condition depends on tuberculosis the 
tuberculin test must be employed. 

We may remark, however, that dry pleurisy in cattle seldom presents 
any definite symptoms, and hence is frequently overlooked. 

Treatment of any kind cannot prove successful, even if the presence 
of the affection could be determined. 


PNEUMOTHORAX—PYO-PNEUMOTHORAX. 


These conditions in cattle may occur in connection with the following 
affections: Pulmonary emphysema may give rise to pneumothorax 
when, during a violent fit of coughing or on severe exertion, the pressure 
of the air causes rupture of the pleura over the emphysematous points. 
Occasionally, as the result of violent coughing or during severe straining 
in cases of difficult parturition, rupture of the pulmonary parenchyma 
may occur, and a communication between an alveolus or a bronchus and 
the pleural cavity is established. 

- Broncho-pneumonia, especially when arising from careless administra- 
tion of fluid medicines, and complicated with pulmonary abscess or 
gangrene, may induce pyo-pneumothorax. Pulmonary tuberculosis, 
when associated with vomice in the lung, may also induce pyo-pneumo- 
thorax, by opening at the same time into the bronchi and pleural cavity. 
As a rare cause of the condition, rupture of ecchinococcus cysts may be 
mentioned. Pyo-pneumothorax may occur during the passage of a 
foreign body from the reticulum towards the heart, as puncture of the 
lung and pleura may result. 

The symptoms are similar to those occurring in the horse; in addition, 
digestive disturbances may be observed, such as frequent eructation of 
gas or tympany of the rumen. 

Treatment is to be conducted on similar lines to those advised for this 
condition in the horse. 


DISEASES OF THE RESPIRATORY ORGANS 
| IN SHEEP 


By G. MAYALL, M.R.C.V.S. 


Acute Nasal Catarrh (Acute Coryza).—This is seen after shearing in 
sheep, especially in damp, cold weather of early spring or late autumn 
and on exposed pastures. Weakly lambs with little wool are subject to 
it. Irritation of the respiratory organs by keen, rough winds, or dusty 
hay in stall-feeding, may occasion it. 

Symptoms.—Redness, dryness, and increased warmth of the nasal 
mucosa are observed: The nasal discharge is at first clear and fluid, and 
subsequently becomes thick, tenacious, and yellowish-white. Some of 
the secretion dries around the nasal orifices and blocks up the nose. The 
irritability of the mucous membrane declines with the advent of the 
discharge. 

Course.—The catarrh frequently runs a favourable course if treated 
suitably, but if neglected, feverish symptoms may develop, and inappe- 
tence, intestinal catarrh, and diarrhoea may follow. Catarrhal inflamma- 
tion of the eyes, mouth, and larynx may occur as a complication. 

Proenosis.—This is as a rule favourable. 

TREATMENT.—House the sheep, sponge their nostrils with a disinfec- 
tant solution, and administer electuaries containing chlorate of potash 
and quinine. In the case of valuable rams employ inhalations of steam 
medicated with Friar’s balsam, terebene or creolin. Barley water or 
linseed mucilage may be mixed with the rations, which are best given 
warm. Give good food and shelter in bad weather. If the animal be 
weak and depressed, prescribe stimulants, such as sweet spirits of nitre 
in linseed mucilage or flour gruel. When convalescence sets in, put on 
sheltered pasture in dry, mild weather, and give a powder night and 
morning in the manger food, consisting of saccharated carbonate of iron 
2 drachms, powdered gentian 2 drachms, and powdered locust bean meal 
2 drachms. 

Chronic Nasal Catarrh develops from ordinary catarrh. Animals 
turned cut day and night in wet inclement weather are specially prone to 
the complaint, but a neglected case of simple catarrh may become chronic. 

958 ‘ 


DISEASES OF THE RESPIRATORY ORGANS: SHEEP 959 


Local diseases of the bones (osteomalacia), carious teeth, nasal polypi, 
or the presence of parasites, may cause the discharge. An infectious nasal 
catarrh of sheep of a chronic character is seen in hemorrhagic septicemia. 
A neglected catarrh may be followed by laryngitis, evidenced by dys- 
phagia, with flow of saliva from the mouth, and a painful cough. 

Symproms.—The nasal mucosa is of a pale or bluish-red tint; a slimy, 
thready, yellowish, ichorous, feetid discharge, more or less profuse, is 
observed from the nostrils; this diminishes in mild weather, but reappears 
in full flow after exposure to cold winds or to wet. The discharge dries 
around the nasal orifices, blocking them up and excoriating their edges. 
The continued secretion in chronic cases produces a thickening of the 
mucosa, accompanied by a hard, painless swelling of the glands of the 
throat. 

Proanosis.—lIf local conditions are favourable, a successful termina- 
tion may result, but relapses readily occur. The animals should be 
housed and protected from chills. 

TREATMENT.—Give good, concentrated food (crushed oats or maize), 
employ inhalations of steam, medicated with disinfectants, cleanse the 
nostrils, and dress with boric acid and vaseline. Prescribe electuaries 
containing quinine, sodium hyposulphite, and liquorice root. Allow 
pure air, avoid draughts, and disinfect the sheep-pens. When convales- 
cence sets in, saccharated carbonate of iron may be given in the food. 
Sheltered pastures are of importance. 

Bronchitis.—According as a catarrhal inflammation of the air-tubes 
attacks the large or small bronchi, it is mild or severe. In the former 
case the congestive or irritation stage soon declines, and is usually followed 
by a profuse secretion and a nasal discharge; but a continuation of the 
causes of the complaint or neglect of a mild case may lead to chronic bron- 
chial catarrh, or to an attack of catarrhal pneumonia. 

Errotogy.—Chills, especially in the case of young animals; exposure 
to wet, inclement, windy weather; going out of a too warm sheepfold; 
shearing and dipping in bad weather, with neglect of hygienic care; direct 
irritation of the respiratory tract by dust when driving on the road. 

Symptoms.—The following symptoms are observed: Dejection; list- 
lessness; a rise of temperature; a dry, painful cough at first, afterwards 
becoming moist; a profuse discharge from the nose and mouth. The 
respirations are increased in number in the early stages, but afterwards 
decline. Moist rales may be heard on auscultation, when recovery is 
taking place. Verminous bronchitis (see section on Parasites) is another 
form of the complaint. Recovery, where care and treatment are adopted, 
may be expected in from eight to fourteen days. 


960 SYSTEM OF VETERINARY MEDICINE 


Proenosis.—Strong and well-nourished subjects recover sooner than 
weak ones in poor condition. A tendency to relapses remains for some 
time. 

TREATMENT.—House or fold the animals in warm, dry, airy quarters. 
In shorn sheep apply liquid mustard to the chest wall; give warm muci- 
lJaginous drinks. The followmg draught may be carefully given: Car- 
bonate of ammonia 2 drachms, ipecacuanha wine 4 ounce, infusion of 
senega 2 ounces, aqua chloroformi to 8 ounces; a fourth part of this to be 
given two or three times daily in a } pint of linseed mucilage. Or the 
following may be prescribed: Acetate of ammonia 34 ounces, glycerine 
of belladonna 4 ounce; a fourth part to be given in linseed mucilage. 
Tonics are indicated during the convalescent stage. Give light, easily 
digested diet. Be cautious about turning out when convalescence occurs. 
Choose a time of good weather, and keep the sheep moving about quietly. 


The Pneumonias of Sheep. 


Catarrhal or Lobular Pneumonia.—Catarrhal pneumonia may develop 
from an attack of bronchitis where the small bronchi are affected (capil- 
lary bronchitis). The inflammatory process extends from the fine bronchi 
to the air vesicles, and the exudate from the bronchi is drawn into the 
vesicles or blocks up the bronchi. As a result of the former the alveoli 
are filled with slimy, inflammatory exudate, and when the latter occurs 
the adjacent alveoli collapse. In favourable cases the exudate may be 
coughed up or absorbed, and recovery may occur; or, by considerable 
extension, death may result from suffocation and exhaustion. Pus 
cavities occasionally arise by purulent degeneration of the lung tissue. 
These may become encapsuled, or their contents break through into the 
bronchi, and either heal up, or, gaining access to the pleural cavity, 
bring about pleurisy. , 

Er1oLocy.—Pasturing in exposed places in cold, wet weather, shear- 
ing and dipping in bad weather, impure air, the inhalation of irritant 
vapours or gases, and penetration of foreign matter (medicines when 
drenching) into the bronchi. As a secondary affection it occurs in the 
hemorrhagic septicemia of sheep and in sheep-pox. 

Symproms.—A painful cough (at first dry and then moist), quickened 
and difficult breathing, and a moderately high temperature, which often 
varies. Recovery is denoted by decline of temperature, loosening of 
the cough, and evacuation of discharge, and slowing of respirations. 

Prognosis.—This is favourable in strong adult sheep; but must be 
guarded in the case of lambs and weaklings. Hmaciation and weakness, 


DISEASES OF THE RESPIRATORY ORGANS: SHEEP 961 


obstinate cough, increased difficulty in breathing, and long-continued 
fever, are unfavourable signs. 

TREATMENT.—House warmly. Apply liquid mustard to the chest 
wall. Give diluents, and two tablespoonfuls two or three times daily (to 
an adult sheep) of the following mixture in water or linseed mucilage: 
Aromatic spirits of ammonia 33 ounces, sweet spirits of nitre 2 ounces, 
tincture of digitalis 4 drachms, ipecacuanha wine 14 ounces, water to 
12 ounces. During convalescence feed on good, concentrated food, and 
turn out only in mild, dry weather. 

Croupous, Fibrinous, or Lobar Pneumonia.—This occurs less fre- 
quently in sheep than catarrhal pneumonia, and is offen complicated with 
pleurisy. 

EKt1oLocy.—Severe chills, long exposure to intemperate weather and 
poor feeding, long road journeys causing overheating and fatigue, and 
subsequent pasturing in bleak, exposed situations. 

Symptoms.—The following are observed: A high temperature, a full 
and hard pulse, cold extremities, diminished appetite, thirst, constipa- 
tion, accelerated and laboured respirations, dilated nostrils, cessation of 
rumination. There may be a reddish or yellow discharge from the 
nostrils, which dries around.them. Percussion shows absence of reson- 
ance in the consolidated areas, and auscultation may reveal tubular 
breathing and absence of vesicular murmurs. Both auscultation and 
percussion are better conducted and more satisfactory on shorn than 
unshorn subjects. Recovery takes place by resolution or dispersion of the 
exuded material. It is announced by a quick decline of temperature and 
free evacuation of urine and feces, marked decline in the number of respira- 
tions and easier breathing, gradual clearing up of the exudate, resonant 
sounds on percussion, mucous rales and vesicular murmurs on auscultation. 

TREATMENT.—House warmly, giving plenty of pure air without a 
draught. Give sodium hyposulphite and potassium nitrate in the 
drinking-water. Prescribe small doses of whisky when cardiac weakness 
is present. Fifteen- to thirty-grain doses of acetanilide dissolved in a 
little whisky and mixed with an equal quantity of water may be given 
two or three times daily in cases of persistent high temperature. 

Light, easily digested, and laxative diet (clover, vetches, etc.) should 
be ordered. Later on, strengthening concentrated food is indicated. 
Observe caution in turning out the animals during convalescence. 

Infectious Broncho-Pneumonia in Lambs.—See Vol. I. 

Chronic Pneumonia of Sheep.—This has been described by Robertson* 
as occurring in South Africa, where it is known as “ Jagziekte.” It 


* Journal of Comparative Pathology and Therapeutics, 1904. 


VOL. Il. 61 


962 SYSTEM OF VETERINARY MEDICINE 


occurs among sheep pastured on high elevations during the winter 
months. There is chronic catarrhal pneumonia, with hepatised areas of 
lung tissue having the appearance of bacon, or great proliferation of the 
connective tissue of the lung is observed. In the later stages there is 
also fibrinous pleurisy. Cylindrical bodies supposed to be protozoa were 
found in the diseased lung tissue. 

Infectious Pleuro-Pneumonia of Goats.—Hutyra and Marek mention 
an infectious pneumonia arising in Germany in imported Swiss goats. 
The disease appeared to affect goats only, and was only prevalent in 
mountainous regions. There was fever, catarrh of the air-passages, 
cough, nasal discharge, and rapid breathing. Respiration became 
laborious, and in thrée to five days exudative pleurisy and hepatisation 
of a portion of lung occurred. About one-half of the affected animals 
died. In some cases the disease caused death in from twelve to forty- 
six hours, but generally lasted from three to four weeks, or assumed a 
chronic course with eventual recovery. 

Autopsies showed hepatisation of a small or large area of the lung, 
sero-fibrinous pleurisy, swelling of the peribronchial lymphatic glands and 
of the spleen. Inoculation of material from the lesions into other goats 
was negative, thus differentiating the disease from contagious pleuro- 
pneumonia of goats. 


DISEASES OF THE RESPIRATORY ORGANS 
IN SWINE 


By G. MAYALL, M.R.C.V.S. 


Rhinitis (Sporadic Nasal Catarrh, Snuffles).—Apart from nasal catarrh 
arising in connection with swine fever, tuberculosis, rickets, etc., and 
the infectious rhinitis of swine, pigs are now and then attacked by a 
sporadic nasal catarrh, followed by bacterial invasion with strepto- 
coccl, etc. 

_ Ertotocy.—Cold, wet weather causing chills, damp and draughty 
sties with insufficient litter, inhalation of irritant dust or vapours, injuries 
to the mucous membrane of the nose. 

Symptoms.—A mucous, purulent, or bloody discharge from the nose, 
and a snuffling noise if the animal is forced to move about, sneezing, and 
snorting. A discharge from the eyes may also be present. The appetite 
may continue good, but in many cases there may be loss of condition 
and emaciation. 

CoursE.—This as a rule is benign, and recovery ensues; but the case 
may be complicated by laryngitis or bronchitis. | 

Morsip Anatomy.—The nasal mucosa is swollen and inflamed, and 
covered with slimy mucus, pus, or hemorrhagic spots, and occasionally 
by fibrinous or croupous deposits. 

TREATMENT.—lInhalations or nasal injections of antiseptics. A 
powder which has been used with much success in the treatment of the 
disease in Germany, and which the writer has frequently prescribed with 
beneficial results, consists of ammonium chloride | part, glycyrrhiza 
_ pulv. 14 parts, and sodium sulphate 2 parts. Dose: a teaspoonful to 
each pig at each meal. The powder may also be made up as an electuary, 
and given on the tongue. Warm mucilaginous diet, and dry, warm 
quarters, are also indicated. 

Infectious Rhinitis of Swine (Malignant Nasal Catarrh, Snuffles).—T his 
purulent and hemorrhagic disease of the nasal and ethmoidal mucosa 
has long been known. Franque and Spinola described it in 1842. Im- 
minger demonstrated its contagiousness in 1890, and Koske showed it 

963 


964. SYSTEM OF VETERINARY MEDICINE 


to be due to the Bacillus pyocyaneus in 1906. The term “ snuffles ” 
is not @ suitable one as a distinct ailment of swine, as it is also applied 
to ordinary rhinitis (see above), and secondary inflammations arising in 
swine plague and swine fever are characterised clinically by nasal dis- 
charges of a similar character. 

Etiotocy.—The disease depends on infection by the B. pyocyaneus, 
the predisposing factors being wooden sties and rough stony floors. 
Natural infection results by the taking up of the organism from dung, 
straw, or liquid manure. 

Symptoms.—The affection is seen chiefly in weaners and stores up to 
six months old. Older pigs are seldom attacked. It generally runs an 
acute course, with rise of temperature, diminished appetite, snorting 
breathing, and brain symptoms. A turbid, slimy, bloody discharge from 
the nose is also observed. The animal frequently sneezes, and rubs the 
snout on handy objects. Swelling of the nasal region and pharynx 1s 
present. Difficulty in breathing and cerebral complications bring about 
death in from three to seven days. The disease occasionally assumes a 
chronic form, and may now and then end in recovery after a period of 
emaciation and loss of condition. 

Morsip ANATOoMY.—T he nasal mucosa is swollen and slimy, a purulent, 
chocolate-coloured exudate occurs on the membrane, and often clots of 
blood. Hemorrhages on the coverings of the brain and a sodden condi- 
tion of the brain substance may be observed. Blood-clots may be found 
in the cells of the ethmoid bone. 

DIFFERENTIAL D1aGnosis.—Ordinary catarrh is non-contagious, and 
runs a much milder course. In swine plague and swine fever there are 
pulmonary, intestinal, and skin complications. A post-mortem will clear 
up doubtful cases. 

TREATMENT.—Separate the healthy animals from the diseased ones. 
Inject the nostrils with 1 in 5,000 solution of perchloride of mercury. 
Trickle a teaspoonful of disinfectant solution down the nose several times 
a day (Imminger). Treat suspicious subjects also. After the disease is 
eradicated, thoroughly purify and disinfect the sty. 

Laryngitis and Bronchitis.—These are associated with certain infec- 
tious diseases, but may also occur sporadically. Bronchial catarrh is not 
uncommon in pigs. It is usually only dangerous in very young animals, 
and as a rule recovery takes place in from one to three weeks. In severe 
cases not suitably treated a chronic or croupous bronchial catarrh may 
ensue. In chronic bronchial catarrh the animals become emaciated, they 
cough up much slimy mucus, and there is great difficulty in breathing. 
In laryngitis, which may affect a number of pigs in early spring and late 


DISEASES OF THE RESPIRATORY ORGANS: SWINE 965 


autumn, and in damp, cold periods of summer, and especially attacks 
weakly swine, suckers, and weaners, there is a frequent and painful 
cough, often heard when the animals are hustled about or when eating 
or drinking, A croupous laryngitis is sometimes observed. 

Kt1oLogy.—Chills from cold winds or draughts, exposure to cold and 
wet, the inhalation of irritant dust or vapours, followed by secondary 
invasion of bacteria, infection from penetration into the air-passages of 
fungi, or micro-organisms taken up in the food. 

Symptoms.—A cough is observed, at first dry and painful, and later 
on loose and moist. The respirations are laboured and quickened, and 
a slimy, watery discharge issues from the nose and mouth. Listlessness, 
lack of appetite (not coming up to the trough to feed), and a rise of tem- 
perature are also present. Mucous rales are detected on auscultation in 
bronchial catarrh. Pain on pressure over the laryngeal region is mani- 
fested in laryngitis. 

CoursE.—Recovery generally ensues, but now and again weakly 
animals die from emaciation and general infection. Slght catarrh, or 
hemorrhagic, fibrinous, or gangrenous inflammation is found on post- 

mortem. 
| TREATMENT.—A similar line of treatment to that advised for rhinitis 
is indicated. In laryngitis, cold, wet, linen compresses may be put 
round the throat, and covered with a dry woollen bandage, arranged so 
that no air can get between the linen bandage and the skin. The com- 
press may be renewed every three or four hours. 

The laryngeal region and the sides of the chest may be rubbed with 
camphorated oil or with liniment containing ammonia and turpentine, 
and a woollen jacket made for the animal by cutting two holes in the 
material, through which the fore-legs are put, and the coat stitched or 
fastened over the withers and back. Let the ailing subject or subjects be 
isolated in well-ventilated quarters, and order rest and easily digested 
food. 

Pneumonia.—This may occur as a result of careless drenching, as a 
metastatic affection from absorption of pyzemic or septicemic material 
from another part of the body, such as the subcutis, udder, or womb, 
or as a sequel of chills followed by secondary bacterial invasion. 
Pneumonia and pleurisy generally exhibit much the same clinica] 
symptoms. Fat pigs overdriven and left in draughty, damp, or too 
warm quarters, may suffer from congestion of the lungs, followed by 
pneumonia. 

Symptoms.—Lack of appetite, a rise of temperature, quickened and 
laboured breathing, avoidance of the flat position on the side when 


966 SYSTEM OF VETERINARY MEDICINE 


lying. Pneumonia due to drenching or occurring as a metastatic affec- 
tion frequently terminates fatally by reason of necrosis and gangrene 
supervening, 

Morsip ANATomy.—Areas of necrosis are found in the lung tissue. 
Evidences of fibrinous pneumonia and pleurisy are present. Brownish 
or brownish-red stinking fluid is found in cavities formed by ls down 
alveoli. Gangrene of the lung is also present. 

TREATMENT.—Order a mucilaginous sloppy diet, also milk and eggs. 
Prescribe electuaries of sodium hyposulphite and belladonna. A mix- 
ture containing sodium hyposulphite 2 to 4 drachms, and sweet spirits 
of nitre 4 ounce, may be given in milk twice daily. Stimulate the sides 
of the chest with turpentine liniment or liquid mustard. Clothe in a 
woollen jacket, and keep the animal warm and dry. If constipation be 
present, administer an occasional enema. 

Atelectasis.—This congenital or acquired condition of the lungs of 
swine was first described by Simader in 1906. In congenital atelectasis 
the lung tissue does not distend after birth, and remains empty of air. 
In acquired atelectasis, which may follow attacks of bronchitis, pneu- 
monia, or pleurisy, single bronchi become blocked, or certain parts of 
the lung tissue are pressed together. | 

Et1oLocy.—In the congenital form, fatty degeneration of the respira- 
tory muscles, foetal bronchitis, and a stiff, inelastic condition of the lung 
tissue are regarded as causes. In-breeding and pedigree breeding is 
believed to be an etiological factor. 

The acquired type is due to occlusion of the bronchi through catarrh 
or compression of the lung tissue by collections of fluid or air in the 
thoracic cavity. It is seen also in rickets, rheumatism, and the scour of 
sucklings. | 

Symptoms.—Where only few and limited atelectic areas are present 
in the lung tissue, symptoms of disease may be absent; but when a large 
area is affected, there is listlessness, weakness, quickened and laboured 
breathing, and coughing. The animals usually appear half dead when 
born, and die in a few hours or days after birth. Survivors do not grow 
or develop, but become emaciated and cachectic. 

Morsip Anatomy.—Atelectic areas are frequently seen at the apices 
of the anterior lobes of the lungs. They are dark red in colour, and — 
wedge-shaped if due to obstruction, and catarrhal slime or débris is found 
in the bronchi. In congenital atelectasis the bronchi of the affected 
region or those bordering on it may be normal, and the pathological 
condition chiefly affects the apex of the anterior lobe of the lung. There 


DISEASES OF THE RESPIRATORY ORGANS: SWINE 967 


may be serous infiltration of the affected areas, and atrophy of lung 
tissue followed by induration. 

PROPHYLAXIS.—T his consists in attention to more rational breeding 
and to hygiene. 

Interstitial Emphysema.—This is often seen in pigs as a post-mortem 
condition after attacks of bronchial catarrh or pneumonia, and dilatation 
of the bronchi, with or without thickening of the bronchial wall (bronchi- 
ectasis), is observed after broncho-pneumonia (swine plague, verminous 
bronchitis). 


DISEASES OF THE RESPIRATORY ORGANS 
IN THE DOG AND CAT 


By E. WALLIS HOARE, F.R.C.V.S. 


General Remarks.—Respiratory diseases occupy a very important 
position in canine practice. They are of frequent occurrence, and, so 
far as pulmonary affections are concerned, the mortality is generally 
very high; while in many instances such affections occur in connection 
with canine distemper, and are comparatively rare as primary maladies. 
This fact is of considerable importance, and, as we shall point out later 
on, marked difficulty is encountered in differentiating between primary 
pneumonia and the pulmonary complications of distemper. A similar 
difficulty is met with in equine medicine when we attempt to differentiate 
between pneumonia as a disease per se, and the pulmonary complications 
of influenza. The modern view that all forms of pneumonia are infectious 
to a greater or less degree is a rational one to adopt in practice, as it 
leads us to isolate all cases of the disease. Probably many cases ex- 
hibiting evidences of pneumonia are erroneously diagnosed as distemper 
with respiratory complications, and no detriment is caused to the patients 
or their owners thereby. But, on the other hand, it is quite certain that 
in several instances, when a diagnosis of bronchitis or pneumonia is 
made, and an opinion given that distemper is not present, after-events 
prove that the pulmonary affection was in reality but one of the mani- 
festations of the disease mentioned; and, although the history of the 
case may in some instances assist us, we are forced to confess that as a 
general rule it is wiser to adopt a “ wait-and-see diagnosis,” and to 
isolate the affected animal, rather than to run the risk of spreading the 
disease by the assumption of diagnostic skill. A reference to the section 
on Canine Distemper in Vol. I. will serve to emphasise the importance 
of this subject, and to put the junior practitioner on his guard when 
dealing with the question. The crucial matter, which will frequently 
come before him, is to decide whether a case is one of primary bronchitis 
or primary pneumonia, or whether he is dealing with a case of distemper 
complicated with respiratory phenomena, 


With reference to the diagnosis of respiratory diseases in the dog, 
968 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 969 


we may remark that the physical examination of the chest is carried out 
with greater facility than is the case with the larger animals. Generally 
speaking, therapeutical measures can be adopted in a more efficient 
manner, and the surroundings—at least, in the case of valuable animals— 
are more favourable. In the present day, as more attention is devoted 
to canine practice, we get more opportunities for early treatment, and 
as a result the percentage of recoveries is far higher. There is still much 
room for improvement in this direction, and the mortality from respira- 
tory affections would be still further reduced if the owners of dogs would 
learn to recognise that the “common cold” may be, and often is, the 
forerunner of a serious malady; that patent “ cure-alls”’ do more harm 
than good, and that the advice tendered in the veterinary columns of 
papers devoted to dogs is simply guess-work, and, if carried out, is caleu- 
lated to exert deleterious rather than beneficial effects. 

Another important element in connection with successful results is 
good nursing. This is now recognised, and less faith placed in drugs 
than was the case in former times. 

Acute Nasal Catarrh (Acute Coryza).—This affection is said by some 
authors to be of frequent occurrence in the dog, but this is not our ex- 
perience. It is a symptom of the catarrhal form of distemper, and 
although certain points of distinction are described with a view to dif- 
ferentiating nasal catarrh per se from the disease mentioned, it is not 
uncommon for errors in diagnosis to occur. Cadéac states that acute 
coryza is infectious, and cites cases in point to show that a bitch suffering 
from the disorder can infect the pups she is suckling. 

Errotogy.—Exposure to chills is regarded as the chief etiological 
factor, but this probably acts by lowering the vital resistance and ren- 
dering the nasal mucosa liable to microbial invasion. A foreign body, 
such as a blade of grass, extending from the pharynx to the nasal 
passages, is not an infrequent cause of nasal catarrh in the dog and 
cat. The condition also occurs from the presence of Linguatula 
denticulata in the nasal cavities. 

Symptroms.—In the early stages the nasal mucosa is dry and con- 
gested, and the animal sneezes frequently. He may rub his nose against 
his paws or surrounding objects. The nasal discharge is at first serous 
in character, but it soon becomes muco-purulent and of a whitish colour. 
It is a benign affection, and recovery generally takes place in from eight 
to ten days. Severe cases are described by some authors, in which the 
catarrhal process extends to the conjunctive, causing lachrymation; also 
the air-sinuses of the head may be involved. Laryngitis and bronchitis 
are mentioned as complications, also chronic nasal catarrh, ozena, etc. 


970 SYSTEM OF VETERINARY MEDICINE 


DIFFERENTIAL DrtacgNnosis.—The affection must be differentiated 
from the catarrhal form of distemper. This is by no means an easy 
matter in the primary stages, and the practitioner soon learns the im- 
portance of isolating all cases that present nasal catarrh, and waiting for 
developments. Some attempt to differentiate the conditions by the 
character of the nasal discharge. Mayhew stated that in acute coryza 
there was a thick mucous discharge, but that in distemper it was thick, 
sticky, and purulent in character. Sewell* says that in coryza there is 
a thin mucous discharge which is not sticky, as in that of distemper. 
Again, it is said that the diagnosis can be based on the presence or absence 
of fever; but we must point out that distemper may be present without 
fever, while in cases of the disease in small dogs the nasal discharge may 
be serous in character (see Canine Distemper, Vol. I.). Friedberger and 
Frohner remark that “a distinction between a simple and specific (as in 
distemper) catarrh is not always easy to draw.” 

T'REATMENT.—Inhalations of steam medicated with oil of eucalyptus 
encourages the flow of nasal discharge and affords relief. Hazeline oint- 
ment may be applied to the nostrils. Irrigation of the nasal cavities is 
advised by some writers, but the procedure is violently resisted by the 
animal, and there is a danger that the fluid may enter the trachea and 
bronchi. The affected animals should be isolated, and placed in proper 
surroundings, and protected from chills. 

Chronic Nasal Catarrh.—This may occur as a sequel to the acute 
form, but in the majority of instances it is a secondary condition, and 
may be associated with a variety of affections, such as chronic catarrh 
of the frontal or maxillary sinuses, neoplasms of the nasal cavities, ulcera- 
tion of the mucosa at the inferior aspect of the nasal cavities, necrosis 
of the turbinated bones, an eczematous condition of the skin of the 
nostrils spreading to the nasal mucosa, the presence of parasites, asper- 
gillosis, tuberculosis, etc. Gray has observed that in old dogs an upper 
canine tooth may become loose, and be pushed into the nasal cavity. 
This causes chronic nasal catarrh, and not rarely nasal hemorrhage. 
The character of the discharge varies according to the condition on 
which it depends. 

The term ozena is applied to an ichorous, very foetid nasal discharge, 
which is usually associated with necrotic changes in the mucose of the 
nasal passages and sinuses of the head, or in the turbinated bones. In- 
this condition the discharge is sometimes sanguinolent. 

TREATMENT.—This will depend on the nature of the primary disease. 
A correct diagnosis of the diseased condition present is of importance in 


* “The Dog’s Medical Dictionary.” 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 971 


order to adopt rational treatment. If surgical conditions be present, 
operative measures are indicated. Medicated inhalations of steam 
generally prove useful. In some instances irrigation of the nasal cavities 
with solutions of bicarbonate of soda or of boric acid becomes necessary, 
although the procedure is difficult to carry out, and may prove dan- 
gerous. 

Chronic Nasal Catarrh in the Cat*— Synonyms.—Feline glanders; 
Snuffles; Snuffling. 

Cause.—This differs from the preceding complaint, inasmuch as it 
runs a very much longer and more persistent course; but it may follow 
on simple catarrh, especially if neglected. Its commonest cause, how- 
ever, 18 distemper, and sometimes diphtheria. It may also occur as a 
symptom of tuberculosis or tuberculous enlargements, foreign bodies in 
the nasal channels, malignant growths, such as sarcoma or carcinoma 
citacking the turbinated bones, necrotic bone, diseased teeth, etc. It 
occurs chiefly in light-coloured, long-haired cats, but no breed is exempt. 

Symproms.—There is a persistent thick, sticky, odourless, or some- 
times foetid discharge, either of a gelatinous or yellowish appearance, 
with or without streaks of blood, from the nostrils, the outside of which 
are sometimes ulcerated. There is an obstructive breathing, the animal 
frequently sneezes, snuffles or snorts, and in doing so throws a quantity 
of thick, ropy, muco-purulent discharge on the ground, on the walls, or 
on to the person examining or attending it. There is generally a good 
appetite, and not much loss of condition. Sometimes an abscess appears 
in the inner corner of the eyelids. The skin over the region of the nose 
may be thickened, enlarged, or prominent. The throat may occasionally 
be swollen, but not painful. In one instance the writer removed a 
greenish concretion the size of a walnut, resembling paraffin-wax, from 
the swollen parotid region of a cat suffering from a chronic nasal dis- 
charge resembling that of glanders in the horse. 

CoursE.—When neglected, it may last for months, and even years, 
and is frequently epee It is often recurrent, and may persist as 
an enzootic in a cattery for an indefinite period. 

Proegnosis.—Usually grave—that is, the complaint is difficult to 
remove, and is very liable to recur. 

TREATMENT.—In those cases that are due to malignant growths or to 
tuberculosis, and in consequence incurable, merciful destruction of the 
animal is called for. If due to fish-bones, the fibula of birds, pieces of 
grass or food, or to diseased teeth, these should be removed. 

Syringing the nasal channels so as to wash the diseased mucous mem- 


* For this note we are indebted to Mr. H. Gray, M.R.C.V.S. 


972 SYSTEM OF VETERINARY MEDICINE 


brane with some mild antiseptic is the only means to insure success. 
The mode of procedure is this: A skilled assistant must firmly hold the 
animal which is laid on one of its sides on a table, by securing the two fore- 
limbs with the left hand and the two hind ones with the right, then the 
operator grasps the head with his left hand, taking care to keep the mouth 
shut by means of the thumb and index-finger, and thus steadies it on the 
table, and with the right hand he carefully and gently passes the pipe of 
the syringe up one of the nasal channels, and then slowly presses out the 
fluid. When this is finished, the other nostril is served the same. The 
syringe should have a small calibre pipe of 3 or 4 inches in length, with a 
bulbous free end. The following is a suitable formula for the solution 
to be injected: 


ADU. oe ie Ai .. OU Stains, 
Boracic acid - .. 2drachms. 
Liquid extract of hydrastis it .. 2drachms. 
Warm water... Ay .. $ pint. 


This should be used every other day until some benefit is derived 
from it. If the disease is not amenable after a fortnight’s adoption of 
this treatment, the following should be substituted : 


Tincture of iodine (B.P.) .. Si .. 10 minims. 
Glycerine ie he Pr .. $drachm. 
Warm water 3 ee = .. 1 ounce. 


Or sulphate of zine, chloride of zinc, nitrate of silver, or sulphate of 
copper (5 grains to the ounce), in a warm solution may be tried. 

Pills or tablets containing iron, arsenic, and quinine should be pre- 
scribed, and plenty of fresh food, along with cod-liver oil, should be given. 

Catarrh of the Maxillary Sinus.—This may occur in the dog and cat 
as the result of extension of an attack of coryza, but the usual lesion is 
a chronic catarrh, leading to a collection of pus in the sinus (pus in the 
antrum). This is associated with a small opening situated a short dis- 
stance below the inner canthus of the eye, from which a slight but per- 
sistent discharge of pus issues (dental fistula). The cause of the affec- 
tion is a diseased condition of the roots of the upper fourth premolar 
tooth (rarely of the first molar), consisting of inflammation, followed by 
absorption. In a case recorded by Hobday, an examination of the tooth 
by Mr. C. Tomes showed that the posterior root suffered from an incom- 
plete fracture of some standing, and this fracture was attributed to force 
exerted while biting a bone, the irritation produced setting up absorp- 
tion of all the roots and destruction of the tooth-pulp, leading to sup- 
puration in the antrum. The crown of the tooth is generally sound. 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 973 


According to Gray, the condition is usually due to periodontitis affecting 
the apex of the root. The tooth may, however, be firmly fixed in the 
alveolus. . 

Disease of this sinus may also result from external injuries, causing 
fracture of any part of its wall. Aspergillosis may be a cause of some 
cases. 

Symproms.—In the early stages the animal shakes his head, and rubs 
his nose with his front paws, or his face on the ground. A unilateral 
muco-purulent discharge, sometimes blood-stained and fcetid, may be 
observed, also a snuffling sound accompanying respiration. Later on a 
swelling occurs in the infra-orbital region, which fluctuates, and ulti- 
mately a fistula develops. In every instance a probe can be passed into 
the fistula, and made to enter the roots of the tooth. 

TREATMENT.—In the case of dental fistula, the only successful treat- 
ment is to extract the offending tooth, and thus remove the source of 
irritation, as well as affording a communication for drainage between the 
antrum and the mouth. When the disease depends on external injury, 
with a depressed fracture of the walls of the sinus, appropriate surgical 
measures must be adopted. - 

Catarrh of the Frontal Sinus.—This is of rare occurrence in the dog. 
Cases are described by Weiss and Parascandolo,* and the treatment 
adpoted was trephining of the sinus. 

Neoplasms in the Nasal Cavities.—These include nasal polypi, and 
occasionally carcinomata and sarcomata, the malignant growths men- 
tioned being usually secondary to neoplasms of the buccal mucosa or 
superior maxillary bone, and causing deformity of the bones of the 
affected region, with a purulent or hemorrhagic nasal discharge, which 
is often foetid. Nasal polypi cause a nasal discharge which may be 
serous or muco-purulent, constant fits of sneezing, a snuffling sound 
during respiration, and oral breathing when the animal undergoes exer- 
tion or is excited. Occasionally the polypus can be detected by ex- 
amination of the nasal orifices. For details of treatment, which is purely 
surgical, see Hobday’s “‘ Surgical Diseases of the Dog and Cat.” 

Parasites of the Nasal Cavities.—See section on Parasites. 

Congenital Malformations (Hare-Lip and Cleft Palate).—See the work 
on canine surgery mentioned above. 

Acute Laryngitis.—This may occur as a disease per se, or may be 
associated with pharyngitis, distemper, etc. Exposure to chills and 
extension of an acute nasal catarrh are regarded as etiological factors. 
It may occur in a mild or in a severe form. The lesions are found chiefly 


* Deutsche Tieradrzt, Wochen., 1903. 


974 SYSTEM OF VETERINARY MEDICINE 


in the aryteno-epiglottidean mucosa and vocal cords, and consist of 
swelling, redness, ecchymoses, and an exudate of tenacious mucus, or 
muco-pus. 

Symptoms.—In mild cases, sneezing, a frequent hacking cough, a 
slight nasal discharge, a slight difficulty in swallowing, and tenderness on 
palpation of the region of the larynx, are observed. 

In severe cases, the fits of coughing are more frequent, and may be 
accompanied by retching; deglutition may be difficult, pharyngitis and 
tonsillitis are generally present, and a varying degree of fever. When the 
aryteno-epiglottidean mucosa is much swollen, the respirations are 
accelerated, and dyspnoea may occur. The tenacious mucus which is 
set free during the act of coughing is generally swallowed by the animal. 
The affection is often mistaken by the owner of the dog for “ choking ” 
or “a bone in the throat.” In peracute cases oedema of the larynx may 
result (see p. 975). Chronic laryngitis may occur as a sequel to the acute 
attack. In the diagnosis of the condition a gag should be placed in the 
mouth, and the tongue drawn forward, and the larynx inspected by 
means of a small electric torch. 

-'TreatmMEeNnt.—lInhalations of steam medicated with terebene, oil of 
eucalyptus, compound tincture of benzoin, etc., are indicated. A linctus 
composed of glycerinum boracis and honey may be applied to the laryn- 
geal mucosa by means of a soft brush. A cataplasm of kaolin and glycerine 
should be apphed to the external laryngeal region. For the relief of the 
cough, a mixture containing heroin and glycerine should be prescribed, 
but care must be taken in administering fluid medicines, so as to avoid 
the danger of inhalation pneumonia resulting. 

Chronic Laryngitis.—This may occur as a sequel to an acute attack, 
but may also be associated with chronic pharyngitis. According to 
some authors, it is observed as a secondary condition in chronic endo- 
carditis and chronic nephritis, and in such instances is ascribed to blood 
stasis and consequent alterations in the laryngeal mucosa. It may also 
be due to tubercular ulceration of the larynx. The affection is said to 
be of more frequent occurrence in short-nosed breeds of dogs, such as 
pugs, bulldogs, etc. The lesions consist of congestion and thickening of 
the mucosa, swelling of the mucous glands, and the presence of a puru- 
lent or a muco-purulent exudate. Friedberger and Fréhner point out 
that im many instances no alterations can be detected in the laryngeal © 
mucosa on superficial examination. 

Symproms.—The prominent symptoms are a spasmodic cough, which 
may be associated with fits of retching, during which a thick mucus 
enters the pharynx, and is subsequently swallowed. Occasionally, 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 975 


owing to an accumulation of secreted products in the larynx, dyspnoea 
occurs. 

TREATMENT.—The affection often proves very obstinate to treat- 
ment. Medicated inhalations of steam are indicated, as in the acute 
form of the disease. A mixture containing heroin and terpene hydrate 
sometimes proves useful. Some authors advise the application of a 
1 per cent. solution of nitrate of silver to the laryngeal mucosa by means 
of a brush, but this procedure is difficult to carry out. The externa 
laryngeal region may be painted with liniment of iodine. 

Cidema of the Larynx.—This consists of an infiltration of the sub- 
mucosa of the glottis and ventricles, and also of the vocal cords. The 
result is obturation of the glottis. Some authors regard it as of com- 
paratively frequent occurrence in the dog, and very fatal. , As a primary 
affection it may result in cases of peracute laryngitis, also from wounds 
due to foreign bodies. As a secondary condition, it may be associated 
with distemper, tuberculosis, tumours in the region of the larynx, abscess 
formation in the pharyngeal lymphatic glands, cardiac and renal dis- 
orders, etc. Cidema of the larynx has occasionally been observed in 
cases of tuberculosis when reacting to tuberculin administered for diag- 
nostic purposes. 

Symproms.—These include a roaring sound heard chiefly during 
inspiration, complete dysphagia, frequent retching accompanied by 
attacks of dyspnea. Spasm of the glottis may sometimes be observed. 
Death may occur from asphyxia. On inspection of the larynx by means 
of a mouth-gag, the swollen condition of the boundaries of the glottis 
can be detected. 

TREATMENT.—When evidences of approaching asphyxia are present, 
tracheotomy should be performed. The other details of treatment are 
similar to those advised for acute laryngitis. 

Paralysis of the Recurrent Nerve (Roaring).—This affection is occa- 
sionally met with in the dog, especially in large sporting breeds. As a 
symptom, roaring occurs in connection with various conditions, such as 
the presence of tumours in the nasal cavities, or new growths causing 
pressure on the recurrent nerve; but roaring due to paralysis of the 
recurrent nerve is of rare occurrence. Cases are recorded by Esser, 
Miiller, and Albrecht, while the existence of the affection 1s mentioned 
by Friedberger and Froéhner. According to Cadéac, the chief cause of 
the condition is distemper. 

Symproms.—The following symptoms are mentioned by Cadéac: 
‘“When the animal is subjected to even a slight amount of exercise, 
dyspnoea is produced, accompanied by a more or less intense roaring 


976 SYSTEM OF VETERINARY MEDICINE 


sound. In some cases the distress is extreme, the mouth is wide open, 
the tongue is cyanotic, and muscular tremors are observed. The distress 
gradually ceases, and the roaring sound diminishes.” 

The intensity of the symptoms depends on the extent of the lesions. 
The latter, as in the horse, are usually found on the left side, but they 
have not been fully investigated. A differential diagnosis is difficult, 
except in cases where the presence of a neoplasm causing pressure on the 
nerve can be detected. If such a tumour is operable, relief may be 
obtained; but if otherwise, or if depending on paralysis of the recurrent, 
treatment is of no avail. Gray has observed cases of whistling in the 
dog. 

Acute Bronchitis.—This may occur in the form of an acute inflam- 
mation of the larger and medium bronchi (simple bronchitis), or as 
capillary bronchitis. The latter, although occurring as a disease per se, 
is so frequently associated with broncho-pneumonia, and, moreover, as 
it cannot be differentiated clinically from the disease named, both affec- 
tions will be considered together (see Broncho-Pneumonia, p. 979). 

Simple bronchitis may occur as the result of exposure to chills, ete., 
or it may follow an attack of acute coryza. It is regarded as infectious, 
but the enzodtic outbreaks which are described by some authors read 
very much like distemper. At any rate, it is difficult or impossible to 
draw the border-line between them, and common sense will dictate that 
such cases should be isolated. 

Symptoms.—The affection may be preceded in some cases by evidences 
of acute coryza. Cough is a prominent symptom. It is at first short, 
hard, and dry in character, but in a few days becomes soft. A muco- 
purulent nasal discharge may be observed, but the major portion of the 
expectorate is swallowed when it reaches the pharynx during the act of 
coughing. Slight fever and constitutional disturbance may be present, 
but as a rule simple bronchitis is a benign affection. If neglected, how- 
ever, the capillary form may result. Auscultation in the early stages 
shows the presence of sibilant rales, and later on, when secretion becomes 
abundant, mucous rales are detected. 

TREATMENT.—Attention to surroundings is essential, and the animal 
should be placed in comfortable quarters and kept at rest. Inhalations 
of steam medicated with terebene, oil of eucalyptus, or compound tinc- 
ture of benzoin, are indicated. During the dry stage a mixture contain- ' 
ing ipecacuanha wine, solution of acetate of ammonia, and sweet spirits 
of nitre, proves useful. Ifthe cough be distressing, a few doses of Dover’s 
powder will give relief. Later on, when free bronchial secretion is 
present, sedatives are contra-indicated, as they interfere with the expul- 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT . 977 


sion of the products of secretion, and at this stage a moderate degree of 
coughing is beneficial. Good nursing is of great importance. During 
convalescence exposure to chills should be carefully avoided. A course 
of cod-liver oil emulsion is indicated, should the duration of the disease 
be protracted. 

Chronic Bronchitis—This is a very common affection in the dog, 
especially in aged, obese animals. It is frequently associated with 
chronic eczema, and tends to recur in cold or damp weather. It may 
also be met with in connection with tuberculosis. Owing to the marked 
respiratory distress that is often present, the affection is frequently mis- 
taken for asthma; but, as we shall point out later on, true asthma is a 
comparatively rare disease in the dog (see p. 978). 

Chronic bronchitis may occur as a sequel to an acute attack of bron- 
chial catarrh, but may also be associated with chronic cardiac and rena] 
affections. 

Morsip AnatomMy.—The bronchial mucosa is thickened, and of a 
greyish or slate colour. Its surface is irregular, and in some cases may 
show minute papillary projections. It is covered by a muco-purulent 
secretion. Various complications may be present, such as dilatation of 
the bronchi, pulmonary emphysema, and atelectasis. 

Symptoms.—The leading symptoms ere cough and dyspnea. The 
cough is generally hard, husky, dry, and occurs in paroxysms. It is 
accompanied by dyspnoea, and is of a peculiar wheezing character, dis- 
tressing to the owner as well as to the animal, and the thick tenacious 
sputum is coughed up with great difficulty. In some instances the 
bronchitis is accompanied by a more or less profuse secretion, and a 
muco-purulent nasal discharge, which rarely is foetid. Retching or 
vomiting may accompany the paroxysms of coughing. When pul- 
monary emphysema is present, a double expiratory movement is observed. 
Evidences of cardiac disorder may be present, such as cedema of the 
sternal region or of the fore-limbs. Auscultation may show the presence 
of sonorous, sibilant, and mucous rales. In advanced cases the animal 
is unable to perform even walking exercise, owing to the dyspnoea that 
is induced. 

TREATMENT.—The affection often proves very obstinate to every 
form of treatment. Gray has found the following line cf treatment 
useful: A mixture composed ‘of equal parts of syrupus apomorphine, 
syrupus ipecacuanhe acet., and syrupus scille acet., 1s first prescribed, 
the dose being 2 drachms three times daily (for a dog of medium size). 
When the cough becomes moist, the treatment is altered to a mixture, 
containing codeine phosphate and strychnine phosphate in the form of 

VOL. Il. 62 


978 SYSTEM OF VETERINARY MEDICINE 


glycerole. This may contain in each drachm codeine phosphate } grain, 
and strychnine phosphate ;3, grain, which is a suitable dose for a dog 
the size of a fox-terrier, and may be given three times daily. 

We have observed good results from a combination of heroin, tinc- 
ture of cocillana, tincture of euphorbia pilulifera, and syrup of squills. 
Syrup of tar produces good effects in some cases. It may be combined 
with small doses of apomorphine or codeine. Inhalations of steam medi- 
cated with terebene should also be prescribed. Iodine ointment applied 
to the external region of the larynx sometimes proves useful. In the 
majority of instances treatment can only be palliative, and the disease 
recurs in cold and damp weather. 

Bronchial Asthma.—We have already remarked that true asthma is 
a comparatively rare disease in the dog, but is often confounded with 
chronic bronchitis. In true asthma, attacks of dyspnoea occur at 
irregular intervals, and there are periods of quiescence lasting in some 
cases for days, during which no symptoms may be observed. In many 
instances cough may be absent. The attacks of dyspnoea are very dis- 
tressing to witness. They appear suddenly, may last for some time, and 
then cease in an abrupt manner. The animal gasps for breath, and 
makes strenuous inspiratory efforts, but very little air enters the lungs, 
owing to the spasmodic constriction of the bronchioles. Asthma may 
occur in connection with chronic bronchitis, and in long-standing cases 
pulmonary emphysema may be present; but in many instances no lesions 
can be discovered post mortem. Gray has observed that the disease 
may be hereditary in some cases, especially in dogs of the Maltese breed. 
Cadéac states that in short-nosed dogs acute coryza may cause attacks 
of asthma, owing to swelling of the nasal mucosa and obstruction of the 
nasal passages by plugs of mucus; and in addition to the dyspnoea a 
roaring sound is manifested, accompanied by a spasmodic contraction of 
the diaphragm. 

TREATMENT.—Many medicinal agents have been tried for the relief 
of this distressing affection. Gray finds that syrup of chloral hydrate 
gives better results than any other drug. We have observed that the 
mixture containing cocillana, as advised for chronic bronchitis (see 
above), proves serviceable as a palliative remedy, and can be continued 
for long periods without damage to the system. A course of arsenic may 
be tried. Attention to diet is necessary, and large feeds should be 
avoided. | 

Congestion of the Lungs and Pulmonary (idema.—Pulmonary con- 
gestion is met with in an active and a passive form. In the active form 
and in association with pulmonary cedema it may occur in the early 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 979 


stages of pneumonia. We rarely observe in the dog the peracute con- 
gestion of the lungs met with in equines. In the passive form it may be 
associated with valvular diseases of the heart, which interfere with the 
circulation in the pulmonary veins. 

Symproms.—In the acute form, accelerated respirations, panting, or 
actual dyspnoea are observed. A mucous nasal discharge, which may be 
tinged with blood, occurs in some cases, and when pulmonary cedema 4s 
present, the discharge is frothy and of a reddish or whitish tinge. 

TREATMENT.—Stimulants are indicated.. A stimulating liniment 
should be apphed to the thoracic walls. Ergotin is advised by Cadéac. 
In pulmonary cedema, Hutyra and Marek recommend subcutaneous 
injections of atropine. 


The Pneumonias of the Dog. 


The majority of authors agree that croupous pneumonia is seldom 
met with in the dog. According to Hutyra and Marek, the reports con- 
cerning this affection are very meagre, and the few cases published refer 
only to clinical observations. These authors are also of opinion that the 
large number of cases recorded in former times were in reality broncho- 
pneumonias associated with distemper, in which entire pulmonary lobes 
are not infrequently involved. The outbreaks of enzodtic croupous 
pneumonia recorded by Roll, Trasbot, Renault, and Bossiére, cannot be 
differentiated from distemper. Cadéac attempts to differentiate croupous 
pneumonia from the pulmonary localisations of distemper by the absence 
of ocular phenomena and cutaneous eruption in the former affection. 
Obviously, this factor could not be relied on. The same author states 
that sufficient knowledge of croupous pneumonia does not exist, in order 
to distinguish it clinically from broncho-pneumonia. Miiller remarks 
that he has never seen a case of true lobar pneumonia in the dog. As 
these views’are in accordance with our own experience, we do not con- 
sider that any advantage would be gained by describing croupous pneu- 
monia as a disease per se. Gray, however, informs us that he has ob- 
served all stages of croupous pneumonia at post-mortem examinations 
on cases of distemper. In the cat, croupous pneumonia occurs not in- 
frequently, according to Friedberger and Frohner. 

Broncho-Pneumonia.—As already remarked, it is practically impos- 
sible to differentiate capillary bronchitis from broncho-pneumonia, nor 
is there anything to be gained by attempting to do so. In the majority 
of instances the affection is associated with distemper, and although 
cases of broncho-pneumonia per se may occur, the difficulties in a dif- 
ferential diagnosis must be admitted. He would indeed be a bold 


980 SYSTEM OF VETERINARY MEDICINE 


clinician who, on attending a case of broncho-pneumonia, would be 
prepared to assert that the pulmonary affection was distinct from dis- 
temper. Moreover, from the point of view of prophylaxis, all pneu- 
monias should be regarded as infectious, and isolation should be adopted ; — 
also, cases of distemper with pneumonic complications should be isolated 
from uncomplicated cases of the disease. 

Exposure to chills is regarded as a cause of broncho-pneumonia, but 
in reality this factor lowers the vital resistance and renders the animal 
hable to infection. Another fairly common cause of the affection is the 
entrance of fluids, etc., into the trachea and bronchi, owing to the care- 
less administration of fluid foods or medicines (see Inhalation Pneumonia, 
p. 981). Broncho-pneumonia may also occur as a sequel to bronchitis. 
Nothing is known definitely with reference to the bacteriology of the 
affection. The lesions are similar to those described in connection with 
the broncho-pneumonia of distemper (see Canine Distemper, Vol. I., 
p. 661). They may be briefly summed up as catarrhal inflammation of 
the bronchi and pulmonary lobules, cedema, atelectasis, emphysema, 
accompanied in some instances by suppuration. 

Symproms.—These are similar to the phenomena observed in cases 
of distemper with pulmonary manifestations (see Vol. I., p. 676). The 
primary symptoms may be those of bronchitis, but are shortly succeeded 
by dyspnoea and a distressing cough. A nasal discharge may be present 
of a greyish or reddish colour, but the major portion of the expectorate 
is swallowed when it reaches the fauces. The animal may sit on his 
haunches during the attacks of dyspnoea, but in the later stages he lies 
on the sternum. Inflation of the cheeks may occur with each expiratory 
movement, and is always an unfavourable symptom. Prostration becomes 
extreme, and the expression of countenance is anxious. Death may 
occur from various causes, such as asphyxia, toxeemia, etc., in from eight 
to fifteen days, but in some cases this period is prolonged. The affection 
must be regarded as a very grave one, and in spite of treatment the 
mortality is high. : 

TREATMENT.—The principles of treatment are similar to those advised 
for the pulmonary complications of distemper (see Canine Distemper, 
Vol. I., p. 715). Nuclein given by subcutaneous injection sometimes 
gives good results. The administration of large amounts of normal 
saline solution subcutaneously proves of marked value, and may be 
regarded as the most important method of treatment. 

Inhalation Pneumonia.—This occurs from the careless administration 
of fluid medicines, or from fluid foods being forced on the patient. Many 
cases of broncho-pneumonia result from these causes, and the pernicious 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 981 


custom of forcing quantities of fluid foods and medicines on dogs 
suffering from distemper, pharyngitis, laryngitis, and other diseases is 
responsible for many deaths. In cases where a large amount of the 
medicament enters the bronchi, especially if it be of an oily nature, a 
fatal termination may occur rapidly. One of the most distressing 
cases of inhalation pneumonia that we met with was due to the careless 
administration of a mixture composed of Epsom salt and water. The 
dog showed marked dyspnoea, and uttered a series of piercing shrieks; 
violent trembling was also observed. When a smaller amount of fluid 
enters the bronchi, the preliminary fit of coughing and dyspnoea may 
be succeeded by a period of quietude, and after a little time evidences of 
broncho-pneumonia are manifested. 

The symptoms are similar to those observed in cases of peracute 
broncho-pneumonia, but suppuration or gangrene of the lung is especially 
able to occur, and pleurisy is often present as a complication. The 
large majority of cases prove fatal. The treatment is similar to that of 
ordinary broncho-pneumonia. 

Chronic Pneumonia.—This may occur as a sequel to broncho-pneu- 
monia, and is also met with in connection with tuberculosis and strongy- 
losis. The symptoms observed are loss of condition, inaptitude for 
exertion, shortness of breath, cough, an intermittent nasal discharge, 
and slight febrile attacks at irregular intervals. The affection must be 
differentiated from tuberculosis by the employment of tuberculin. 

Treatment rarely proves satisfactory. Iodide of sodium is advised 
by some authors. Cod-liver oil emulsion and a liberal diet are indi- 
cated. 

Pulmonary Emphysema.—This condition is not uncommon in the 
dog, and also in the cat. It may occur either in the acute or in the 
chronic form, and is associated with several affections. 

Acute Form.—This occurs in connection with broncho-pneumonia, or 
any lesions producing obstruction or narrowing of the trachea, or obstruc- 
tion to the nasal passages. It may also result from any conditions which 
induce persistent coughing, such as chronic bronchitis, and from cardiac 
lesions associated with dyspnoea, etc. 

Under the heading of “ Polyadénome Bronchique,” Cadéac describes 
a pathological condition occurring in the cat, which is an important 
cause of pulmonary emphysema in this animal. The lesions consist of 
a hyperplasia of the bronchial glands, which causes stenosis of the bronchi, 
and induces first acute emphysema, followed by the chronic form. Chronic 
bronchitis is believed to be the primary cause of the condition. 

The symptoms of acute pulmonary emphysema are persistent cough, 


982 SYSTEM OF VETERINARY MEDICINE 


shortness of breath on exertion, increased resonance on percussion of the 
affected areas, and diminished respiratory murmurs on auscultation.. 

In the cat affected by the form of pulmonary emphysema mentioned 
above, the symptoms observed are shortness of breath, inability to move 
about, a dilated appearance of the thorax, irregular respirations, a more 
or less persistent cough, and a slight nasal discharge. The disease is 
progressive, and may prove fatal in a few months. ) 

Chronic Form.—This is not infrequently associated with chronic 
eczema in aged, obese dogs. Such animals are little inclined for exertion, 
and are frequently affected with chronic bronchitis. From a combina- 
tion of these conditions chronic emphysema is likely to result, and may 
be vesicular, interlobular, or occasionally subpleural. It is often asso- 
ciated with dilatation of the right side of the heart. Chronic emphysema 
may also occur in connection with bronchial asthma (see p. 978). 

The symptoms observed are dyspncea on the slightest exertion, the 
respiration is chiefly oral, frequent paroxysms of cough are lable to 
occur, especially during night-time, in consequence of particles of mucus 
accumulating in the respiratory passages. Evidences of chronic bron- 
chitis are generally present, but in emphysema depending on cardiac 
lesions these may be absent. Occasionally retching or vomiting may 
accompany the paroxysms of coughing. The thorax has a dilated ap- 
pearance, and when the dog is exercised the mouth is kept open and the 
tongue protrudes. The physical signs are similar to those observed in 
the horse. 

TREATMENT.—The general health of the animal must receive atten- 
tion. When evidences of chronic bronchitis are present, suitable treat- 
ment for this condition must be prescribed. 

Arsenic gives good results in some cases, but the effect of any 
medicinal agent can only be palliative, as recovery is impossible. Cadéac 
prefers nux vomica or strychnine, but the risks of toxic effects from these 
agents must be considered, as it is very difficult in the smaller breeds to 
determine the doses that may be safely employed. Cardiac complica- 
tions will require special treatment, according to the indications present. 

Neoplasms of the Lung.—These include carcinomata, sarcomata, and 
chondromata. The two former are generally secondary to growths in 
other regions of the body. Chondromata may become generalised, and 
in some cases may attain a very large size. Neoplasms of the lung are 
of more interest to the pathologist than to the clinician, as, beyond 
causing difficulty in respiration, and in the case of malignant growths 
producing cachexia, no evidences of their presence are observed during 
life. 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 983 


Parasites of the Lung.—See section on Parasites. 

Pleurisy.—The majority of authors state that pleurisy in the dog and 
cat is nearly always associated with tuberculosis. This is also the ex- 
perience of many practitioners who specialise in canine medicine. Pleurisy 
may also occur in connection with distemper, and as the result of injuries 
to the thoracic walls, or fracture of ribs, etc. Penetrating wounds of the 
thorax may give rise to a septic or purulent pleuritis. The latter also 
results from perforation of the intrathoracic portion of the csophagus 
by sharp portions of bone, or needles, etc., or from the careless use of the 
probang in cases of choking. Exposure to chills, etc., acts as a predis- 
posing cause of the disease by lowering the vital powers of resistance, all 
cases of pleurisy being now regarded as microbial in character. Malig- 
nant tumours of the pleura are an occasional cause of the affection. 
Hutyra and Marek observed cases of pleurisy due to actinomycosis. 

The affection may occur in a sero-fibrinous or in a dry form, the 
former being more frequently met with than the latter. Pleurisy also 
occurs in the cat under similar conditions to the above. : 

Morsip ANnatomy.—As the affection is in the large majority of 
instances associated with tuberculosis, the lesions will be found fully 
described in connection with canine tuberculosis (see Vol. I., p. 176). 
For a description of the lesions of the pleurisy of distemper, see Vol. I., 
p. 662. In cases of sero-fibrinous pleurisy not depending on the ‘condi- 
tions mentioned, the lesions resemble those met with in the analogous 
disease in equines. 

Symptoms.—In the pleurisy associated with tuberculosis the disease 
may remain latent for a long period, and without any apparent cause, 
or in some instances from exposure to chills evidences of pleuritic effu- 
sion appear rather suddenly. The clinical phenomena will be found fully 
described in Vol. I., p. 179, and there is no necessity to repeat them here. 
It is impossible to differentiate definitely tubercular from non-tubercular 
pleurisy by a clinical examination; hence either the tuberculin test must 
be employed, or some of the fluid removed from the thoracic cavity by 
aspiration must be subjected to a bacteriological examination. Cadéac 
and other writers point out that, although a bacteriological examination 
may prove negative, it does not always indicate the absence of tuber- 
culosis, as in the case of an old effusion tubercle bacilli may be absent, 
although the vegetations on the costal and diaphragmatic pleura contain 
these micro-organisms in abundance. 

In order to detect the presence of pleuritic effusion, a careful physical 
examination of the chest is necessary. This is carried out with more 
facility in the dog and cat than in other animals, and by changing the 


984 SYSTEM OF VETERINARY MEDICINE 


position of the patient the alteration of the line of dulness can be observed. 
The effusion may be unilateral or bilateral. In unilateral cases with 
extensive effusion, if the dog be laid on the unaffected side, marked 
dyspncea results, owing to the normal lung being compressed by the 
animal’s weight, and also by the pressure of the effusion. 

TREATMENT.—It is of importance to decide whether the case 1s one 
of tuberculdésis or otherwise before adopting treatment. If tubercular, 
the animal should be destroyed, as it would be a source of serious danger 
to human beings. 

~ Tf non-tubercular, and if evidences of effusion be present, paracentesis 
thoracis should be carried out. The site selected is usually between the 
sixth and seventh or seventh and eighth ribs, about an inch above and 
behind the point of the elbow. If the effusion is on the left side only, 
the puncture must be made on this side, care being taken to avoid 
wounding the heart. For the technique of the operation, see works on 
canine surgery.* 

The administration of potassium iodide proves useful in some cases. 
We are seldom called to treat acute cases of pleurisy in the early stages, 
but, should such be met with, salicylate of soda, salicin, or aspirin, may 
be prescribed. 

Dry Pleurisy is not infrequently met with, and in many instances this 
form is tubercular. The affection is latent, and the lesions are only 
discovered at autopsies, in the form of pleuritic adhesions. It is rare in 
the cat. 

Empyema, or Purulent Pleurisy.—This may occur in the dog under 
similar conditions to those mentioned for the analogous affection in 
equines. As already mentioned, sharp-pointed foreign bodies, when 
swallowed, may penetrate the cesophagus in its thoracic portion, enter 
the pleural cavity, and set up a purulent pleurisy. Attempts to dislodge 
sharp pieces of bone by the employment of the probang may have a 
similar effect. 

The diagnosis is based on an exploratory paracentesis thoracis. The 
treatment is surgical, and for the technique the reader is referred to Cecil 
French’s work on “ Canine Surgery.” 

Hydrothorax.—aA collection of serous fluid in the thoracic cavity, 
without inflammatory changes in the pleure, may occur in connection 
with various conditions, such as valvular diseases of the heart, tuber- 

* Gray has found that it is generally difficult to obtain satisfactory results from 
paracentesis thoracis in the cat and in very small dogs, as in many instances the fluid 
does not issue from the cannula. He therefore in such cases makes an incision from 


3 to 1 inch in length in the thoracic wall between two ribs, for the evacuation of the 
fluid. The skin should be drawn to one side prior to making the incision. 


DISEASES OF THE RESPIRATORY ORGANS: DOG AND CAT 985 


culosis of the bronchial and mediastinal lymphatic glands, renal affec- 
tions, carcinomata, etc. The symptoms resemble those of pleural 
effusion, but the physical signs demonstrate that fluid is present in both 
sides of the chest, and the horizontal line of dulness is symmetrical 
on each side. The symptoms develop slowly, and are associated with 
those of the primary disease. The transudate may be clear, reddish- 
yellow, or slightly turbid. 

Treatment must be directed to the primary disease. When the 
transudate is extensive, paracentesis thoracis gives temporary relief. 

Heematothorax.—This term signifies the presence of blood in the 
thoracic cavity. The hemorrhage may result from rupture of a bloodvessel 
in the vicinity, due to external injuries, or it may occur in connection with 
neoplasms. Some writers include under this heading cases in which a 
serous or purulent exudate or transudate becomes hemorrhagic in 
character. Such a condition occurs in connection with peracute infec- 
tions and exhausting diseases, the hemorrhage resulting from rupture of 
vessels in the throacic cavity. We must point out, however, that in 
numerous cases of pleurisy in the dog and cat, the exudate is intensely 
hemorrhagic in character. 

The symptoms in cases where the bleeding is profuse are those of 
internal hemorrhage. In less severe cases evidences of pleural effusion 
are present, and the nature of the case can only be detected by an 
exploratory paracentesis thoracis. 

Treatment must be directed to the primary disease that is present. 
If evidences of internal hemorrhage are observed, the hypodermic injec- 
tion of adrenalin is indicated, also subcutaneous injections of normal 
saline solution. When marked dyspnea is present, Miiller advises that 
paracentesis thoracis should be performed without delay. 

Pneumothorax.—The entrance and accumulation of atmospheric air 
between the parietal and visceral layers of the pleura, causing compres- 
sion or collapse of the lungs, may depend on various conditions similar 
to those mentioned in connection with the analogous affection in equines. 
The symptoms and treatment are also similar (see p. 925). 

Neoplasms of the Pleura.—These include carcinomata, sarcomata, and 
endotheliomata. There are no characteristic symptoms. Sarcomata 
have often been confounded with tuberculous growths of the pleura. 

Parasites of the Pleura.—Sce section on Parasites. 


DISEASES OF THE RESPIRATORY ORGANS 
IN BIRDS 


By E. WALLIS HOARE, F.R.C.V.S. 


Simple Nasal Catarrh.—This is not uncommon in cage-birds. The 
usual cause is exposure to draughts, chills, etc. Cadéac describes a simple 
form of coryza in poultry, which appears to be a mild type of roup ‘(see 
Roup, Vol. 1.). 

Friedberger and Fréhner state that a simple primary nasal catarrh 
occurs in various kinds of poultry, and originates from exposure to cold 
or inhalation of irritant matter. The symptoms observed are sneezing, 
snorting, whistling or rattling sounds accompanying respiration, slight 
dyspnoea, the beak is held open, the bird frequently shakes his head, and 
a muco-purulent nasal discharge is present, which often tends to dry up 
and form a crust within the nostrils. It is a benign affection, which 
tends to a spontaneous recovery. Other authors describe a coryza 
which, if neglected, may terminate in bronchitis or pneumonia. In 
parrots, nasal catarrh is not uncommon, and if the birds be exposed to 
draughts or chills, the catarrh extends to the conjunctive, to the 
bronchi, or to the intestines, and may prove fatal. 

TREATMENT.—Friedberger and Frohner advise the administration of 
Carlsbad salt in the drinking-water. Some authors recommend that in 
the early stages tincture of opium should be prescribed—for a small bird 
1 minim, and for a parrot from 4 to 6 minims. Aspirin or tincture of 
camphor may be given. Tincture of aconite in small doses is also said 
to prove useful. The surroundings should be kept at a high temperature. 
The nostrils should be cleansed with a warm solution of boric acid. 

Contagious Nasal Catarrh.—See Roup (Vol. I.). 

Inflammation of the Cella Infra-Orbitalis in Fowls.—This is evidenced 
by a swelling in the infra-orbital region, which is at first tender to palpa- 
tion, but subsequently becomes firm and insensitive. If pressure be 
exerted on it, a muco-purulent discharge issues from the nostril of the 
affected side. The condition may be associated with an attack of con- 
tagious nasal catarrh, aspergillosis, or avian diphtheria. and in water 
birds ma depend on the presence of parasites. 

986 


DISEASES OF THE RESPIRATORY ORGANS: BIRDS 987 


The treatment advised is to open the swelling in a longitudinal 
manner, to press out the cheesy contents, and to irrigate the part with 
an antiseptic solution. 

Acute Bronchitis.—This may result from extension of a nasal catarrh, 
or may depend on the presence of parasites, or be associated with tuber- 
culosis, avian diphtheria, aspergillosis, etc. Chills act as an important 
predisposing cause. 

The symptoms observed are accelerated respirations, cough, a rasping 
sound in the trachea, which is accelerated by movement, and is audible 
at some distance. In some cases a nasal discharge is present. The 
course of the disease varies. Broncho-pneumonia may supervene, and 
bring about a fatal termination, or chronic bronchitis may occur, and 
may be complicated with catarrh of the air-sacs. 

Treatment consists in attention to the surroundings. An equable 
temperature of not less than 80° F. is necessary. Inhalations of steam 
medicated with agents such as terebene are indicated, but care should 
be taken not to induce suffocation. Ziirn advises the followmg mixture, 
which may be given in doses of a teaspoonful or a tablespoonful three 
times daily: Chloride of ammonium, 0°5 gramme; honey, 0°5 gramme; 
and fennel water, 50 grammes. Syrup of squills and glycerine is a popular 
remedy, in doses of from 1 to 10 drops, according to the size of the patient. 

_ Chronic Bronchitis.—T his is often mistaken for asthma. It is charac- 
terised by continuous distress in breathing, cough, wheezing, and gradual 
emaciation. | 

Pneumonia.—This is often met with, especially in cage-birds and 
exotic birds confined in aviaries. It is very fatal, and generally resists 
treatment. Ziirn records cases of pneumonia in poultry in which the 
following lesions were observed: Hepatisation, subpleural ecchymoses — 
and extravasations, and the presence of a thick fibrous exudate in the 
bronchi. The symptoms were as follows: Accelerated short respirations 
accompanied by a whistling sound, the beak is kept widely open, the 
bird coughs, and may expectorate a tenacious, greyish-white, or saffron- 
yellow mucus from the beak and nostrils. Pneumonia may also be due 
to aspergillosis (see Aspergillosis, Vol. I.). 

Hepatisation is relatively rare in birds. The lesions more commonly 
found resemble those seen in peracute pulmonary congestion of animals 
(splenification). An apoplectic condition of the lungiscommon, Caseous 
changes due to aspergilli, parasites, tubercle, etc., are not infrequent. 
Dropsy of the air-sacs is not rare. The air-sacs may be the seat of an 
inflammatory exudate due to infectious diseases, especially aspergillosis 
and parasitic affections. 


988 SYSTEM OF VETERINARY MEDICINE 


In cage-birds the usual cause of pneumonia is exposure to draughts, 
etc., and the prominent symptoms are difficulty in breathing, marked 
prostration, and occasionally a discharge of blood-stained mucus from 
the beak and nostrils. 

Treatment consists in placing the bird in warm surroundings, and 
attending to its general comfort. Salicylate of soda or antifebrin may 
be given in the drinking-water. Some authors advise that 1 drachm of 
solution of acetate of ammonium and 5 minims of tincture of aconite be 
added to each ounce of drinking-water. 

Pulmonary Emphysema.—This condition is met with in birds, espe- 
cially in canaries, and in many instances the air escapes into the sub- 
cutaneous connective tissue in the region of the neck, or may become 
generalised. It may be due to rupture of the lung and air-sacs. Cases 
are said to occur as the result of a bird’s strenuous efforts to emulate a 
rival in singing. André recorded instances occurring in carrier pigeons 
after traversing long distances, in which the emphysema of the skin 
usually disappeared after a few days’ rest. 

Asthma.—The so-called asthma in canaries and other cage-birds is 
generally due to aspergilli in the air-passages. It may occur as a verit- 
able enzootic. The symptoms observed are wheezing, and a creaking or 
whistling sound during expiration. The birds are sickly in appearance 
and sterile. Hen-birds are more often affected than cocks. 

Treatment consists in attention to good hygiene, sound food, and 
fresh air. Iodide of potassium, Fowler’s solution of arsenic, Donovan’s 
solution, syrup of tar, or compound tincture of benzoin may be given in 
the drinking-water. If the weather be favourable, it is good practice to 
put the affected birds into an aviary. 

Accidents due to “ Cramming with Food ’’—Rupture of the Larynx.— 
This is often seen in birds which are forcibly “‘ crammed,”’ either by the 
fingers or a cramming-machine. The force employed ruptures the larynx, 
the latter descends in the neck, and death soon follows from asphyxia. 

Asphyxia from the Entrance of Food into the Trachea.—This is also met 
with as the result of ‘‘ cramming,” especially when the food is given in 
a pasty or too fluid condition. If care 1s not exercised in the process, the 
food enters the trachea, and asphyxia results. A similar condition may 
occur in cases of paralysis of the crop, as, owing to the food fermenting, 
it tends to regurgitate into the mouth, and to enter the trachea. Over- 
loading of a paralysed cesophagus also induces mechanical obstruction of 
the trachea, as ingesta is likely to enter the latter organ. 


DISEASES OF THE RESPIRATORY ORGANS: BIRDS 989 


NOTE ON THE NURSING AND ADMINISTRATION OF MEDICINES 
TO BIRDS. 


As birds drink very little water, the dose of medicinal agents pre- 
scribed must be relatively high. For example, if we wish to administer 
potassium iodide to cage-birds, we allow an ounce of water containing 
5 grains of the drug. In the case of pigeons and poultry, drugs can be 
given in the form of pills, or in the food or water. Cage-birds will often 
eat a piece of sponge-cake moistened with a palatable medicine. To 
smaller birds, medicines can be introduced into the beak by means of a 
fountain-pen filler. In the case of parrots, the bird should be wrapped 
in a thick bath-towel, and the head held so that the practitioner cannot 
get bitten. In order to examine the throat in parrots, or to apply 
remedies to this region, a pair of scissors held between the beak forms a 
serviceable mouth-gag. In holding birds care must be taken not to 
compress the chest, otherwise suffocation would be induced. 

Owing to the fact that the temperature of birds is generally much 
higher than that of mammals, they can stand a high temperature of 
their surroundings. Birds suffering from prostrating maladies should 
therefore, whenever possible, be kept in a temperature of from 80° F, 
100° F, 


DISEASES OF THE DIAPHRAGM IN THE 
HORSE AND OTHER ANIMALS 


By E. WALLIS HOARE, F.R.C.V.S. 


HORSE 


Spasm of the Diaphragm—Synonyms.—Chorea of the diaphragm; 
Abdominal ‘‘ pulsation.” 

Various views were at one time held with reference to the nature of 
this affection. Thus, it was ascribed to palpitation of the heart, increased 
pulsation of the aorta, spasm of the abdominal muscles, etc. The con- 
dition was studied by Thomassen and also by Ziirn, and the modern view 
now generally held is that the condition is a neurosis of the diaphragm, 
probably of reflex origin, resulting in spasmodic movements of the struc- 
ture, and evidenced by a convulsive jerking of the body, accompanied 
by a dull, thumping sound unconnected with the beats of the heart. 
Although the affection is said by Hutyra and Marek to be not uncommon 
in horses, this is not our experience, as we have seen very few cases of 
the disorder. In the Report of the Army Veterinary Service, 1911-12, 
only two cases of spasm of the diaphragm were recorded, and in 1912-13 
we find no mention of the disease. According to the authors mentioned 
above, cases are exceptionally observed in cattle and in dogs. 

EtroLoey.—According to W. Williams,* the affection is ‘‘ generally 
caused by over-exertion, such as a fast run in the hunting-field, and is 
also sometimes seen in tetanus.” The condition is not mentioned by 
Robertson.t According to Hutyra and Marek, the affection is rather 
often preceded by digestive disturbances or acute gastric ailments, or 
it occurs In association with intestinal catarrh or impaction of the bowels. 
These authors state that the spasm is probably a reflex condition, the 
irritation originating in the mucosa of the stomach or intestine being 
transmitted by the vagus to the medulla, and from thence to the diaphrag- 
matic nerves, and possibly also to the nerves supplying other muscles. 
Cases may occur in the absence of digestive disturbances, and are attrib- 


* “ Principles and Practice of Veterinary Medicine.” 
+ '** Practice of Equine Medicine.”’ 


990 


DISEASES OF THE DIAPHRAGM: HORSE 991 


uted to very severe work or to excitement; but although theories are 
advanced to account for the condition under such circumstances, they 
cannot be accepted as logical or even probable. Cases are recorded 
in which spasm of the diaphragm was associated with acute pleurisy, 
and also with myelitis in the vicinity of the diaphragmatic nerve-centre 
(Hutyra and Marek). Instances were observed in conjunction with 
vomiting, the drinking of cold water, the ingestion of mouldy hay, and 
following the administration of an aloetic purgative ball (Friedberger 
and Frohner). 

Symproms.—The characteristic phenomena are a violent throbbing, 
which may at first be mistaken for cardiac palpitation. This is asso- 
ciated with a convulsive jerking of the whole body. The throbs may 
in some cases coincide with the number of heart-beats, and in such 
instances the former immediately follow the latter. But in the majority 
of cases there is no regular relation between the throbbing and the cardiac 
beats. According to Friedberger and Fréhner, the throbbing is most 
marked in the region of the left posterior ribs and flank, and in some 
instances the sounds are audible at some distance from the animal. The 
throbs decrease in intensity towards the anterior region of the thorax. 
The action of the heart may be normal, or it may be small and frequent. 
Occasionally cardiac palpitation is associated with spasm of the diaphragm 
(Friedberger and Fréhner). According to Hutyra and Marek, at each 
convulsive movement a depression is observed in the vicinity of the costal 
arch, the abdominal wall posterior to this bulges slightly, and the inter- 
costal spaces along the entire extent of the lower part of the chest, or 
only in the posterior third of this region, show spasmodic retraction. A 
nasal sound of a sobbing character accompanies the throbs in rare cases. 

Tremblings, restlessness, distress, and yawning are observed in some 
instances. Wilhams mentions dyspnoea as one of the symptoms. The 
attack may occasionally be ephemeral, lasting but a few minutes. In 
other cases the symptoms continue from twelve to twenty-four hours, 
or even from two to four days (Friedberger and Fréhner). A case re- 
corded by Leblanc lasted three weeks. 

Proenosis.—Hutyra and Marek state that only Perrin met with a 
fatal result in the horse. But Friedberger and Frohner quote Cartwright 
as having observed a mortality of six out of eighteen cases. This latter 
seems curious, as other authors regard the affection as recovering spon- 
taneously or with simple treatment. 

DIFFERENTIAL Diaenosis.—The affection is distinguished from cardiac 
palpitation by observing that the throbbing is not synchronous with the 
beats of the heart, and that it lessens in intensity at the anterior region of 


992 SYSTEM OF VETERINARY MEDICINE 


the chest. The history of the case will also assist. Hutyra and Marek state 
that by a rectal examination the attachments of the diaphragm can be 
palpated and the convulsive movements in this structure can be detected. 
We imagine that very few practitioners possess this degree of dexterity. 

TREATMENT.—Antispasmodic remedies are advised, such as a hypoder- 
mic injection of morphine, or a dose of chloral hydrate combined with 
potassium bromide. Williams found a diffusible stimulant useful. As 
already remarked, spontaneous recoveries are not uncommon. When 
the affection depends on digestive disturbances, these must receive 
suitable treatment. 

Rupture of the Diaphragm—Synonyms.—Hernia of the diaphragm; 
Diaphragmatocele. 

This condition may be considered under two forms—viz., (1) As an 
opening in the diaphragm, congenital in origin, through which a portion 
of intestine may enter the thoracic cavity; (2) as a rupture depending 
on mechanical or traumatic causes. 

The results vary according to the extent of the opening in the dia- 
phragm, the amount of viscera which enters the thoracic cavity, and the 
degree of compression to which they are subjected. The lesion is usually 
met with in the horse, but occasionally occurs in other animals. It cannot 
be described as a common condition, and, as pointed out by Williams, 
some, at least, of the recorded cases are due to post-mortem distension 
of the large colon, which brings about rupture of the diaphragm by 
mechanical means. In the Report of the Army Veterinary Service, 
1911-12, fourteen cases of rupture of the diaphragm were recorded, and 
in 1912-13 only nine cases occurred. 

ErioLogy.—According to Cadéac, the condition is of congenital 
origin in the majority of cases. He gives a full description of the manner 
in which the arrest in development is brought about, and points out that 
in some instances the opening may be present in the absence of hernia.* 
Of course, with the existence of such an opening mechanical causes are 
more likely to produce fatal lesions. 

Mechanical or traumatic causes are recognised by all authors. Sudden 
violent falls, more especially when the animal is suffering from disten- 
sion of the stomach or large intestines, and throws himself about during 
a paroxysm of pain, may induce rupture of the diaphragm. Violent 
straining, such as may occur when a horse is cast for operation with 
hobbles, is occasionally a cause of the lesion; the violent contraction of 
the expiratory muscles tends to force the abdominal viscera against the 
diaphragm, and thus to produce rupture of the latter. A portion of 


* See “ Pathologie Chirurgicale de |’ Appareil Digestive.”’ 


DISEASES OF THE DIAPHRAGM: HORSE 993 


intestine, etc., may be forced through the opening, whether the latter 
be congenital or accidental. We met with one case in a four-year-old 
stallion that was cast for the operation of castration. Hardly an ounce 
of chloroform was inhaled when he commenced to strain violently, and 
died in a very short time. The post-mortem showed a rupture of the 
diaphragm through the tendinous portion of the structure. In such 
cases repletion of the digestive organs favours the occurrence of the 
accident. Cadéac states that energetic attempts at vomition, associated 
with an attack of acute gastric indigestion, may be an occasional cause 
of the lesion. External violence to the region of the diaphragm, injuries 
from the horns of cattle, and fractured ribs, are also regarded as etiological 
factors. 

Morsip Anatomy.—According to Cadéac, congenital openings o 
small dimensions are usually situated at the line of union of the tendinous 
centre to the muscular portion of the structure. The borders of these 
openings are thick, smooth, and free from adhesions. The viscera 
which pass through vary according to the seat and the dimensions of 
the openings. Cases are recorded in which the congenital orifices were 
so extensive that the stomach, a lobe of the liver, the spleen, and a portion 
of intestine, passed through and entered the thoracic cavity. Generally 
the omentum and portion of the small or large intestine are the organs 
forming the hernia. In chronic cases the viscera involved may show 
no lesions, but when strangulation occurs, the morbid changes are similar 
to those met with in ordinary cases of strangulated hernia. 

Begg recorded a case in which a loop of small intestine 2 yards in 
length passed through the foramen sinistrum. The portion of bowel 
was found lying between the lungs, and was distended with gas and 
fluid. The foramen was larger than normal, but there was no evidence 
of laceration.* | 

In accidental rupture of the diaphragm the lesion may occur in any 
part of the structure, but is more commonly met with in the tendinous 
portion. The opening is more or less irregular in shape, its borders 
have a lacerated appearance, and, if recent, they show intense congestion 
and are blood-stained ; but if of longer standing, adhesions with the viscera 
passing through the opening are formed. The organs forming the hernia 
vary according to the extent of the rupture. In chronic cases adhesions 
may be formed to the lungs, pericardium, ribs, etc. Cases are recorded 
in which rupture of the intercostal muscles was associated with the lesion 
in the diaphragm, the skin being intact, the result being that a diaphrag- 
matic and a ventral hernia coexisted. | 


* Vide Veterinary Record, vol. ix., p. 222. 
VOL. Il. 63 


994 SYSTEM OF VETERINARY MEDICINE 


It is of importance to distinguish an ante-mortem from a post-mortem 
rupture of the diaphragm. W. Willams stated that the latter was 
frequently mistaken for the former, also that post-mortem rupture was 
not uncommon in cadavers kept unopened until the abdomen became 
much distended, owing to the formation of large amounts of gas in the 
intestines. This, however, is not our experience. The distinguishing 
features of ante-mortem and post-mortem rupture are said to be that 
in the former the lesion is found in the tendinous portion of the diaphragm, 
and the borders are stained with extravasated blood. 

Symproms.—In congenital or chronic cases, with only a small 
opening and a slight degree of hernia, no symptoms may be present. 
Cases are observed, however, in which recurrent attacks of colic occur 
after any exertion; others show distress, especially in gomg downhill; 
others, again, never lie down, show permanent difficulty in respiration, 
and become emaciated. In such instances, of course, acute symptoms 
develop, if from any cause a large amount of viscera enters the thoracic 
cavity and becomes strangulated, or causes compression of the lungs 
and heart. 

In acute cases the symptoms observed are dyspnea, spasmodic con- 
traction of the abdominal muscles, violent colicky pains, sitting on the 
haunches, profuse sweating, etc.; but the only phenomena of diagnostic 
value are those obtained by a physical examination of the chest. Per- 
cussion shows a tympanitic sound which may extend as far forward as 
the shoulder. Auscultation reveals the presence of gurgling or splashing 
sounds which mask the vesicular sounds. Friedberger and Frohner, 
however, point out that such phenomena may be absent, as in cases where 
the portion of intestine does not extend forwards, but remains in the 
posterior region of the thorax. In Begg’s case, already alluded to, the 
horse first showed symptoms of intestinal tympany, a haggard expression 
of countenance, and made frequent attempts to lie on the back. The 
duration of the case was three days, the animal dying on the morning 
of the third day. No evidences were obtained from a physical examina- 
tion of the chest until fourteen hours from the commencement of the 
attack. Sounds resembling those of water being displaced were easily 
detected. These were synchronous with the action of the heart, and in 
six hours afterwards were so marked that they could be heard while 
standing at the animal’s head. They resembled the sounds usually 
present in cases of traumatic pericarditis in the ox. Hutyra and Marek 
state that in diaphragmatic hernia of the left side the heart may become 
displaced by prolapsed loops of bowel, and the apex-beat cannot be 
detected. 


DISEASES OF THE DIAPHRAGM: CATTLE AND DOG = 995 


Course AND Duration.—These vary according to the extent of the 
opening and the bulk of viscera which have passed into the thoracic 
cavity. Death may occur rapidly or within half an hour from asphyxia, 
or it may take place later on from strangulation of the incarcerated 
portion of bowel. In the case we met with due to violent straining while 
cast for operation, death occurred in a few minutes, and was no doubt 
accelerated by chloroform. A large rent was found through the tendinous 
portion of the diaphragm, but no viscera had entered the thoracic cavity. 
Chronic cases may last for an indefinite period. 

DirFERENTIAL Di1acnosis.—This must be based on the evidences 
obtained from a physical examination of the chest. If this examination 
proves negative, a diagnosis 1s impossible. It must be remembered, as 
pointed out by Hutyra and Marek, that, exceptionally, in cases of very 
acute gastric tympany the diaphragm may be pushed forward by the 
greatly dilated stomach, and both structures may come into contact 
with the thoracic wall, and give rise to a tympanitic sound on 
percussion behind the cardiac region. This can be mistaken for the per- 
cussion sound of diaphragmatic hernia. 

TREATMENT.—It is quite obvious that the condition cannot be in- 
fluenced by therapeutical measures. 


OTHER ANIMALS. 


Rupture of the Diaphragm—Caittle.—Cases are recorded in which 
the reticulum passed through a laceration of the foramen sinistrum or 
through the tendinous portion of the diaphragm. The condition may 
become chronic, and the symptoms are obscure. In a case reported by 
Baraillé, the omasum and abomasum, with the reticulum, were found in 
the thoracic cavity. i 

Dog.—Rupture of the diaphragm is generally due to violent injuries, 
such as being run over by a motor-car or other vehicle. It may be 
associated with displacement of the liver into the thoracic cavity. _ 


DISEASES OF THE MEDIASTINUM IN 
THE HORSE, OX, AND DOG 


By E. WALLIS HOARE, F.R.C.V.S. 


Accorpinc to McFadyean,* the mediastinum is a septum formed 
towards the mesial plane of the chest by the approximation of the two 
layers of the pleura, one from each side. At some points the right and 
left layers are in close contact—e.g., in front of the heart in a lean sub- 
ject—but at other points the layers are pushed apart by organs 
included between them. The mediastinum contains very important 
organs, such as the heart, the large vessels, the trachea and bronchi, 
the cesophagus, the vagus, sympathetic, diaphragmatic, and cardiac 
nerves, and various nerve ganglia. In addition to these structures 
are two groups of lymphatic glands, and it is in connection with the 
latter that the chief lesions of clinical importance in the mediastinum 
arise. These lymphatic glands comprise: (1) The bronchial, which are 
situated in the angle of bifurcation of the trachea. They are continued 
with the bronchi for a short distance into the pulmonary parenchyma. 
(2) A series of glands on the sides of the inferior aspect of the trachea, 
extending from the base of the heart to the first rib. These glands are 
related to the brachial trunks, the anterior aorta, the anterior vena cava, 
the cardiac and recurrent nerves, the base of the heart, the inferior 
cervical ganglia of the great sympathetic, the vena azygos, and the arch 
of the aorta. Diseases of these glands, either a simple adenitis or the 
presence of neoplasms, exert pressure on the vessels or nerves or other 
structures, and bring about various clinical phenomena. 


DISEASES OF THE MEDIASTINUM IN THE HORSE. 
These include hypertrophy of the glands, and the presence of neo- 


plasms. | 
Hypertrophy of the glands may depend on strangles, in which case 
the bronchial glands are chiefly affected. Hither abscess formation or 
sclerosis may result. Tuberculosis, lymphadenitis, lympho-sarcomata, 
* “ Anatomy of the Horse.”’ 
996 


DISEASES OF THE MEDIASTINUM: HORSE 997 


and melanotic sarcomata also cause enlargement of the glands and exert 
compression on important structures, such as the vene cave, the jugular 
veins, the carotid arteries, the heart, the inferior extremity of the trachea, 
the vagi, the esophagus, etc. 

Neoplasms, such as epitheliomata and carcinomata, are occasionally 
observed, and cause compression of the heart, lungs, etc. Barrier and 
Weber record a case in which, in addition to the above phenomena, the 
thoracic duct was distended along its course by a sanguinolent lymph. 

Symptoms.—These depend on the compression exerted on important 
structures, but in addition there may be symptoms attributable to the 
primary affection. Owing to the pressure exerted on the vagus and 
recurrent nerves, irregular respiration accompanied by a roaring sound 
and spasmodic cough is observed. These phenomena are intermittent, 
and recur at indefinite periods. Pressure on the cervical sympathetic 
induces vaso-dilation of the capillaries of the head and neck, and sweating 
of the skin in these regions is observed. 

Interference with the circulation is brought about by pressure on the 
large vessels, and even on the heart itself. Hence a weak pulse, dimin- 
ished cardiac impulse, and weakened cardiac sounds, are observed. 
Owing to compression of the anterior vena cava, there is increased tension 
in the jugular veins and distension of these vessels, and in some instances 
a jugular pulse is present. An cedematous swelling of the sternal region 
is observed, extending to the base of the jugular furrow, and terminating 
abruptly in this region. The swelling also extends along the inferior 
aspect of the abdominal region, and in the male involves the sheath. 
(Edematous swellings may also appear on the fore-limbs, and the case 
may resemble one of purpura hemorrhagica. Evidences of pulmonary 
cedema may be manifested, and also of hydrothorax. 

The general symptoms observed are a subnormal . temperature, 
emaciation (which varies in degree according to the nature of the tumour 
—1.e., whether malignant or otherwise), weakness in the hind-limbs, and 
a staggering gait if forced to move. . 

DIFFERENTIAL D1acnosis.—The history of the case, its progressive 
nature, the absence of fever and of petechiz on the nasal mucosa, the 
distended jugular veins, and the presence of roaring accompanying 
respiration, will assist in differentiating the condition from purpura 
heemorrhagica. 

Procnosis.—The affection is always very grave, and sooner or later 
terminates fatally. 

TREATMENT.—Beyond palliative measures and treating symptoms as 
they arise, no therapeutical measures can prove of any permanent value 
in this affection. 3 


998 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE MEDIASTINUM IN THE OX. 


Enlargement of the lymphatic glands and tumours of the mediastinum 
in the ox occur under the following conditions: Tuberculosis, lymphaden- 
itis, lympho-sarcomata, and in comparatively rare instances carcinomata, 
epitheliomata, papillomata, and cysts. Cadéac states that cysts of the 
mediastinum should be regarded as developing from sarcomata or lympho- 
sarcomata which have undergone cystic changes. 

The enlargement of the glands due to tuberculosis or to lympho- 
sarcomata may be very extensive. 

Symproms.—Owing to pressure of the growths on the cesophagus, 
deglutition, rumination, and the eructation of gases, are interfered with, 
hence dysphagia, salivation, and the occurrence of tympany of the rumen 
after feeding are observed. In some cases the tympany may be per- 
manent. On attempting to pass the probang, the operator finds that the 
instrument meets with an obstruction in the gullet at the entrance to the 
chest. In some cases this cannot be overcome, while in others it is found 
that at times the instrument can be got to enter the rumen. Owing to 
the pressure exerted on the large veins, an oedematous swelling occurs on 
the dewlap, and gradually extends up the tracheal region to the throat and 
also to the fore-limbs. The jugular veins are much dilated and prominent, 
but there is no venous pulse. The mammary veins and the facial veins 
are also distended with blood. The cardiac beats are much accelerated, 
but the cardiac impulse may be difficult to detect. Accelerated irregular 
respirations and evidences of pulmonary cedema and hydrothorax are also 
present. Emaciation and cachexia are observed in the later stages. 

DIFFERENTIAL Dr1acnosis.—The disease may be mistaken for trau- 
matic pericarditis. This is more especially the case when the heart is 
surrounded by neoplasms, so that the normal sounds and cardiac impulse 
are difficult to detect. But under ordinary conditions, in tumours of the 
mediastinum, the cardiac phenomena do not show the characteristic 
alterations present in traumatic pericarditis (see p. 1099). 

TREATMENT.—Therapeutical measures of any kind are of no value in 
this condition. 


DISEASES OF THE MEDIASTINUM IN THE DOG. 


Tuberculosis is the most common cause of enlargement of the medias- 
tinal glands in the dog. The lesions may occur independent of tuber- 
culosis of the lungs and pleure. They may reach tremendous dimen- 
sions, and not rarely become cystic. 


DISEASES OF THE MEDIASTINUM: DOG Jug 


Amongst other causes may be mentioned lymphadenitis, lympho- 
sarcoma, carcinoma of the lung, and ossifying chondromata. 

Symproms.—In the case of enlargement of the mediastinal 
glands due to tuberculosis, Gray has observed that in the early stages 
only a slight occasional cough followed by expectoration is present, but 
later on the dog becomes unthrifty, and shows a staring coat and eleva- 
tion of temperature. The lower region of the chest wall appears to fall 
in on each side, the cardiac impulse can be detected by palpation, and 
the cardiac sounds are audible by auscultation all over the thoracic region. 
When tuberculin is employed as a diagnostic agent in this condition, it 
usually causes a severe reaction and marked aggravation of the symp- 
toms. | : 

Cadeac records the following symptoms: A violent cough occurring in 
paroxysms, and due to pressure on the vagus. When paralysis of this 
nerve 1s produced by the continued pressure, the cardiac beats become 
accelerated and violent, and the cardiac impulse is perceptible to inspec- 
tion. In some cases a roaring sound accompanies respiration. 

DifFERENTIAL D1aGnosis.—In cases where the lesions are suspected 
to be tuberculous, the tuberculin test must be employed. When the 
symptoms are due to lymphadenitis (Hodgkin’s disease), the presence of 
enlarged glands in various regions of the body is suggestive. 

TREATMENT.—Palliative treatment may be adopted in cases where 
the tuberculin test shows the absence of tuberculosis. Iodide of sodium 
with arsenic may be tried, but in the majority of instances treatment 
proves useless. 


DISEASES OF THE CIRCULATORY ORGANS 
IN THE HORSE 


By E. WALLIS HOARE, F.R.C.V.S. 


INTRODUCTORY REMARKS. 


THESE diseases will be considered in the following order: (1) Diseases of 
the Pericardium ; (2) Diseases of the Heart ; (3) Diseases of the Bloodvessels. 

Before proceeding to deal with these affections it is desirable to devote 
some space to the subject of alterations in the character of the pulse in 
connection with cardiac diseases, and to the physical examination of the 
heart. These are of great importance to the clinician, and will amply 
repay careful study. 

Diseases of the heart are regarded by some writers as being of com- 
paratively rare occurrence in the horse. 

¥. Smith* states: ‘‘ Disease of the heart of the lower animals is un- 
common.... The hearts of horses exposed to the greatest strain seldom 
show any pathological change; probably the most uncommon lesions 
found on post-mortem examination are those affecting the heart.” We 
cannot agree with these statements, as experience has taught us that, 
especially in the case of aged horses, cardiac lesions are frequently met 
with post mortem. We readily admit that, owing to the difficulties in 
diagnosis, and to the fact that the physical examination of the heart is 
not studied with anything like the same degree of exactitude in 
veterinary practice as compared with human medicine, many cases of 
cardiac disease are overlooked in the horse. We must admit also that, 
in consequence of not being able to gain any assistance from subjective 
symptoms in our patients, we are placed at a great disadvantage as 
compared with the human physician. In very many cases of cardiac 
disease in the horse no symptoms are presented that would direct our’ 
attention to the heart, and it is only by the systematic employment of 
the stethoscope that we can succeed in detecting the presence of lesions 
of this organ, which otherwise would be overlooked. Practitioners who 


* “Veterinary Physiology,” 1912. 
1000 


DISEASES OF THE CIRCULATORY ORGANS: HORSE 1001 


have devoted special attention to this subject—and they are on the 
increase—support the above view, and in the present day we are com- 
mencing to recognise that many horses suffering from chronic cardiac 
affections can and do perform fast work, without the owners having any 
suspicion of the existence of the lesions. This is demonstrated by the 
fact, not uncommonly observed, of horses in apparent health, and per- 
forming their usual work, dropping dead, and showing on post-mortem 
examination well-marked cardiac lesions. Even the older authors recog- 
nised the comparative frequency of latent cardiac disease in the horse. 
Percivall* remarked in dealing with cardiac affections: “ The class of 
diseases we are now about to consider may be regarded as the least 
advanced of any in veterinary medicine—a circumstance not to be ascribed 
so much to their comparative rarity as to their existing undiscovered, 
or rather being confounded during life with other disorders, and in par- 
ticular with pulmonary affections, with which they will be found in 
practice often to be combined.” After drawing attention to the improved 
methods of diagnosis in diseases of the heart in human medicine as the 
result of the researches of Leennec and the employment of the stethoscope, 
he remarked: “ To the same influential auxiliary must veterinary surgeons 
have recourse, if they would aspire to anything approaching the same 
perfection of art.” 

W. Williams} observed that ‘‘ Heart diseases, although rare in the 
lower animals as compared with man, and much more difficult of diagnosis, 
are neither infrequent nor unimportant.” 

Law,t in considering the subject, after drawing attention to the 
facilities open to the human physician in the diagnosis of cardiac diseases, 
remarks: “ Veterinarians have too generally refused to face the difficulty, 
preferring to ignore heart diseases, or, still worse, seeking to cover their 
ignorance by the assertion that such affections rarely exist.” 

Friedberger and Fréhner§ state: ‘‘ Valvular defects are extraordin- 
arily common among our domestic animals, especially dogs, horses, and 
pigs.” 

In order to appreciate the alterations brought about by cardiac 
diseases, and to draw correct deductions from a physical examina- 
tion of the heart, it is essential for the student to be perfectly familiar 
with the characters of the normal pulse, and with the cardiac 
sounds as studied by means of the stethoscope. To educate himself 
in such matters he should make a practical study of the subject on 
a number of healthy horses before commencing his observations on 


* “ Hippopathology.”’ 
~ “‘ Principles and Practice of Veterinary Medicine.” 
t “ Veterinary Medicine,”’ § “ Veterinary Pathology.’ 


1002 SYSTEM OF VETERINARY MEDICINE 


cases of cardiac disease. The stethoscope, like all instruments of pre- 
cision, requires a long course of study before the technique of its 
successful application can be mastered. The advantages which the instru- 
ment possesses over the direct method of examining the heart are quite 
obvious, and amongst these must be mentioned the facility with which 
the points of maximum intensity of the various cardiac murmurs can be 
determined by the aid of this instrument. Some practitioners prefer an 
instrument termed the “ phonendoscope,” but after a trial of both we 
think that the binaural stethoscope, especially the pattern known as 
Haydn-Brown’s, is the most useful for the purpose of auscultation. 
It is essential, in order to avoid erroneous conclusions, that special care 
should be exercised in using the instrument. Certain sounds, such as 
those due to the contact of the instrument with the hair, or arising from 
movements of the skin in the case of a nervous, irritable animal, may 
easily be mistaken for murmurs. Similar errors may arise In connection 
with the vesicular murmur arising from the lungs, or from sounds originat- 
ing in the double colon (borborygmi). Constant practice in the use of the 
instrument will overcome these difficulties. Perfect quietness of the 
surroundings is essential. Another matter of importance which should 
not be overlooked is that in the case of nervous or unhandled horses the 
mere application of the instrument may cause disturbance of the cardiac 
action, if not actual palpitation, and this must not be mistaken for 
disease. We must admit that errors are far more likely to occur from 
imagining that a cardiac murmur is present than from overlooking its 
presence. In well-marked cases of valvular disease the murmur is 
detected with comparative facility, but to ascribe it to its origin is quite 
another matter, and requires considerable experience. 

In order to draw correct inferences it is always advisable to make 
several examinations of a case at intervals before giving a definite 
diagnosis. 

The Pulse-—Under normal conditions each beat of the pulse corre- 
sponds to a contraction of the heart. As pointed out by F. Smith,* when 
the left ventricle contracts it drives a new supply of blood into an already 
full aorta. In order that the latter may accommodate this blood, the 
vessel distends, and then an elastic recoil of its wall occurs, which propels 
the blood along another segment of the vessel, which also distends and 
then recoils, and the process is repeated as a wave throughout the arterial 
system. ‘ This distension and elastic recoil is the pulse.” 

It can be readily understood how diseases of the heart induce altera- 
tions in the character of the pulse. Although such alterations per se 


* “ Veterinary Physiology.” 


DISEASES OF THE CIRCULATORY ORGANS: HORSE 1003 


cannot be regarded as diagnostic symptoms of cardiac diseases, yet taken 
in conjunction with the evidences obtained from a physical examination 
of the heart, they prove very valuable. Space will not permit us to 
enter into a description of the various alterations occurring in the pulse 
as the result of diseased conditions of the body. For information on these 
points the reader is referred to our work on “ Veterinary Therapeutics.” 
Here we shall only refer to alterations of the pulse in connection with 
cardiac disease. : 

Irregular Pulse—This term signifies that the pulsations occur at 
irregular intervals, and are usually unequal in force. In some instances 
it is a temporary condition arising from slight reflex irritation, such as 
occurs in indigestion, or from the presence of parasites in the gastro- 
intestinal canal. When persistent it is often associated with cardiac 
diseases, but it cannot be regarded per se as an indication of the presence 
of such affections. 

Intermittent Pulse.—In this a pulsation is omitted from time to time. 
The intermittency may occur at regular intervals—i.c., at the end of a 
certain number of beats, or irregularly, so that only an occasional omission 
of a beat is observed; this is termed an “irregularly intermittent pulse.” 
The pulse may be irregular as well as intermittent. 

In certain cardiac affections the ventricular systole is too feeble to 
develop a perceptible pulse-beat—+.e., the pulse wave is abortive—hence 
the pulse is found slow and intermittent, although the cardiac contractions 
are normal as regards frequency; this is sometimes termed “ false inter- 
mission.” An intermittent pulse may be compatible with apparent 
health (see p. 1023). 

‘ Water-Hammer,” Collapsing, or Corrigan’s Pulse, is met with in 
aortic insufficiency and in aneurism of the aorta. The pulse-beat is 
sudden and abrupt, and is followed by an equally sudden collapse of the 
vessel (see p. 1053). 

Jugular Pulse—This is also termed the “venous pulse.” In the 
normal horse distinct pulsations are seen in the jugular veins at the 
root of the neck, but they do not extend any distance upwards, and are 
believed by some observers to depend on the pulsations in the carotid 
arteries. According to F. Smith, the normal jugular pulse is due to a 
backward positive wave in the anterior vena cava which occurs at the 
moment of systole of the auricles. When horses are cast for operations, 
a more distinct jugular pulse is observed, and Stockman suggests that 
it probably originates in a congestion of the pulmonary vessels. The 
true venous pulse is, however, distinct from the above. A well-marked 
wave passes up each jugular vein with each cardiac systole, and is fol- 


1004 SYSTEM OF VETERINARY MEDICINE 


lowed by a retrograde wave. This is plainly visible to inspection, and, 
as pointed out by Stockman, the wave is double. According to Hutyra 
and Marek, the explanation of the systolic jugular pulse—z.e., when the 
pulsation follows immediately upon the heart-beat—in insufficiency of 
the tricuspid valve is as follows: When the auricle is unable to propel its 
entire blood-content owing to diminished power in its walls, a certain 
amount of blood is forced at each systole from the right ventricle into the 
right auricle, and from the latter into the vene cave. Owing to this 
regurgitation a systolic wave is produced which is transmitted to the 
jugular veins. A presystolic jugular pulse—i.e., one which precedes the 
heart-beat—may also be observed in tricuspid insufficiency. 

Although a jugular pulse is stated by some authors to be pathog- 
nomonic of tricuspid insufficiency, it is also observed in cases of mitral 
incompetency, and in such instances it probably depends on an associated 
dilatation of the right ventricle, with relative insufficiency of the tricuspid 
valve (see p. 1058). 

In many instances a distinct dilatation of the jugular veins is associated 
with a jugular pulse. 

Sounds of the Heart.—It is important that the student should be 
thoroughly acquainted with the character of the normal sounds of the 
heart, and also with the mode of their production. The space at our 
disposal will not permit us to enter into a consideration of this subject, 
but the reader is referred to F. Smith’s “‘ Veterinary Physiology ” for a full, 
clear, and lucid description of this important matter. 

Here we shall only remark, as pointed out by the above author, that 
the first sound of the heart is made up of two causes—viz., the muscle 
sound of the contracting ventricle and the closure of the auriculo- 
ventricular valves. The second sound is due to the closure of the aortic 
and pulmonary valves. According to the same author, the sounds “ are 
heard better on the left side than the right, not because the heart is 
nearer to that side than to the other, but for the reason that there is a 
larger gap in the left lung, which exposes the heart and allows its impulse 
to be felt against the chest wall.” 

Physica] Examination of the Heart—Insprction.—In equine practice 
the only evidences obtained from inspection are pulsation in the cardiac 
area, which is observed in some cases of valvular disease, also in thin, 
well-bred horses that are clipped, the cardiac impulse may be visible 
in certain cardiac affections when palpitation occurs. 

Inspection also enables us to detect the presence of a jugular pulse. 

Patpation.—By this means the character of the cardiac impulse is 
determined, and the presence of a fremitus or “ thrill” can be detected.. 


DISEASES OF THE CIRCULATORY ORGANS: HORSE 1005 


The Cardiac Impulse is felt between the fifth and sixth ribs. F. Smith 
points out that it is not given by the apex, but by the lower half of the 
left ventricle, as the apex practically does not move as long as the heart 
is retained within the pericardium. In fat horses the cardiac impulse 
is not felt with such facility as under opposite conditions. According to 
Stockman it is best felt in the fifth intercostal space, a few inches from 
the floor of the sternum. 

Fremitus or Thrill.—This is detected in some cases of valvular 
disease, and, according to Cadéac, it is due to the vibration of the 
blood against the wall of the affected cardiac orifice. In some instances 
it is of a purring character (frémissement catavre). 

PrRcussion.—This is applied in order to determine the presence of 
an increase in the area of cardiac dulness,.such as occurs in cases of cardiac 
hypertrophy, and also in pericardial effusion and hydropericardium. 
Stockman* devoted special attention to the subject, and he concludes 
that if absolute dulness is detected in the area extending from the posterior 
border of the fifth rib into the sixth intercostal space, one may conclude 
that hypertrophy of the heart is present. He has never found cardiac 
dulness beyond the seventh rib. In carrying out percussion the left fore- 
leg is drawn forward by an assistant until the lower part of the third rib 
is exposed. 

AUSCULTATION.—This is the most important diagnostic procedure in 
the detection of abnormal conditions of the cardiac valves. The majority 
of authors state that, owing to anatomical peculiarities in the larger 
animals, auscultation of the heart is surrounded by marked difficulties. 
These peculiarities are—the heavy muscular shoulder which covers the 
upper and anterior region of the heart, the thickness of the thoracic walls, 
and the small area of the organ which is available for examination owing 
to the heart being to a great extent covered by the lungs. Moreover, 
it is difficult or impossible to examine the large vessels arising from the 
heart. The difficulties in connection with the employment of the 
stethoscope have already been alluded to (see p. 1002). 

Nevertheless, some at least of these difficulties can be overcome, and, 
as Stockman has pointed out, by drawing the left fore-leg of the animal 
well forward so as to expose the third rib a good portion of the cardiac 
area can be made available for auscultation. This writer has found that 
the cardiac sounds are best heard in the areas which correspond most 
nearly to the seat of their production. Thus the first sound is best heard 
at the anterior border of the fifth rib in the cardiac area, being carried 
well backwards and downwards over the extent of the ventricular wall. 


* Journal of Comparative Pathology and Therapeutics, 1894. 


1006 SYSTEM OF VETERINARY MEDICINE 


It diminishes in intensity in a forward direction until it almost disappears 
at the posterior border of the third rib. The second sound is best heard 
at the anterior border of the fourth rib in the cardiac area; it decreases 
in distinctness in a backward direction, and is carried well down the 
ventricular wall. 

With reference to reduplications of the sounds, Stockman has observed 
that such a condition may be compatible with health, and that the first 
sound is frequently double in the absence of any cardiac lesion. The 
seats of the various murmurs occurring in chronic valvular disease will 
be described under the section dealing with that subject (see p. 1051). 

Murmurs.—These are abnormal sounds which may precede, take the 
place of, or follow one or other of the cardiac sounds. They usually 
depend on the presence of lesions in the cardiac valves, but may also 
occur in the absence of valvular lesions (see p. 1050). The character of the 
murmurs, and the areas where they are best heard (points of maximum 
intensity), will receive attention in the section on Chronic Valvular 
Diseases (see p. 1051). | 

As regards the explanation of how murmurs are produced, authorities 
differ in their views on this point. Stockman remarks that in valvular 
incompetency, owing to the column of blood passing in a backward 
direction and meeting with the advancing one, an eddy is produced and 
a murmur arises. In stenosis of a cardiac orifice the volume of blood 
passes through it with greater difficulty into a bagel wide cavity 
beyond, and a murmur results. 

With regard to the time at which murmurs are heard, they are termed 
systolic when occurring during systole, and diastolic when arising during 
diastole. When occurring just previous to systole—i.e., with the auricular 
contraction—they are termed presystolvc. 

In order to determine the time of the murmur, if by placing a finger 
on a convenient artery the murmur is found to be coincident with the 
pulse, it is systolic in time; if, on the other hand, it is heard after the pulse 
or after the second sound of the heart, it is diastolic in time. 

Ante-Mortem and Post-Mortem Clots.—In connection with autopsies 
on cases of cardiac disease it 1s of importance to differentiate ante-mortem 
and post-mortem clots. 

Post-Mortem Clots are formed after the death of the animal. Accord- 
ing to Cadéac, they occur in the right auricle and ventricle, and are only 
found in the left ventricle in cases of sudden death from syncope. They 
are formed slowly, as coagulation of the blood is not a quick process. 
They are generally “ buffy,” the upper layer being pale, owing to the 
sinking of the red corpuscles to the lower layers. They are also watery 
and non-adherent. 


DISEASES OF THE PERICARDIUM: HORSE 1007 


Clots formed in the heart just before death are usually classified as 
‘* post-mortem clots,” though in reality this designation is not correct, 
as the former connect the post-mortem clot with the true ante-mortem 
clot or thrombus. They depend on a stagnation of the blood in the 
heart, owing to the inability of the latter, through weakness, to empty 
its cavities. The process of coagulation is hastened by the “ whipping ” 
effect of the chorde tendinee. Such clots are of a uniform yellow colour, 
are firm in consistency, and frequently extend some distance into the 
large vessels, from which they may be drawn in long strings. They are 
non-adherent to any part, though they may be closely entangled with the - 
chordee tendinee. 

True Ante-Mortem Clots, or Thrombi, always depend upon some 
marked alteration of the endocardium. They may occur towards the 
apex of the heart, or in the depth of the auricle, but are more frequent 
on the free border of the valves. In some cases they completely fill the 
left auricle and ventricle. When formed for some time they are yellowish 
or greyish in colour, and are composed of a series of layers of fibrin on 
the mural endocardium or on the diseased valves. In some cases the 
deposits of fibrin are elastic, resistant, or friable. They adhere more or 
less firmly to the endocardium, which is inflamed and rugged at certain 
points, but smooth at others. The clots may be prolonged into the aorta, 
and even into one of the coronary arteries (Cadéac). 


DISEASES OF THE PERICARDIUM. 
PERICARDITIS (INFLAMMATION OF THE PERICARDIUM). 


GENERAL REMARKS.—Some authors state that pericarditis is not a 
common disease in the horse. According to Hutyra and Marek, it is of 
rare occurrence in equines as compared with other species of animals, 
and in the former is usually met with as a sequel to pneumonia. F. 
Smith* states: ‘‘ There are few attacks of severe pleurisy in the horse 
which are not associated with pericarditis, followed not only by a great 
thickening of the heart sac, but of more or less extensive effusion into it.’’ 

Judging by the results of autopsies, we are inclined to the opinion that 
the disease is more common than is generally imagined; but, owing to the 


* “ Veterinary Physiology.” 


1008 SYSTEM OF VETERINARY MEDICINE 


obscure nature of the symptoms, and also to the fact that it usually 
occurs as a secondary condition, its presence is often overlooked during 
life. No doubt it is easy to describe what are regarded as the diagnostic 
features and physical signs of the disease, but their clinical application 
is surrounded by great difficulties. These points will receive attention 
farther on. : 

With reference to the frequency of the disease, it is interesting to note 
that, according to the Report of the Army Veterinary Service, 1911-12, 
2 cases of pericarditis were admitted for treatment, while for the same 
period the number of cases of pleurisy was 47, of influenza 20, and of 
pneumonia 293. In the Report for 1912-13, the figures stand as 
follows: Pericarditis, 2; pleurisy, 34; pneumonia, 296; influenza, 1. 
In the Reports of the Army Veterinary Service in India for 1911-12 and 
1912-13, the figures stand as follows: 1911-12—Pericarditis, 5; pleurisy, 8; 
pneumonia, 21; influenza, 101. 1912-13—Pericarditis, 6; pleurisy, 5; 
pneumonia, 21; influenza, 87. 

As a primary disease pericarditis is very rarely met with, but occasion- 
ally cases of the affection are observed in which it is difficult or impossible 
to trace the etiology. In the large majority of instances the disease is 
secondary, either arising in connection with other morbid conditions, or 
by extension from contiguous organs. 

Some authors recognise two types of the disease—viz.: 

1. Acute Fibrinous, Plastic, or Dry Pericarditis, characterised by a 
small amount of fibrinous exudation, a slight amount of effusion, and a 
benign course. 

2. Pericarditis with Effusion, also known as sero-fibrinous pericarditis , 
in which an abundant effusion is present. It is a serious and very 
important affection. 

We consider that there are sufficient reasons for describing pericarditis 
under one heading. In the first place, although admitting that the dry or 
plastic form may occur and recovery may result, the symptoms are not 
sufficiently marked to draw the attention of the practitioner to the cardiac 
region. No doubt if a careful physical examination of this region were 
always carried out it is possible that some at least of these cases would 
be recognised. In the next place, this dry form constitutes the first 
stage of sero-fibrinous pericarditis, and some authors hold that when the 
inflammatory process ceases at this stage the dry or plastic form results. 
According to this view, the sero-fibrinous type should be regarded as the 
direct sequence of the dry form and as the second stage of the disease. 
We deem it more convenient and more in accordance with the clinical 
aspect of the subject to describe the disease under the heading of sero- 


DISEASES OF THE PERICARDIUM: HORSE 1009 


fibrinous pericarditis, and to point out the symptoms of the various 
stages. The nature of the effusion will demand attention, as, under certain 
circumstances, it shows important changes, and may become purulent 
or hemorrhagic in character. The chronic form of pericarditis must also 
be considered. Latent types are sometimes met with in chronic diseases, 
being generally discovered post mortem. 


ACUTE SERO-FIBRINOUS PERICARDITIS. 


Synonym.—Pericarditis with effusion. 

Etrotocy.—In former times an idiopathic type of the disease was ° 
recognised. Exposure to chills, insufficient shelter, and inadequate food, 
were regarded as etiological factors by Robertson, who met with cases 
in horses under two years of age subjected to the above unfavourable 
conditions. In the present day such causes are believed to act as pre- 
disposing factors by lowering the vital resistance of the animal. The 
disease in all its types is regarded as depending on microbial infection, 
although the specific micro-organisms have not been definitely deter- 
mined. According to Hutyra and Marek, the bipolar bacillus, not only 
alone, but also in association with other micro-organisms, may be an 
important etiological factor, and these authors point out that in the 
diseases for which this bacterium is responsible pericarditis is occasionally 
found as one of the lesions. They regard the pyogenic bacteria and the 
tubercle bacillus as also capable of taking part in the production of the 
disease. According to Cadéac, the strangles streptococcus, the micro- 
organisms causing pneumonia, staphylococci, etc., may be etiological 
factors. Assuming the microbial nature of the disease, one can under- 
stand the manner in which pericarditis occurs as a secondary condition in 
connection with pleurisy, pneumonia, influenza, strangles, purpura 
heemorrhagica, septicemia, pyemia, tuberculosis, etc. Infection takes 
place by way of the blood and lymph streams, and probably a combination 
of micro-organisms are responsible. Enzo6étic outbreaks of pericarditis 
were recorded by Tabusso. Verheyen met with 104 cases of the disease 
in one year. Woerz and Dumas observed pericarditis associated with 
epizodtics of pleurisy and pneumonia. According to Cadéac, one may 
observe during an epizootic outbreak a series of cases of pneumonia, then 
a series of pericarditis, with occasional cases of pleuro-pneumonia, 

Rheumatic Influences—Some authors ascribe considerable importance 
to the influence of rheumatism in the production of pericarditis. It is 
difficult to explain the connection, seeing that little is definitely known 


with reference to the pathology of rheumatism. In man pericarditis 
VOL, Il. 64 


1010 SYSTEM OF VETERINARY MEDICINE 


occurs most frequently in connection with rheumatic fever, and the 
percentage given by different authors ranges from 30 to 70. In 330 cases 
of rheumatic fever (Johns Hopkins Hospital) pericarditis occurred in 20— 
practically 6 per cent.* Rheumatic fever in the horse no doubt occurs, 
but it is rare, and has not been specially studied. But clinical evidence 
is not wanting to show that pericarditis may be associated with arthritis 
of a rheumatic nature. We have observed cases in young horses badly 
fed, and exposed to cold and wet, in which lameness of a metastatic 
character was associated with swollen joints, high fever, and evidences of 
pericarditis. Leblanc recorded instances in which pericarditis preceded, 
coincided, or followed the inflammation of the synovial membranes. 
Several other Continental observers recognise the association of peri- 
carditis with articular or muscular rheumatism. Robertson regarded 
rheumatism as “the most potent cause of pericarditis in the horse.” 
W. Willams met with outbreaks of influenza which were of a rheumatic 
type, with a tendency for the pleure, pericardium, and endocardium to 
become involved, as well as the fibrous structures of other parts of the 
body. 

Traumatic Causes.—Traumatic pericarditis is rare in the horse as 
compared with cattle; in the latter it constitutes a very important form 
of the disease (see p. 1099). Henniges recorded a case in which a needle 
entered the pericardium, probably by passing through the cesophagus. 
Lewin met with an instance in which a darning-needle was found in the 
pericardium, having probably passed through the wall of the stomach or 
duodenum. 

Contusions of the cardiac region are regarded as a cause of pericarditis 
by lowering the vitality of the parts, and thus permitting micro-organisms 
which are present in the blood-stream to invade and multiply in the 
injured area. A punctured wound involving the pericardium, or a 
fractured rib, one of whose ends penetrates the structure, can also set up 
the disease, in which case the lesions are of a septic character. As a rare 
cause of pericarditis, we may mention the presence of neoplasms. A 
latent or terminal form of the disease has been met with in cases of chronic 
nephritis or other chronic diseases. Borchardt recorded a case of lysol 
poisoning in the horse, in which a sero-heemorrhagic pericarditis associated 
with nephritis and hepatitis was present. 

Morsip Anatomy.—The lesions vary according to the intensity of 
the inflammatory process, the nature of the disease with which the peri- 
carditis is associated, and the stage at which death has taken place. 
Opportunities for examining the lesions of the early or dry stage do not 


* QOsler’s ‘‘ Practice of Medicine.’ 


DISEASES OF THE PERICARDIUM: HORSE 1011 


often occur, as death rarely sets in at an early period. Moreover, in the 
form known as “ fibrinous” or “dry” pericarditis a fatal termination is 
not common, except as the result of an associated disease. Chronic 
lesions of the pericardium are not uncommonly found as a surprise 
at autopsies. 

In the early stage the lesions may be partial or general. In some 
instances the morbid changes are limited to the base and median portion 
of the structure, but in the majority the entire pericardium is involved, 
the visceral layer being chiefly affected. The external aspect is involved 
when the disease is associated with pleurisy. In mild cases the visceral — 
layer shows a lustreless, roughened appearance, due to the presence of a 
thin fibrinous sheeting; on removal of the latter the serosa is injected or 
ecchymotic. As the exudate increases in amount a series of layers is 
formed of firmer consistence than the original sheeting, and, owing to the 
constant movements of the adjacent surfaces, either a ridge-like or a 
reticulated aspect is produced. In cases where the fibrinous exudate is 
more abundant, the surface of the heart becomes uneven, and owing to 
the formation of long shreds of fibrin a villous or shaggy appearance is 
produced (cor villosum). The fibrinous exudate usually contains a small 
amount of fluid, also leucocytes and endothelial cells. In mild cases the 
myocardium appears normal, but if the attack be prolonged and severe, 
myocarditis is present; a very superficial depth of the muscle beneath the 
visceral pericardium shows a pale turbid appearance. The inflam- 
mation may subside at this stage, and, in the case of a very thin layer of 
exudate, absorption may occur without the formation of adhesions. 
Generally, however, the thin fibrinous laminz gradually become converted 
into connective tissue, which causes adhesion between the visceral and 
parietal layers of the pericardium. The changes above described are 
those met with in the acute fibrinous, dry, or plastic form of pericarditis. 

But in most instances the inflammation progresses, the exudation 
increases, and the sero-fibrinous form of the disease is produced; this is 
also known as pericarditis with effusion. The amount of effusion varies ; 
it may be very large, and then causes great distension of the pericardial 
sac, so that the latter occupies a considerable proportion of the thoracic 
cavity. Cases are recorded in which the effusion amounted to 15 or 20 
litres, or even 40 litres. 

The effusion may be sero-fibrinous, hemorrhagic, or purulent in 
character. 

The sero-fibrinous effusion may be colourless, slightly yellow, or cloudy, 
and contains flocculi of fibri. The parietal pericardium is thickened, 
and may become very firm in texture. 


1012 SYSTEM OF VETERINARY MEDICINE 


The hemorrhagic or sero-sanguinolent effusion may be associated with 
acute infectious diseases, neoplasms of the pericardium, tuberculosis, or 
it may result in the sero-fibrinous form during the process of organisation, 
when small vessels become ruptured, either by the movements of the 
heart or by a fresh attack of inflammation. 

The purulent or sero-purulent effusion is met with in strangles or other 
pyemic infections; it may be thick and opaque, or thin and turbid, and 
contains flocculi of fibrin. The visceral and parietal layers may show a 
rough granular surface of a greyish tint, and occasionally erosions may 
be present on the visceral membrane. 

Morbid alterations are observed in the myocardium; infiltration of 
the connective tissue septa with a sero-cellular exudate may occur. and 
if the effusion be extensive, the heart is compressed and atrophy of the 
organ results. The heart muscle may show on section, to a very super- 
ficial depth, paleness and turbidity, with evidences of fatty and granular 
changes. 

When the stage of absorption occurs, the exudate undergoes fatty 
degeneration, and is absorbed by the lymphatics; but it is rarely that a 
complete return of the membrane to a normal condition is established, 
and usually chronic lesions remain. In some instances lesions of endo- 
carditis are associated with those of pericarditis. Passive congestion of 
the lungs and cedematous infiltrations of the connective tissue in the 
dependent parts of the body are often present. 

Chronic Lesions.—These may consist of simple thickening of the peri- 
cardium, firm adhesion of the visceral to the parietal layer (cardiac 
symphysis), adhesion of the pericardium to the centre of the diaphragm 
or to the costal pleura. In cases where adhesions are absent, whitish 
rounded or oval spots may be observed on the layers of the pericardium, 
especially where this structure comes into contact with the thoracic wall 
during the cardiac impulse. An extensive effusion in the pericardial sac 
is another phenomenon common to chronic pericarditis. 

Symproms.—As already remarked, the “dry” form of pericarcitis, 
or the early stage of the sero-fibrinous type, is likely to be overlooked 
owing to the lack of definite symptoms which point to a morbid condition 
of the cardiac region. The phenomena presented may resemble those 
occurring in the early stages of pleurisy, and a physical examination of 
the heart is essential in order to detect the evidences of pericarditis. 
The fever varies in degree; as a rule the temperature is not high, but 
when the pericarditis is associated with an acute infectious disease or 
with acute rheumatism, hyperpyrexia may occur. Rigors and coldness 
of the extremities may be observed; the patient avoids all motion. In 


DISHASES OF THE PERICARDIUM: HORSE 1013 


very acute cases evidences of dull pain may be manifested. Pressure on, 
or percussion of, the region of the heart causes the animal pain, and 
groaning is produced. The respirations are shallow and of the abdominal 
type. The pulse is increased in frequency, and may be of a wiry char- 
acter. The cardiac impulse is increased in intensity, and the heart-beats 
are irregular. A feeble suppressed cough may be present; this is attrib- 
uted by Cadéac to irritation of the vagus. If the animal be forced to 
move, cardiac palpitation is produced. Lameness is sometimes observed 
in a fore-limb. W. Willams observed, both in pericarditis and endo- 
carditis, spasms or cramps of the superficial muscles of the neck and . 
pectoral region, and occasionally of those of the posterior extremities. 
The disease may not progress farther, and recovery may ensue, the 
symptoms gradually disappearing. 

When, however, effusion occurs, new symptoms develop. These 
depend on distension of the pericardial sac, which interferes with the 
action of the heart and with the general circulation; myocardial changes 
also exert important effects. The fever abates, and evidences of pain 
disappear. The pulse becomes small, thready, intermittent, and irregular, 
and the cardiac impulse weaker. In extensive effusion the heart-beat 
can only be detected with difficulty; the respirations are laboured, owing 
to displacement and compression of the lung by the distended peri- 
cardium, and also to pulmonary cedema. The veins become distended, 
this phenomenon being most noticeable in the jugular veins. A true 
venous pulse is not present, but undulations are observed which slightly 
precede the heart-beats (presystolic venous pulse). C&dematous swellings 
appear on the inferior aspect of the sternum and anterior abdominal 
region. | ) 

PuysicaL Signs.—These are of great importance from a diagnostic 
point of view. | 

Palpation.—In the early or “dry” stage pressure of the cardiac 
region causes the patient to flinch and groan. In some cases a fremitus 
or thrill is detected when the hand is applied to this region, and ‘is 
due to the rubbing of roughened pericardial surfaces together. When 
effusion occurs the cardiac impulse becomes gradually diminished, and 
when the amount of fluid is extensive the heart-beats may not be 
detected. 

Percussion.—In the stage of effusion the area of cardiac dulness is 
greatly increased, but, as pointed out by Hutyra and Marek, this can 
only be detected when a large amount of fluid or fibrinous exudate is 
present, or in the case of neoplasms of the pericardium. According to 
these authors, the increase in dulness gradually extends upwards as 


1014 SYSTEM OF VETERINARY MEDICINE 


high as the line of the shoulder, and backwards to the sixth or seventh 
intercostal space. 

Auscultation.—In the early or “dry” stage friction sounds are 
detected. They are limited to the cardiac region, and may be audible 
on both sides of the chest. They depend on the movement of the altered 
visceral and parietal layers on each other, and are of a to-and-fro char- 
acter, not synchronising accurately with the heart-sounds, as they 
usually outlast the time occupied by the latter. The friction sounds may 
be of a creaking kind, or may be grating or rasping in character. It 
must be remembered, however, that these sounds may be heard at one 
examination of the case and not at another, and, according to Robertson, 
they are often ill-defined; this is also our experience. 

In the stage of effusion the friction sounds usually disappear, but, 
as pointed out by Hutyra and Marek, if the amount of fluid be small, or 
if with an extensive effusion very copious masses of fibrin are present, 
the pericardial layers may come into contact, and friction sounds will 
then persist. During the stage of absorption these sounds may reappear. 
The cardiac sounds gradually become weakened, and as effusion increases 
they become muffled and indistinct. In the case of an extensive effusion 
they may become inaudible. 

Some authors describe other phenomena, such as a “ cooing ”’ sound 
when the animal is forced to move; also a sound of a splashing character, 
resulting from the impact of fluid on the fibrinous exudate. We must 
confess that we have never been able to recognise such sounds in the 
horse. There are no special symptoms by which we are enabled to 
distinguish traumatic pericarditis in the horse from the ordinary forms 
of the disease, except an external wound be present. 

CoursE.—This is very variable, as it depends on the rapidity with 
which the effusion develops, on the nature and extent of the exudate, 
on the degree of the myocardial lesions present, and on the nature of the 
disease with which the pericarditis is associated. In favourable cases 
with only a moderate amount of effusion, absorption of the latter takes 
place, evidenced by an improvement in the general symptoms, a gradual 
diminution of the abnormal area of cardiac dulness, and a return of the 
heart-beats and cardiac sounds to normal. Convalescence may be slow, 
owing to the existence of adhesions, which may or may not be permanent 
(see Adherent Pericardium, p. 1017). ) 

In the purulent form, or when the disease is associated with pneumonia 
or pleurisy, a fatal termination usually occurs in about seven days. Cases 
of the sero-fibrinous type may last from two to three weeks, showing, 
perhaps, transitory periods of improvement, and ultimately dying from 


¢ 


DISEASES OF THE PERICARDIUM: HORSE 1015 


myocardial lesions and associated complications, such as pulmonary 
oedema, hydrothorax, etc. Cases are recorded of sudden death during 
convalescence even when progress seemed satisfactory. 

Chronic pericarditis may result from an acute attack, or may develop 
insidiously ; in the latter instance the affection will be overlooked until far 
advanced. The symptoms observed in the chronic form are dyspnoea, 
fatigue on slight exertion, weakness of the cardiac impulse, and mufiled 
cardiac sounds when the amount of effusion is large in extent, also dis- 
tension of the jugular veins, and cedematous swellings on the inferior 
aspect of the sternum. | 

Proewosis.—Even in mild cases this must be guarded. As already 
remarked, the purulent forms and those associated with pneumonia or 
pleurisy are generally fatal. The chronic type seldom repays the cost of 
treatment. 

DIFFERENTIAL D1aGnosis.—As already remarked, in the “ dry ” form 
of the disease the symptoms are generally overlooked. Even in the sero- 
fibrinous type the presence of the affection may not be recognised, more 
especially when it is associated with pneumonia or pleurisy. The diagnosis 
must be based on a physical examination of the cardiac region,but there 
are many conditions simulating pericarditis, and the most experienced 
and observant clinician may arrive at incorrect conclusions with refer- 
ence to the nature of the case. As already remarked, it is easy to describe 
the various features with reference to the differential diagnosis, but it is 
quite another matter to apply them clinically. Even in human medicine, 
where the facilities for a physical examination are far greater, and the 
subject is more carefully studied, the difficulties in diagnosis are admitted. 
by the highest authorities. The following affections are those which are 
likely to offer difficulty in the differential diagnosis. 

Plewrisy.—Friction sounds occur in both pleurisy and pericarditis in 
the early stages. It is suggested that the friction sounds in pericarditis 
synchronise with the cardiac sounds, while in pleurisy they synchronise 
with the respiratory movements. In pleurisy the friction sounds are not 
limited to the cardiac region. but are detected more posteriorly as well. 
It must be remembered that pleurisy and pericarditis are not infrequently 
associated, then the difficulties in diagnosis are largely increased. When 
an extensive effusion is present in pericarditis it may be confounded with 
a pleural effusion, owing to the large area of dulness, especially if the 
Case be examined for the first time. 

According to Hutyra and Marek, the diagnosis is to be based on the 
fact that in pleural effusion the heart-beat and the cardiac sounds are 
not weakened, or only to a slight extent. When pleurisy and pericarditis 


1016 SYSTEM OF VETERINARY MEDICINE 


are associated, the differentiation may be impossible without an explora- 
tory puncture of the thoracic cavity. The above authors state that 
an encapsulated pleural exudate in the vicinity of the heart may also 
simulate pericardial effusion. 

Pneumonia.—Consolidation of the lungs in the lower sections close 
to the heart may give rise to an increased area of cardiac dulness, and 
be mistaken for pericardial effusion. The differential diagnosis is based 
on the altered character of the heart-beat and cardiac sounds in perl- 
carditis with effusion. 

Endocarditis —The following are regarded as the distinguishing 
features: In the early stages of pericarditis friction sounds are detected; 
these are not present in endocarditis. In pericarditis with effusion the 
gradually imperceptible cardiac impulse and muffled cardiac sounds are 
important points in the differential diagnosis. But the morbid sounds 
in endocarditis are notoriously uncertain (see Endocarditis, p. 1041). 
W. Williams stated that pericarditis and endocarditis were generally 
associated, and that it was a most difficult matter to distinguish between 
the two affections. 

Dilatation of the Heart.—This may easily be confounded with peri- 
cardial effusion. In dilatation of the heart the cardiac impulse is more 
distinctly palpable, and the heart-sounds are clearer. But in the majority 
of instances it is highly probable that only an exploratory puncture of 
the pericardium will differentiate the conditions. 

Nature of the Effuston.—An accurate opinion can only be formed after 
an exploratory puncture has been carried out. The nature of the primary 
disease may enable us to offer a guarded opinion in the case. Thus, when 
the pericardial effusion occurs in connection with rheumatism or pleurisy 
the exudate is likely to be sero-fibrinous in character. When associated 
with strangles or other pyemic conditions the effusion is generally 
purulent. 

Chromic Pericarditis —This condition is rarely diagnosed except the 
history of the case can be traced—+z.e., that the affection has followed an 
acute attack. 

TREATMENT.—Perfect rest is essential, also attention to dietetic and 
hygienic details. Continental authors advise the application of an 
ice-bag to the cardiac region in order to alleviate the inflammatory 
process. Its effect, however, is highly problematical. If hyperpyrexia — 
be present, salicylate of soda may be given.in the form of electuary; this 
is especially valuable in rheumatic cases. In the stage of effusion, when 
cardiac weakness is present, some authors recommend digitalis. We 
prefer hypodermic injections of strychnine and caffeine, also the adminis- 


DISEASES OF THE PERICARDIUM: HORSE 1017 


tration of large amounts of normal saline solution by subcutaneous 
injection. In order to promote absorption of the effusion potassium 
iodide may be given. 

If the effusion be extensive, evidenced by dyspnoea, serious inter- 
ference with the action of the heart, small rapid pulse, paracentesis peri- 
cardi (puncture of the pericardium) should be performed. The site 
selected is the fifth or sixth intercostal space on the left side, in the area 
of dulness. Aseptic precautions similar to those advised for paracentesis 
thoracis (see p. 884) should be observed. A fine trocar and cannula is 
employed; the instrument should be directed upwards and inwards so as 
to avoid wounding the heart. Hutyra and Marek suggest that after 
removal of the fluid the pericardial cavity may be irrigated with luke- 
warm sterilised water or a mild antiseptic solution, while if the effusion 
be purulent they advise incision of the pericardium and thorough irriga- 
tion. We hardly think that the latter operation is likely to be attempted 
by the genera] practitioner. 

As already remarked, chronic pericarditis, even if its presence be 
recognised, will hardly repay the cost of treatment. 


CHRONIC ADHESIVE PERICARDITIS. 


Synonym.—Adherent pericardium. 

This occurs as a sequel to pericarditis. Two varieties are recognised— 
viz., (1) Simple adhesion of the pericardial and epicardial layers; this is 
frequently met with at post-mortem examinations, when its presence was 
not suspected during life. It may occur without interfering with the 
function of the heart, or it may induce cardiac hypertrophy. (2) Adherent 
pericardium, with chronic mediastinitis and adhesion of the outer 
layer of the pericardium to the pleura, to the thoracic wall, or to the 
diaphragm. This is the most serious form, as by interfering with the 
action of the heart it may lead to extensive cardiac hypertrophy and 
dilatation. 

Symproms.—In the simple form no symptoms may be present. 

In the other form, symptoms of hypertrophy with dilatation are 
observed (see p. 1027), and in the later stages evidences of cardiac in- 
sufficiency are present, such as palpitation, an irregular weak pulse, 
dyspnoea on slight exertion, swelling of the limbs, ascites, and a jugular 
pulse. | 

D1aenosis.—This presents considerable difficulties. Attention should 
be directed to the history of the case; if it points to an attack of acute 
pericarditis, and if the above symptoms follow, adherent pericardium may 


1018 SYSTEM OF VETERINARY MEDICINE 


be suspected. The information gained from percussion and auscultation 
does not prove of much assistance. 

TREATMENT.—Beyond administering potassium iodide, the value of 
which is problematical, little can be done in the way of treatment. 


HYDROPERICARDIUM. 


SyNnoNyms.—Hydrops pericardii; Dropsy of the pericardium. 

This term is sometimes incorrectly applied to pericardial effusion. 
The affection consists of an accumulation of serous fluid in the pericardial 
sac. It is always a secondary condition, and is associated with chronic 
cardiac and renal affections, owing to the stasis of the blood which is 
produced ; it is also met with in chronic wasting diseases, and frequently 
accompanies dropsy of the other serous cavities of the body. The fluid 
is thin, light yellow or lemon coloured, clear or slightly turbid, and the 
specific gravity is below 1016. 

SyMproms.—The symptoms are similar to those observed in peri- 
cardial effusion, but the history of the case shows an absence of the acute 
phenomena of pericarditis. The evidences of the primary disease are 
generally prominent, and the hydropericardium is often overlooked. 
When the amount of fluid is large, it adds to the gravity of the primary 
disease by interfering with the cardiac and pulmonary functions. 

TREATMENT.—This must be conducted according to the underlying 
conditions present. If the amount of fluid be excessive, paracentesis 
pericardw should be performed. 


HAMOPERICARDIUM. 


In this condition an accumulation of blood occurs in the pericardial 
cavity. It may arise from injury to the heart, resulting from the presence 
of a sharp-pointed foreign body; it is also observed in cases of spon- 
taneous rupture of the heart, or rupture of a dilated coronary artery, or 
of a large vessel trunk, such as the aorta. 

Symproms.—When the hemorrhage is extensive, death occurs rather 
quickly, with symptoms of rapid heart failure due to compression. Accord- 
ing to some observers, the animal may succumb in from half to one hour. 
When the hemorrhage is slow, symptoms resembling those of pericardial — 
effusion will be manifested, with evidences of progressive heart failure 
and dyspnoea. Death is usually preceded by well-marked ansemia of 
the visible mucose. 


DISEASES OF THE PERICARDIUM: HORSE 1019 


PNEUMOPERICARDIUM. 


The presence of air or gases in the pericardial cavity is a very rare 
condition in the horse, but is met with in the traumatic pericarditis of 
cattle. According to Hutyra and Marek, atmospheric air enters the peri- 
cardium only in very exceptional cases, such as penetrating wounds of 
this structure due to external injury, or from fractured ribs, or from 
breaking down of a lung cavity. which had been adherent to the peri- 
cardium. The same authors also state that pneumopericardium may | 
occur in purulent pericarditis, owing to the formation of putrefactive 
gases. 

Symptoms.—On physical examination, percussion over the cardiac 
area reveals a tympanitic sound. In most cases effusion is present as 
well as gases, and a splashing sound is said to be detected on auscultation. 
Petit points out that a diaphragmatic hernia, involving the pericardial 
region or the pericardium itself, may give rise to a tympanitic percussion 
sound. 

TREATMENT.—Operative measures are advised similar to those em- 
ployed for pericardial effusion. 


RUPTURE OF THE PERICARDIUM. 


This is a very rare lesion. In the recorded cases the etiological factors 
were not known, and violent blows or injuries in the vicinity of the cardiac 
region are suggested as probable causes. It is believed that a previous 
attack of pericarditis acts as a predisposing cause by lessening the re- 
sistance of the pericardium. According to Cadéac, it is generally the 
apex of the heart which protrudes through an opening in the pericardum, 
the rupture measuring about 6 to 8 centimetres in length. Larcher records 
cases in which a rupture of the aorta at its origin was followed by rupture 
of the pericardium, owing to pressure exerted by the blood on the walls 
of the pericardial sac. Instances due to penetrating wounds have also 
been met with. 

Symptoms.—There are no characteristic symptoms of the lesion. 
Marked cardiac disturbance is observed, the heart-beats are tumultuous 
and violent, the pulse is intermittent, and becomes imperceptible. Death 
may occur quickly, or in some instances may be delayed for some days, or 
even for two weeks. 


1020 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE HEART. 
FUNCTIONAL AFFECTIONS OF THE HEART. 


GENERAL REMARKS.—These affections are of great importance in 
equine medicine, not in consequence of their serious nature, but because 
of the difficulty often experienced in differentiating them from organic 
cardiac diseases. These functional affections generally depend on 
nervous disturbance, which in its turn may originate from a variety of 
causes, such as dyspepsia, or the effects of a recent attack of an acute 
infectious disease, debilitated conditions, etc. In some instances func- 
tional disturbance of the heart occurs in nervous excitable horses when 
approached by a stranger or frightened by any cause. Again, we must 
point out that the symptoms of functional cardiac disorders may also 
occur in organic diseases of the heart. 


Palpitation. 


An irregular or forcible action of the heart occurs under a variety of 
conditions, and shows various grades of intensity. In a young horse, 
caught for the first time, and especially if subjected to rough handling, 
cardiac palpitation may be so marked that the heart-beats can be heard 
while the observer stands close to the animal; this continues until the 
animal ig released. We have not infrequently met with a nervous ex- 
citable horse in whom the application of a stethoscope has produced 
irregular and forcible action of the heart, so that the examination had 
to be postponed until the animal became placid. Severe frights, the 
securing for operations, excessive exertion, etc., may induce cardiac 
palpitation. The condition may also be observed during convalescence 
from acute debilitating diseases, in cases of anemia, and in dyspepsia.’ 

Symptoms.—In the mild forms the cardiac action may be simply 
accelerated (tachycardia), and may show slight irregularity or intermit- 
tency ; these phenomena may disappear spontaneously in a variable time, 
or may persist indefinitely. In severe cases the cardiac impulse is violent, 
and the heart-beats are accelerated and irregular; similar alterations — 
are observed in the pulse. The symptoms may disappear in a short 
time, but may recur if the animal is again subjected to the exciting 
causes. 

DIFFERENTIAL Diacnosis.—Considerable care is necessary in arriving 
at a diagnosis, so as to avoid mistaking a functional disorder for an organic 


DISEASES OF THE HEART: HORSE 1021 


cardiac disease. The history of the case must be studied, and a very 
careful physical examination of the heart must be carried out. Hasty 
opinions should be avoided, and it is often necessary to make several 
examinations before a definite opinion can be given. The animal should 
be placed in quiet surroundings, and should not be excited in any way. 
When he becomes placid, if the case is one of functional disorder, the 
violent or disturbed cardiac action subsides, and a physical examination 
of the heart will show the absence of phenomena pointing to organic 
disease of the organ. Cases in which the palpitation tends to persist are 
those most likely to be mistaken for organic cardiac disease, and such 
an error has probably occurred in the experience of most practitioners. 
Horses have been condemned for organic disease, have passed into other 
hands, and worked satisfactorily for years afterwards; but, as we shall 
point out later on, the fact of a horse being capable for work does not 
always negative the existence of organic disease of the heart, and remark- 
able instances are recorded in which hunters have been capable of great 
exertion, although suffering from chronic valvular disease, as proved by 
post-mortems. For the differential diagnosis of cardiac palpitation and 
spasm of the diaphragm, see p. 991. 

TREATMENT.—This must be conducted according to the condition on 
which the cardiac palpitation depends. No hard-and-fast rules can be 
laid down; each case must be treated on its merits. When occurring 
during convalescence from influenza and allied affections, cardiac tonics 
are indicated, of which nux vomica or strychnine gives the best result. 


Tachycardia. 


This term is applied to a rapid action of the heart. Some authors 
describe it under the heading of “‘ cardiac palpitation,” and no doubt it is 
generally one of the phenomena associated with that condition; but 
instances are met with in which horses show a rapid action of the heart 
within certain limits, and yet are perfectly normal. Temporary tachy- 
cardia is common in nervous horses when excited, or when approached by 
a strange individual; it also occurs during violent exercise, in cases of 
pain from any cause, and in febrile conditions. 


Bradycardia. 


This signifies a slow action of the heart. In some horses a slower 
pulse than normal is observed, and may be compatible with perfect 
health. It is important to note that in certain pathological conditions 
of the heart the pulse does not always coincide with the c rdiac beats, 
as the latter may be far quicker than the former, 


1022 SYSTEM OF VETERINARY MEDICINE 


EtioLocy.—The condition may accompany various diseases, but 
instances occur in which the etiological factor cannot be determined. 
According to Hutyra and Marek, it may depend on either an excessive 
stimulation of the vagus or on certain affections of the myocardium. In 
the former instance compression of the nerve may occur from the presence 
of morbid growths or abscess formation in the thoracic cavity; the nerve 
may also be affected through central compression in certain cerebral 
diseases, and in a reflex manner in certain disorders of the stomach and 
intestines. Myocardial affections, which induce bradycardia, include 
chronic myocarditis, degeneration of the myocardium the result of acute 
infectious diseases, also affections of the coronary arteries. Brady- 
cardia is also observed in the early stages of jaundice, but the explanation 
of its occurrence in this condition has not been definitely determined. 

Symproms.—Various observers have met with cases in which the 
number of heart-beats has been reduced to 20, or even 12, per minute. 
The cardiac impulse and the sounds of the heart may be normal. Of 
course, when associated with serious diseased conditions, the symptoms 
of the latter will be in evidence. The action of the heart may be weak 
as well as slow in some cardiac affections. 

TREATMENT.—This must be directed to the cause of the condition. 


Arrhythmia. 


Synonyms.—Disturbance of the rhythm of the heart; Intermittent 
action of the heart; Irregular action of the heart. 

Disturbance of the rhythm of the heart occurs under a variety of 
conditions. In some instances it is compatible with apparent health, 
while in others it is associated with organic cardiac disease, or with various 
affections. The subject has been specially studied by human path- 
ologists, with the result that the views formerly held are now considerably 
modified. Owing to the fact that the source of the action of the heart 
is now placed in the heart muscle itself, certain modifications in the latter 
are held to be responsible for arrhythmia, in addition to the influence 
exerted by extrinsic nerves (the vagi and sympathetic nerves). 

Amongst the conditions producing arrhythmia associated with modi- 
fications of the cardiac muscle, we may mention increased irritability of 
the heart, deficiency of contractility in the cardiac muscle, and disturbed 
diastolic filling of the heart. 

INTERMITTENCY.—In intermittent action of the heart a beat is 
dropped or omitted from time. to time; this may occur at regular intervals 
or in an irregular manner, so that there is only an occasional omission of 
a beat. According to Hutyra and Marek, the condition may be produced 


DISEASES OF THE HEART: HORSE 1023 


by (1) the total omission of one or several ventricular contractions, or 
(2) by additional systolic contractions (extra-systoles). 

1. Omassion of Ventricular Contractions.—This may occur during 
convalescence from acute infectious diseases, such as influenza, and the 
above authors attribute it under these conditions to a reflex or an imme- 
diate stimulation of the vagus. Amongst other conditions in which this 
form of arrhythmia may be observed, we may mention affections of the 
brain (the intermittency then depending on central stimulation of the 
vagus), digestive disturbances, in which the absorption of toxins probably 
causes irritation of the vagus or its nerve centre, either directly or in a 
reflex manner, also diseases of the heart and of the myocardium. 

The intermission may occur after every two to five heart-beats, but 
may be much less frequent. Asa rule only one heart-beat is omitted. 
but occasionally two to four successive beats are missing. The pulse 
also shows intermittency. 

2. Hatra-Systolic Arrhythmia.—Some authors state that this form 
always depends on an abnormal stimulation of the heart, but, as we have 
already pointed out, certain modifications in the cardiac muscle may be 
the underlying etiological factor. According to Hutyra and Marek, the 
phenomena observed are the rapid succession of two or several heart-beats 
which are separated from the normal heart-beats by a pause; the pulse- 
beat corresponding to the additional systole is usually absent, and the 
intermittency becomes more marked if the animal be exercised. 

IRREGULARITY of the heart’s action is another form of arrhythmia; 
the heart-beats occur at irregular intervals, and are also unequal in force. 
The pulse is also irregular in such instances. 

SIGNIFICANCE OF ARRHYTHMIA.—Although an intermittent or an 
irreeular action of the heart may depend on cardiac disease or on other 
affections, yet there are many instances in which the conditions are per- 
manent, and do notseem to interfere with the general health of the animals. 
Mote especially is this the case with regard to intermittency. A careful 
and prolonged physical examination of the heart is necessary, and even 
repeated examinations are desirable before the practitioner can decide 
as to the cause of arrhythmia. Of course, if definite indications of a 
chronic valvular affection of the heart are present, the diagnosis is toler- 
ably clear. A diagnosis of cardiac disease should never be given on the 
presence of arrhythmia per se. 

¥, Smith* remarks: “ Irregularities in the heart’s action are very com- 
mon, frequently purely functional in character, unassociated with organic 
change, and do not interfere with the usefulness of the animal. A horse 


* “ Veterinary Physiology.” 


1024 SYSTEM OF VETERINARY MEDICINE 


condemned for heart disease on the strength of an intermittent pulse 
may remain a living reproach to the practitioner.” 

According to Cadiot,* cardiac intermittency, although not necessarily 
implying the existence of any organic disease or material change in the 
heart, yet in the majority of cases, when permanent, it commonly indi- 
cates a change in the heart muscle or in the nervous mechanism of the 
heart, and caution must be exercised in expressing a definite opinion. 


AFFECTIONS OF THE MYOCARDIUM. 


Hypertrophy. 

An increase in the cardiac muscle is recognised post mortem by an 
enlargement of the heart and thickening of the walls of the organ. It is 
of very common occurrence in the horse, and may constitute a lesion 
per sé, or be associated with certain cardiac valvular diseases, and also 
with chronic interstitial nephritis. 

The following forms are recognised: 

1. Semple, in which the walls of the organ are increased in thickness, 
but the cavities are normal in extent. 

2. Eccentric, in which the cavities are enlarged or dilated and the 
walls thickened. 

Some authors describe a concentric form, characterised by a diminu- 
tion in size of the cavities with thickening of the walls, but, according to 
other observers, this is as a rule a post-mortem change. 

The entire organ may be involved, or only one side or one chamber 
may be affected. The left ventricle is most commonly involved, in 
consequence of the large amount of work it has to perform. In the 
auricles hypertrophy is always associated with dilatation. 

Krrotoey.—In animals used for rapid work, such as race-horses, 
general hypertrophy is very frequently observed post mortem; this is 
believed to depend on severe repeated exertion, which brings about 
enlargement of the heart in order to meet the demand for extra work. 

In special types of hypertrophy the enlargement is a natural effort 
to overcome a deficiency of cardiac structure, such as occurs in valvular 
disease, or to combat abnormal conditions of the bloodvessels. Thus 
hypertrophy of the left ventricle is observed in disease of the aortic valves, | 
or in mitral insufficiency, and then depends on increased intraventricular 
pressure; it also occurs in pericardial adhesions and in chronic mvocar- 
ditis, in which instances the symmetrical and orderly contraction of the 


* “Clinical Veterinary Medicine and Surgery,” by Cadiot and Dollar. 


DISEASES OF THE HEART: HORSE 1025 


cardiac chambers is directly interfered with. Increased arterial tension, 
such as occurs in chronic renal disease (see p. 699), also brings about 
hypertrophy of the left ventricle, owing to the increased action “ neces- 
sary to send the blood through the distant subdivisions of the vascular 
system ”’ (Bright). This, however, is rare in the horse as compared with 
the dog. According to Senator, the narrowing of the vessels in this 
condition is produced by irritating substances retained in the blood, and 
the cardiac hypertrophy is in part due to irritation of the heart muscle 
by the same materials. Hypertrophy of the right ventricle occurs in 
connection with lesions of the mitral valve, owing to increased resistance 
in the pulmonary vessels, also in pulmonary emphysema and pericardial 
adhesions. Hypertrophy with dilatation of the left auricle is observed 
in mitral valve disease, especially stenosis, and the right auricle hyper- 
trophies under similar conditions, or, in fact, when there is increased 
blood-pressure in the lesser circulation from any cause. 

Morzsrp ANAtomy.—The heart is enlarged and increased in weight, 
but in order to appreciate these changes the observer must be acquainted 
with the dimensions and weight of the normal organ in relation to the 
size of the animal. Similar remarks apply to the appreciation of the 
extent of the cavities of the heart and the thickness of the cardiac walls. 
Hutyra and Marek draw attention to peculiarities in the form of the heart 
according to the regions affected, and these we can confirm by experience. 
Thus, in hypertrophy of the left ventricle “the heart as a whole is 
slender and elongated like a pointed cone, while in hypertrophy of the 
right ventricle the organ as a whole becomes broader and more flat, the 
right heart taking part in the formation of the apex. If the hypertrophy 
be very marked, the right ventricle reaches beyond the apex of the left 
ventricle.” The altered cardiac muscle is firmer than normal. When 
dilatation is associated with the hypertrophy, an increase in extent of 
the cavities is observed. 

Symproms.—In simple hypertrophy no symptoms. are observed. 
The forms associated with valvular diseases present symptoms which will 
be considered in connection with these affections. Increased cardiac 
dulness, a forcible cardiac impulse, an accentuated diastolic heart-sound, 
and a strong, tense pulse, are said by Hutyra and Marek to occur in cases 
of hypertrophy not depending on organic cardiac disease. 

TREATMENT.—In the majority of instances it is probable that the 
condition will be overlooked, so that treatment is rarely called for until 
evidences of cardiac dilatation appear. The indications for treatment of 
dilatation will be found on p. 1027. 


VOL, II, 65 


1026 SYSTEM OF VETERINARY MEDICINE 


Dilatation. 


In this condition either one or more of the cavities of the heart is 
increased in size, and hypertrophy is usually associated with the lesion; 
but cases are met with in which the walls of the affected cavities are very 
thin and attenuated. Dilatation succeeds hypertrophy when degenera- 
tive changes occur in the myocardium. Acute dilatation may be tem- 
porary, and may result from severe exertion in animals out of condition 
and not properly trained for fast and prolonged work; but we have no 
direct evidence of its occurrence in horses. In the process of training 
the capability of the heart is gradually increased, especially with regard 
to the right side of the organ, so that the animal can be subjected to 
severe exertion with safety. In horses properly trained for racing the 
heart possesses increased resistance to dilatation, probably depending on 
increased muscular and nervous energy in the organ. We are not aware 
whether horses suffer from what is known in man as “ heart-strain ’’—a 
condition which results from severe exertion when the individual is not 
in proper training ; 1t may be temporary, or if the cause is repeated, another 
attack may result, and there may be unfitness for exerton for a long period. 
The symptoms in man are—Pain in the cardiac region, a sense of distress 
in the epigastrium, and rapid breathing (cardiac dyspnoea). According to 
Osler, “it seems probable that sudden death in men during long-continued 
efforts, as in a race, is sometimes due to overdistension and paralysis of 
the heart.” | 

We do know, however, that sudden death may occur in the horse 
as the result of severe exertion when the animal is not in proper training, 
but we must admit that acute pulmonary congestion is far more 
commonly met with under such circumstances. In acute pulmonary 
congestion there is, without doubt, an overdistension, and probably a 
dilatation, of the right side of the heart, which contributes to the serious- 
ness of the case. It is interesting to note that the pulmonary lesion 
mentioned is regarded by medical authors as of rare occurrence in 
man as the result of overexertion, but cases are recorded by some ob- 
servers in which an intense and rapidly fatal congestion of the lungs 
followed violent exertion. Doubt is, however, expressed as to the real 
nature of such cases, as there was no evidence with reference to the con- 
dition of the heart. According to F. Smith,* “the hearts of horses 
exposed to the greatest strain seldom show any pathological change... . 
The heart may dilate under strain, but such dilatation, when accom- 
panied by hypertrophy, is compensated, and no indication of trouble 


* “ Veterinary Physiology.” 


DISEASES OF THE HEART: HORSE 1027 


exists during life.” The same author, however, in the Report of the 
Army Veterinary Service, 1908, remarks: ‘“‘ Hitherto horses have not 
failed in heart and bloodvessels, as men have, but have given way in 
legs and feet. There are indications that circulatory and other troubles 
due to exhaustion and strain will now be superadded. It would almost 
appear that the motor-car has temporarily disturbed our judgment of 
endurance when we learn of seven horses being killed in one day’s 
manoeuvres from overmarching, four more in the course of a day or two 
from the same cause, and two from one regiment in a single gallop.” 

The permanent forms of cardiac dilatation occur under a variety of 
conditions, and may be said to depend on two important causes—viz., 
increased pressure within the cavities, and impaired resistance due to 
structural changes and consequent weakening of the muscular walls of 
the heart. These causes may act singly, but are often combined. The 
condition thus occurs in all forms of valve lesions, in degenerations of the 
myocardium, in pulmonary emphysema, and in cases of pericardial 
adhesions. It should be noted that where degenerative changes in the 
heart wall are present, dilatation may result even with normal blood- 
pressure. One of the most important effects of cardiac dilatation is the 
deficient emptying of the cavities during systole. As the condition plays 
an important part in connection with the lesions and symptoms of chronic 
valvular diseases, it will be more conveniently discussed in connection 
with such affections; it will here suffice to point out briefly the manner in 
which dilatation is brought about in some valvular affections. Thus, 
in aortic incompetency, owing to the aortic semilunar valves being in- 
competent, the walls of the left ventricle are subjected to a high degree 
of pressure, because during diastole not only does this cavity receive blood 
from the left auricle, but also from the unguarded aorta. As a result, 
the walls yield, hypertrophy occurs after a time, and this, in its turn, is 
associated with dilatation (eccentric hypertrophy). In mitral insuff- 
ciency the walls of the left auricle are subjected to increased pressure, 
owing to regurgitation of blood from the left ventricle during systole, hence 
dilatation occurs. (See Mitral Insufficiency, p. 1056, for further details.) 

Dilatation of the right ventricle is met with in conditions in which 
the tension of the blood in the pulmonary vessels is permanently increased. 
This also explains its occurrence in, pulmonary emphysema. Finally, 
we may remark that dilatation of one cavity of the heart may, owing to 
the circulatory disturbances produced, be followed by a similar change 
in other cavities of the organ. 

The treatment of cardiac dilatation will be considered in connection 
with the valvular diseases with which the condition is associated. 


1028 SYSTEM OF VETERINARY MEDICINE 


Cardiac Insufficiency. 


Under this heading we propose to discuss conditions in which, owing 
to various morbid conditions of the myocardium and to other causes, 
the muscular power of the heart is lessened, and interference with the 
normal circulation of the blood results. In extreme cases the rapidity 
of the circulation becomes so diminished that serious consequences ensue 
—viz., the tissues are deprived of their proper supply of nutriment and 
oxygen, and their waste products are not adequately removed—cardrac 
failure and death then result. This subject requires special consideration, 
as it explains many of the phenomena which occur in valvular diseases of 
the heart, to be described later on. Moreover, as the morbid conditions 
of the myocardium are responsible for a large proportion of cases in which 
cardiac insufficiency is a prominent feature, and as clinically it is not 
possible to differentiate the exact pathological condition of the heart 
muscle that is present, the symptoms being very similar in each, it 
seems desirable to consider these lesions and their effects under the 
heading of cardiac insufficiency. The various morbid conditions of the 
myocardium will be discussed briefly, but we shall first draw attention 
to some important points in connection with the production of cardiac 
insufficiency and cardiac failure. 

Although failure of the circulation generally depends on failure of 
the heart, it must be remembered that certain conditions of the blood- 
vessels may bring about a similar effect. Owing to the fact that the 
amount of blood in the body is less than the capacity of the vascular 
system, it is necessary that the arterioles should be constricted to a proper 
degree in order to insure a sufficient quantity of blood in the arterial 
system. When, however, a general vaso-dilatation of the arterioles 
occurs, especially in the splanchnic area, the amount of blood reaching 
the heart is not sufficient to supply the tissues, and similar effects to those 
mentioned in connection with cardiac failure result. According to some 
authorities, this condition is the essential feature in what is known as 
shock.” 

In the present section we shall deal only with cardiac insufficiency 
depending on morbid alterations in the heart itself. The weakness or 
failure in muscular power may affect the entire heart or any of the cavities 
singly. The effects produced vary according to the part of the organ 
affected. If the left ventricle be involved, an insufficient supply of blood 
enters the arterial system and a general anemia of the various tissues of 
the body results. In insufficiency or failure of the left auricle, stasis 
occurs in the pulmonary vessels, there is deficient aeration of the blood, 


DISEASES OF THE HEART: HORSE 1029 


and pulmonary oedema or hydrothorax may be observed. Insufficiency 
or failure of the right auricle and ventricle causes a cyanotic condition 
of the visible mucose, dyspnoea, and stasis of the circulation in the 
abdominal organs, followed by cedema. 

The course of cardiac insufficiency varies according to the nature of 
the lesion on which the condition depends. In sudden failure of the left 
ventricle death occurs suddenly; but when the process is more gradual, 
evidences of cardiac weakness and a staggering gait, due to cerebral 
anemia, are observed. When cardiac insufficiency depends on lesions 
of the right ventricle, sudden dyspneea may result, or the dyspnoea may 
only follow after slight exertion if the ventricular lesion is not extensive. 

Although the morbid conditions of the myocardium, which we shall 
describe farther on, are responsible for the majority of cases of chronic 
cardiac insufficiency, yet it is important to remember that cardiac failure 
may result without any apparent lesion of the myocardium. Of course, 
sudden cardiac failure, also known as “ acute cardiac insufficiency,’ may 
depend on a variety of conditions, such as rapid effusion of serous fluid 
into the pericardium, the rapid formation of large thrombi in one of the 
cavities of the heart, wounds of the heart, rupture of the heart, or rupture 
of a cardiac valve, the entrance of air to the chambers of the heart, etc. 

Disease of the coronary arteries is recognised as an important cause 
of cardiac insufficiency in man, but this subject has not received the 
same amount of attention in animals. Thus, in man a thrombus, or 
embolus, in one of the coronary arteries may induce a condition known 
as “ angemic necrosis,” while natrowing of a coronary branch, due to a 
process of obliterative endarteritis, results in the production of fibrous 
myocarditis. Again, thrombosis of a coronary artery, which has become 
narrowed by arterio-sclerosis, is regarded as a not uncommon cause of 
sudden death. Probably, if more attention were devoted to post- 
mortem examinations in animals, diseases of the coronary arteries would 
be found to be of some importance in those obscure cases of sudden 
death without apparent cause. Continental authors recognise various 
affections of the coronary arteries, such as endarteritis, thrombosis, and 
aneurism (see pp. 1074, 1083). Cadéac, under the heading of “Angina 
Pectoris,”’ describes arterio-sclerosis of the coronary artery, and quotes 
other writers who have observed Paste death from cardiac failure to - 
result from this condition. 

In man the condition known as “ fibrillation” is regarded as an 
important cause of cardiac insufficiency. By this term is meant an irreg- 
ular, rapid, and independent contraction of the cardiac muscle fibres, so 
that the cavities involved cease to contract and stand still, while all their 


1030 SYSTEM OF VETERINARY MEDICINE 


fibres are in incessant movement. When this condition occurs in the 
ventricles, sudden death ensues; when the auricles only are affected, 
cardiac irregularity and distress are manifested, but death does not 
follow. Fibrillation of the auricles has been observed in the horse by 
Lewis. For full information on this subject the reader is referred to 
F. Smith’s “ Physiology.” 

We shall now proceed to consider the morbid conditions of the myo- 
cardium, which are very frequently the cause of cardiac insufficiency ; 
these include myocarditis and fatty heart. 


Myocarditis (Inflammation of the Myocardium). 


An acute and a chronic form are recognised. 

Acute Myocarditis —Two types of acute myocarditis are described 
by some authors—viz., a parenchymatous or diffuse, and a purulent type. 
Although these differ as regards morbid anatomy, they cannot be differ- 
entiated clinically, hence it is advisable to consider the symptoms and 
treatment of both under the same heading. 

Diffuse or Parenchymatous Myocarditis—According to Hutyra and 
Marek, this type cannot be sharply distinguished from fatty degeneration 
of the heart. The effusion in the former may be so slight that it is only 
by microscopical examination one can decide whether the lesion should 
be regarded as an inflammation or a degeneration; hence, as both pro- 
cesses may develop under similar conditions, and are manifested by the 
same symptoms, these authors describe acute parenchymatous myo- 
carditis and fatty degeneration together, and also include the purulent 
type under the same heading. While admitting the above statement, 
we think it is more convenient to consider fatty degeneration under the 
heading of Fatty Heart (see p. 1034). 

ErroLogy.—Acute parenchymatous myocarditis is in the large 
majority of instances a secondary affection. According to Friedberger 
and Fréhner, and Zschokke, a primary form may occur in rare instances 
in horses and sporting dogs, as the result of severe exertion. The toxins 
present in the blood during the course of acute infectious diseases, such 
as influenza and contagious pneumonia, constitute the most common 
cause of acute parenchymatous myocarditis; the affection may also be 
- associated with pericarditis and acute endocarditis. In the latter it is 
believed that pathogenic bacteria may enter the bloodvessels of the 
cardiac valves and reach the smaller branches of the coronary arteries, 
thus setting up the morbid changes in the myocardium; but, according 
to Hutyra and Marek, the inflammation may be continued directly from 
the diseased valves to the heart muscle. Cadéac states that azoturia 


DISEASES OF THE HEART: HORSE 1031 


may be complicated by a diffuse myocarditis when the course of the 
disease is prolonged. Myocarditis may also be observed in acute glanders 
and in cases of septiceemia. 

Morsrp ANATOMy.—In some instances no macroscopic changes may 
be observed, and the lesions can only be detected by a histological exam- 
ination, or the heart may be flaccid, showing a yellowish tint in certain 
parts, its cavities are dilated, and its walls are friable. Some authors 
recognise two varieties of lesions—viz.: (1) Intersteteal, in which the 
intermuscular connective tissue is swollen, infiltrated with small round 
cells and leucocytes, the bloodvessels are dilated, and the muscle fibres 
show granular, fatty, and hyaline degeneration. (2) Parenchymatous 
Deyeneration. In this the cardiac muscle presents general paleness and 
turbidity, and on microscopical examination the muscle fibres show 
degeneration and granular infiltration; in some instances the granular 
change is so extreme that the striae cannot be detected. In cases of 
extensive degeneration, Hutyra and Marek have observed an almost 
uniform greyish-yellow colour of the cardiac muscle, but the lesions were 
not uniformly distributed, some parts of the organ showing extensive 
disease, while in others only slight changes were observed. 

Suppurative Myocarditis—EtioLogy.—In this form purulent foci of 
various sizes occur in the heart muscle. The condition is met with in 
connection with various affections, such as strangles, purulent infections, 
omphalo-phlebitis in foals, pyemia, etc. According to Hutyra and 
Marek, infected emboli derived from any part of the body where sup- 
puration or gangrenous disintegration of tissues is present, may enter the 
coronary vessels and cause purulent myocarditis; thus, in addition to 
the affections mentioned above, the lesion may occur in connection with 
purulent or gangrenous pneumonia, purulent wounds of the extremities, 
puerperal metritis, and gangrene due to prolonged decubitus. Injuries 
of the myocardium, due to foreign bodies, are a rare cause of the condition 
in the horse. 

Morsip Anatomy.—When resulting from strangles, abscesses of 
various sizes may be found in the walls of the ventricles or in the cardiac 
septum; they may contain a thick creamy pus, or it may be hemorrhagic 
in character, or even fostid. The wall of the abscess is generally thin, 
and, owing to the movements of the heart, rupture may occur into the 
pericardial cavity or into one of the cavities of the heart. Hutyra and 
Marek state that the contents of the abscess may eventually become 
inspissated, a cheesy mass being formed, or even calcification may take 
place. 

In pyemia, emboli may enter and cause obstruction of the smaller 


1032 SYSTEM OF VETERINARY MEDICINE 


branches of the coronary artery, and produce infectious or septic infarcts 
im the myocardium in the form of small abscesses. 

Symproms.—We have already remarked that it is not possible to 
distinguish clinically the different forms of myocarditis, nor can we 
differentiate fatty heart from the condition mentioned. The symptoms 
of all may be included under the general heading of cardiac insufficiency, 
some of the features of which we have already discussed (see p. 1028). 
When myocarditis is associated with acute infectious diseases, the symp- 
toms usually develop gradually. The heart - beats are increased in 
number, but the pulse is weak and often irregular, and a cyanotic condition 
of the visible mucose is observed. Cadéac states that cardiac palpita- 
tion may be present, and on auscultation the first sound is weakened 
and the second sound is reduplicated, while, on palpation of the cardiac 
region, a purring “‘ tremor,” or thrill, can be detected. According to 
Hutyra and Marek, in severe cases the heart-beats become very rapid, 
the pulse is thready, irregular, and intermittent, venous pulsation is 
observed, the respirations are increased in frequency, and more or less 
dyspnoea occurs. A fatal termination may be preceded by muscular 
trembling, vertigo, and evidences of cardiac failure. These authors also 
record rare cases of influenza complicated with myocarditis, in which 
the cardiac weakness develops so rapidly that the animals fall down and 
die within a short period of time; also instances in apparently healthy 
animals, which die suddenly, and on post-mortem show evidences of an 
abscess in the myocardium, which ruptured into the pericardial sac, or 
into a cavity of the heart. 

According to Cadéac, a common phenomenon in acute myocarditis 
is a tendency to equalisation of the two pauses (7.e., the short pause be- 
tween the two cardiac sounds and the long pause succeeding the second 
sound); also the two sounds of the heart resemble each other in tone and 
in length. Owing to the similarity of these to the heart-sounds of the 
foetus, this condition is known as “ embryocardia.”” This phenomenon 
has also been observed by Horace L. Roberts, F.R.C.V.S., on several 
occasions. 

In consequence of blood stasis, symptoms attributable to alterations 
in the lungs, liver, nerve centres, etc., may also be observed. 

CoursE AND Proenosis.—According to some authors, in the milder 
forms of the affection recovery occurs, the abnormal cardiac conditions 
gradually disappear, and the heart-beats and pulse assume their normal 
character. In the severe cases, however, a fatal termination is the rule. 
When pneumonia is complicated by myocarditis, death probably always 
occurs, 


DISEASES OF THE HEART: HORSE 1033 


DIFFERENTIAL DraGNosis.—This possesses extreme difficulties. In 
the early stages especially, acute myocarditis cannot be differentiated 
from pericarditis and endocarditis. Later on, it is said that the absence 
of abnormal sounds in myocarditis may enable us to differentiate it from 
the other conditions mentioned; but it must be remembered that. peri- 
carditis and endocarditis may be associated with myocarditis. Again, 
we must point out that during the course of influenza, or during con- 
valescence, well-marked arrhythmia of the heart may occur, which may 
ultimately disappear. It would not be rational to conclude that such a 
condition is due to myocarditis, as it may result from disordered cardiac 
innervation. 

In connection with the subject, it is interesting to note that Horace 
L. Roberts, F.R.C.V.S., has observed during the course of epidemics of 
contagious pneumonia, cases of myocarditis in the absence of pulmonary 
or pleural lesions. 

TREATMENT.—The therapeutical measures to be adopted will depend 
on the leading phenomena present. In cases where cardiac weakness is 
marked, cardiac stimulants are indicated; these include strophanthin, 
digitalin, cafiein, and strychnine administered by subcutaneous injection. 
Large amounts of normal saline solution should also be given subcu- 
taneously. Continental authors strongly recommend the administration 
of camphor subcutaneously in cases of threatened cardiac failure. Cadéac 
advises that the drug should be dissolved in equal parts of ether and oil 
and administered hypodermically at frequent intervals. Digalen is also 
highly spoken of. Absolute rest and nourishing food are important 
details in treatment. 

Chronic Myocarditis.—This is also known as “sclerotic or fibrous 
myocarditis,’ and has been studied by various Continental authorities. 

KirroLocy.—It may follow an attack of acute myocarditis, and, accord- 
ing to some authors, this not infrequently occurs. Cadéac, however, 
states that the affection is generally a sequel to strangles or influenza, 
the microbial toxins of which exert a chronic irritation on the cardiac 
muscle and induce sclerotic changes therein. Obliterative endarteritis 
of a branch of the coronary artery is also recognised as an etiological 
factor. Cadiot has observed cases due to parasitic thrombosis of the 
coronary artery. The condition may also be associated with pericarditis 
and endocarditis. Hutyra and Marek state that occasionally chronic 
muscular rheumatism, chronic nephritis, and chronic endarteritis, may 
act as exciting causes. 

Morsip ANAToMY.—In well-marked cases the heart is enlarged, 
increased in weight, and shows extensive hypertrophy of the left ventricle. 


1034 SYSTEM OF VETERINARY MEDICINE 


The hypertrophy may be general and associated with dilatation. The 
colour is a yellowish-brown, the muscular tissue is firm and resistant, 
and on section may give a marbled appearance, owing to the presence of 
greyish-white spots or streaks, which represent the formation of fibrous 
tissue. In far advanced cases the muscle fibres lose their fibril bundles 
and are completely replaced by connective tissue. Chronic valvular 
lesions may be associated with the myocarditis. In some cases evidences 
of fatty degeneration can be detected. Cadéac states that the condition 
known as “fragmentation and segmentation ’’ may be present. This 
condition was described in human medicine by Renaut and Landouzy, 
and in veterinary medicine by Montané.* In segmentation the muscle 
fibres separate at the cement line, while in fragmentation the fracture 
occurs across the fibre itself. The condition may be associated with fatty 
degeneration, as well as with fibrous myocarditis; and when fragmenta- 
tion is well marked, the myocardium appears pale, cloudy, soft, and friable. 
According to Hutyra and Marek, when the scar tissue is extensive in any 
part of the organ, a bulging outwards may occur, owing to the effect of 
blood-pressure, and an aneurism of the heart is then produced (see p. 1069). 

Symptoms.—The symptoms are similar to those described as occurring 
in cardiac insufficiency due to various causes, and there are no means by 
which we can differentiate the condition from other lesions of the cardiac 
wall. | 

TREATMENT.—This will depend on the phenomena presented, and 
the suggestions for treatment of acute myocarditis will also apply here. 
Needless to remark, when the symptoms clearly point to a chronic 
cardiac disease, on economical grounds treatment of any kind cannot be 
attempted. 


Fatty Heart. 


Two conditions are usually described under this heading—viz., fatty 
degeneration and fatty overgrowth. 

Fatty Degeneration.—This is a lesion of comparatively frequent 
occurrence in the horse. W. Williams regarded it as the most common 
organic change in the heart. 

EtrioLocy.—The condition may occur in connection with various 
diseases, as follows: Pericarditis, endocarditis, myocarditis, influenza, 
strangles, pneumonia, in wasting affections and cachectic states, and in 
cases of poisoning from phosphorus, lead, and arsenic. It is not un- 
common to find fatty degeneration of the heart at post-mortem examina- 
tions, although no evidences of its presence were observed during life. 

* Revue Vétérinaire, 1890, p. 301. 


DISEASES OF THE HEART: HORSE 1035 


In chronic valvular disease the lesion is often found affecting the hyper- 
trophied ventricular wall. 

Morsrp ANAaToMy.—The fatty degeneration may be limited to the 
heart, or it may be more or less general in the solid viscera. The lesion 
may be local, or the entire myocardium may be involved. When local, 
the left ventricle is most commonly affected. In advanced and generalised 
cases the heart appears enlarged, and its walls are flabby, relaxed, and 
friable. The colour of the organ is a light yellowish-brown, and is some- 
times termed “ the faded leaf colour.” In some cases it shows a yellow 
or orange tint, which is unevenly distributed in patches. When occurring 
in connection with pericarditis, the superficial layers of the myocardium 
as a Tule are involved. 

On microscopical examination, minute globules are observed in the 
muscular fibres, and in advanced cases these globules appear as if taking 
the place of the fibres. Associated lesions may be present, such as dila- 
tation, myocarditis, pericarditis, endocarditis, and valvular lesions. 

Symproms.—These are similar to the phenomena observed in myo- 
carditis, and included under the heading of cardiac insufficiency and 
cardiac failure. There are no diagnostic features, and the presence of 
the disease may not be suspected during life. Sudden death may occur 
from cardiac failure or from rupture of the heart. 

TREATMENT.—Therapeutical measures of any kind are useless. 

_ Fatty Overgrowth.—In this condition mild grades may be observed in 
which there is simple excess of the normal subpericardial fat, or advanced 
cases, where the fat not only covers the surface of the heart, but also 
infiltrates between the muscular fibres and forces them apart, and by the 
pressure exerted may produce atrophy of the fibres. The condition is 
not uncommon in aged, fat animals, especially in old stallions. In 
advanced cases the contractile power of the heart is impaired, and 
atrophy, with fatty degeneration, may result. 

No symptoms may be observed until the action of the heart becomes 
impaired, and then evidences of cardiac insufficiency present themselves. 
Dyspnoa and vertigo may be observed during severe exercise, and, accord- 
ing to Hutyra and Marek, these may partly depend on a deposition of fat 
in the respiratory muscles. 

In our experience fatty overgrowth of the heart is only discovered post 
mortem. 

Ossification of the Myocardium. 


This condition is of more interest to the pathologist than to the 
clinician, as the symptoms presented do not enable a diagnosis to be 
made. According to Hutyra and Marek, it is an extremely rare disease, 


1036 SYSTEM OF VETERINARY MEDICINE 


while Cadéac states that ossification of the auricles has been observed on 
a large number of occasions in horses, but is very rare in cattle, and has 
not been recorded in the dog. 

Nothing is definitely known as regards the etiology of the affection. 
Hutyra and Marek state that the lesion commences in the wall of the 
right auricle, in the form of a connective-tissue proliferation followed by 
calcification and the formation of platelets of spongy bone substance, 
which unite later on, and finally the auricle is transformed into a bony 
plate, and may be considerably enlarged. According to Cadéac, the right 
auricle is more frequently, or more completely, ossified than the left. The 
ossification is generally incomplete, and the process usually ceases at the 
point where the venz cave enter the heart; these vessels sometimes 
show a dilatation at the part mentioned. The vena azygos may, in some 
instances, be involved in the calcification. There are no characteristic 
symptoms. Evidences of cardiac insufficiency and of venous stasis may 
be present, but the cause cannot be determined. A tumultuous action 
of the heart, followed by sudden death, has been observed in some cases. 
In instances where the lesion is not far advanced, the animals may be 
apparently healthy, and the condition is discovered post-mortem as a 
surprise, when death has occurred from other diseases. 


ENDOCARDITIS. 


This signifies inflammation of the endocardium. It is an important 
affection, as in its chronic form it constitutes one of the commonest types 
of organic cardiac disease. As the lesions are usually confined to the 
valves, the term “ valvular endocarditis’ is often applied to the con- 
dition. 

Two forms of the affection are recognised—viz., acute and chronic. The 
latter may be a sequel to the former, or it may develop in the absence of 
acute symptoms. 

Acute Endocarditis. 

This form is characterised by the acuteness of the symptoms and by 
the special nature of the valvular lesions, which consist of either pro- 
liferative changes, resulting in the formation of vegetations, or in loss of 
continuity or of substance in the valve tissues. In rare cases the affec- 
tion may be primary, but in the great majority of instances it is a second-. 

ary condition, occurring in connection with various infective processes. 

Some authorities recognise two types of the disease—viz., a simple, 
benign, or verrucous endocarditis, and a malignant, ulcerative, or infective 
endocarditis. As, however, the latter can develop from the former. or the 


DISEASES OF THE HEART: HORSE 1037 


lesions may be associated together, and as various gradations can be 
traced between them, many authors now consider these types as represent- 
ing but different degrees of intensity of the same process. At the same 
time, in order to facilitate the description of the disease, it is convenient 
to retain the terms mentioned. In the present day all types of endo- 
carditis are regarded as microbial in origin, and there is abundant 
evidence, both clinical and experimental, to support this view. It is 
important to remember that although a distinction is made between 
the acute and the chronic form of the disease, yet the latter may at 
any time be complicated by an acute attack. 

With reference to the incidence of the affection in equines, it must be 
regarded as uncommon, especially as compared with the frequency of 
chronic valvular lesions. But it is probable that, in consequence of the 
difficulties in diagnosis, and from the fact that the disease is generally 
associated with other maladies, its presence may be overlooked. Accord- 
ing to the Report of the Army Veterinary Service, 1911-12, three cases of 
endocarditis were admitted for treatment, and in the Report for 1912-13 
only one case of the disease was recorded. 

Eriotocy.—As already remarked, all types of the disease depend on 
microbial infection. In the semple or benign type it is said that the disease 
is never primary. According to Hutyra and Marek, “in contrast to man, 
articular rheumatism is not often complicated with endocarditis in 
animals.” But Cadéac states that acute articular rheumatism and 
rheumatic inflammation of the great sesamoidean sheaths are frequent 
causes of endocarditis. He has also observed the simultaneous develop- 
ment of endocarditis and acute synovitis of the great sesamoidean sheath. 
According to Trasbot, endocarditis is a common sequel of rheumatism, 
and on some occasions it may precede the articular phenomena. Other 
observers have also confirmed these opinions, and shown that the simple 
verrucous type of the disease is that usually associated with rheumatism ; 
the cardiac symptoms generally manifesting themselves in a few days 
alter the appearance of the lameness and other articular phenomena. It 
is believed that the same micro-organisms which are responsible for the 
rheumatism may produce the endocardial lesions, or a secondary infection 
may be superadded. 

Malignant or infective endocarditis, although sometimes met with as a 
primary disease, is usually associated with influenza, pneumonia, various 
pyemic and septicemic affections, strangles, suppurating wounds, 
omphalitis, suppurative pleurisy, pericarditis, suppurative arthritis, etc. 

Cases are recorded in which wounds of the skin, or mucous membranes, 
or small ulcers, bites, injuries to the feet due to careless shoeing, or from 


1038 SYSTEM OF VETERINARY MEDICINE 


“* picked up nails,” surgical wounds resulting from the excision of tumours, 
etc., were followed by endocarditis. Blanc observed a case following an 
attack of angiocholitis (inflammation of the bile-ducts), and Cadéac found 
endocarditis resulting from the toxic effects of arsenic and emetine. 
Cases are recorded of intra-uterine infection, the micro-organisms passing 
from the blood of the mother to the foetus. The above-mentioned author 
believes that the disease may be hereditary, and Ingueneau reported an 
instance in which seven foals, the produce of two stallions, were affected 
with endocarditis. Kitt met with several cases in which botriomyces 
were discovered in the cardiac lesions. Marek observed instances of the 
disease in two horses which had been employed for the production of 
erysipelas serum. 

Predisposing causes are recognised, such as exposure to cold and chills, 
overexertion, injuries to the region of the heart, etc.; these probably 
act by lowering the vital resistance of the animal and rendering the 
endocardium vulnerable to the action of micro-organisms. 

Lustig records a case in which endocarditis followed a kick inflicted on 
the right side of the chest. As already remarked, the chronic form of 
endocarditis may be followed by an acute attack. 

The bacterrology of endocarditis requires further investigation. Various 
micro-organisms have been found in the lesions, such as streptococci, 
staphylococci, the bacillus cola communis in association with other bacteria, 
and, according to Cadéac, the ovoid bacterium may be present. This 
author states that no specific micro-organism for the disease has yet been 
discovered, but that all microbes which are capable of circulating and 
living in the blood and serous membranes may cause endocarditis. 

Mode of Infection—Some authors state that the micro-organisms 
circulating in the blood may become directly localised on the surfaces of the 
valves. But, according to Hutyra and Marek, this mode of infection is 
probably rare, and the usual course is that the bacteria become arrested 
in the capillaries of the valves, and simultaneously in the bloodvessels of 
the myocardium. 

The micro-organisms and their toxins induce inflammatory changes in 
the tissue of the valves and also in the myocardium, which constitute the 
special lesions of the disease. 

Morsrp ANatomy.—In the majority of cases the valves of the left side | 
of the heart are involved, but cases are met with in which the lesions are 
also found in the tricuspid valve. In very rare instances only are the 
pulmonary semilunar valves affected. According to some authors, when 
endocarditis occurs in the foetus the lesions occur in the right side of the 
heart. Various theories are put forward to explain why the lesions are 


DISEASES OF THE HEART: HORSE 1039 


met with more frequently in the left side of the heart, such as the aérobic 
nature of the micro-organisms, the vitality of the latter being more marked 
in the arterial blood; but in cattle the tricuspid valve is more commonly 
affected, so this explanation cannot be accepted. Another theory is that 
the valves of the left side have more work to perform, are more exposed 
to mechanical pressure and distension, and hence are more liable to be 
attacked by micro-organisms. The endocardium lining the cavities of the 
heart is rarely involved (parietal or mural endocarditis). 

The mitral and the aortic semilunar valves may, then, be regarded as 
the most common seats of the lesions, and not only is the structure of the 
valves affected, but also the chord# tendinew and their attachments. 
The superior or auricular aspect of the mitral valve (and of the tricuspid 
when affected), and the inferior or ventricular aspect of the aortic semi- 
lunar valves, are the usual locations of the lesions, these being the surfaces 
which face the blood-stream. 

In the benign or verrucous type of the disease minute vegetations are 
found on the surface of the valves or at their margins. They show an 
irregular or fissured surface, and have a warty or verrucose appearance. In 
many instances they occur in the form of very small cauliflower-like 
excrescences attached by narrow pedicles. The vegetations after a time 
may increase in size or may become confluent. Their derivation and 
structure have been very extensively studied by pathologists, but space 
will not permit us to do more than give an outline of the subject. _ In their 
earliest stage the vegetations are composed of elements derived from the 
blood, such as blood platelets, leucocytes, and fibrin. Later on important 
changes occur; the endothelial cells and the cells of the subendothelial 
layer proliferate, and gradually invade the fresh vegetations, disintegra- 
tive changes occur in the blood-cells and fibrin, and ultimately the vege- 
tations are converted into connective tissue, and they are usually covered 
by a thin layer of fibrin and leucocytes. The course of events now depends 
on the subsequent changes that take place. Some authors state that at 
this stage the vegetations may gradually become smaller and the affected 
valve may return to a normal condition, but this is very doubtful. It is 
far more likely that when the vegetations become organised and disap- 
pear, nutritive changes have already taken place in the valve tissue, 
which ultimately lead to sclerosis, thickening, and deformity of the valve. 
But in other cases the process may extend further, and ulcerative changes 
may occur, so that the simple or benign type 1s converted into the malig- 
nant or infective type. In some instances portions of the vegetations 
may be broken off and lead to embolism in various organs. But this is more 
likely to occur in the ulcerative type of the disease. 


1040 SYSTEM OF VETERINARY MEDICINE 


Malignant or Ulcerative Type.—This may occur as a sequel to the 
simple type, but according to Hutyra and Marek, the inflammatory 
process may be ulcerous in character from the beginning. It is generally 
admitted that vegetations are associated with the ulcerative lesions. In 
the malignant type the loss of substance in the valves is well marked, and 
micro-organisms are present in large numbers. According to Hutyra and 
Marek, the ulcers show red, uneven borders, their bases are covered with a 
greyish-red or yellowish deposit, and fibrin becomes deposited upon the 
ulcerating surfaces in thick, uneven masses. The lesions may also be found 
in valves that are already the seat of sclerotic changes. Certain changes 
may occur in the valves as the result of the ulcerative lesions. These 
include valvular aneurism, in which, owing to the weakened condition of 
the valve, the latter becomes displaced by the pressure of the blood. The 
loss of substance in the valve may be superficial and limited to the endo- 
cardium, but more commonly it extends to the deeper structures, and 
may lead to perforation of the valve, or of the cardiac septum. When the 
endocardium lining the heart cavities is involved, the lesions are generally 
found at the upper part of the septum of the left ventricle or on the wall 
of the left ventricle. Hutyra and Marek have observed that in mural 
endocarditis a purulent inflammation may occur in the heart muscle, 
giving rise to distension of the walls of the affected cavity, and leading to 
the formation of cardiac aneurism (see p. 1069). These authors also state 
that the.valve may be torn from the chorde tendinez, or from its attach- 
ment. A most important part of the pathological changes occurring in 
the disease depends on the effects of embolism in various organs. The 
emboli may consist of portions of blood-clots, or of the valvular tissue, or 
débris of the vegetations, and they are carried by the blood-stream, finally 
lodging in the vessels of various organs, and producing infarcts of a 
suppurative character, or a purulent inflammation. Thus serious altera- 
tions may occur in the brain, lungs, liver, kidneys, spleen, and gastro- 
intestinal canal, according to the location of the emboli. But cases are 
occasionally met with in which no embolic processes can be detected. 

The associated lesions may be briefly summed up as follows: In some 
cases only a few infarcts can be detected in one or two organs; in other 
instances a large number are present in various parts of the body. The 
lesions of the primary disease may be observed, also those due to embolism 
and to changes in the myocardium. Infarcts in the lung result when the 
emboli enter the ramifications of the pulmonary artery, and this is most 
likely to occur when the endocarditis exists on the right side of the heart. 
Acute meningitis is observed when the embolic process affects the cerebral 
arteries. When the kidneys are involved, renal infarcts, with various 


DISEASES OF THE HEART: HORSE 1041 


morbid changes, are found, and in some instances a diffuse interstitial 
nephritis is present. | 

Amongst other lesions we may meution acute pulmonary congestion, 
and in the later stages passive congestion and pulmonary cedema, nutmeg 
liver, acute congestion of the gastro-intestinal mucosa, enlargement of the 
abdominal lymphatic glands. Myocarditis of the usual type is also 
present. 

Although the lesions we have mentioned may, with certain modifica- 
tions, depending on the intensity of the affection, the organs involved, and 
the nature of the primary disease, be observed at autopsies on acute 
endocarditis, yet they are far from being constant. In a case of the 
disease recorded by Wilkinson and Craig,* the duration of the affection 
was eight days, and the following lesions were observed: The right heart 
was much dilated, a few subendocardial hemorrhages—one the size of a 
sixpenny plece—was found on a papillary muscle in the left ventricle, and 
another, smaller in size, on the septum of the right ventricle. The mitral, 
aortic semilunar, and tricuspid valves were all affected, and showed a 
roughened aspect in parts, especially on the surfaces facing the blood- 
stream. The left cusp of the tricuspid showed a fibrinous deposit the size 
of a hazel-nut, the right cusp presented one about the size of a walnut, 
which was attached to a similar deposit on the wall of the right ventricle; 
the posterior cusp was diffusely thickened. The mitral valve was also 
thickened throughout and very dark in colour, and a slight layer of fibrin 
covered the cusps towards their free border. The segments of the aortic 
semilunar valve showed similar features, slight fibrinous nodules had 
formed on the inner surface of two of the cusps and at the bases of all the 
segments. The pulmonary semilunar valve was normal. In the lesions 
small Gram-staining diplococci were found in pure culture. 

Symptoms.—Although very elaborate descriptions of the symptoms of 
acute endocarditis and of the evidences obtained from a physical exam- 
ination of the heart are given by some authors, we must confess that in 
our experience the clinical picture is anything but satisfactory. No doubt 
if certain symptoms suggestive oi cardiac disease present themselves, or 
if such are detected by a careful clinical examination during the course 
of influenza, pneumonia, acute rheumatism, etc., then we are enabled to 
recognise the existence of the affection. But, unfortunately, owing to 
the variable character of the symptoms, and the tendency to complica- 
tions, the presence of the disease is often overlooked. Again, cases are 
met with in which acute symptoms are absent while the horse is at rest, 
and a difficulty may arise in deciding at the first examination whether the 


* Veterinary Record, January 3, 1914. 
VOL, II. 66 


1042 SYSTEM OF VETERINARY MEDICINE 


animal is suffering from a subacute form of the disease or from a chronic 
valvular affection. For it must be remembered that in the former in- 
stance auscultation may reveal the presence of certain murmurs, etc., 
which are similar to those found in the chronic types; yet after rest and 
suitable treatment the animal may be able to perform even fast work 
until another attack comes on. Moreover, a horse that is already suffer- 
ing from a chronic valvular lesion may be attacked by acute endocarditis; 
the symptoms will then prove confusing even to the most experienced 
clinician. 

We must regard acute endocarditis as being, in the majority of cases, a 
local process in an acute infection rather than as a disease per se. In the 
malignant type the nature of the infecting agent varies as regards viru- 
lency, and, as a result, the morbid changes induced are by no means 
constant; while the associated lesions may be very extensive. Hence it 
is not surprising to find that the symptoms vary in different cases. Even 
in human medicine, where marked facilities for a physical examination of 
the heart are present and the study of the subject has been made a 
speciality, the variability of the symptoms and the difficulties of diagnosis 
are admitted by experienced clinicians. In some textbooks we find 
under the heading of the physical examination of the heart in endocarditis 
descriptions of the phenomena detected by auscultation, but as these 
depend on alterations in the valves, and are practically similar to those 
met with in cases of chronic valvular lesions, we do not intend to draw 
attention to them under the present heading. Moreover, it is admitted 
that in very many cases of acute endocarditis the evidences obtained by 
auscultation are by no means definite, nor can we, with any degree of 
certainty, ascertain the special seat of the lesions. 

In the simple form of the disease the symptoms may easily be over- 
looked, and it is not uncommon to find verrucous lesions of the valves at 
post-mortem examinations, although their presence was not suspected. 
Some authors state that if a careful and systematic examination of the 
heart be carried out during the course of affections such as influenza or 
acute rheumatism, it may be possible to detect certain abnormal sounds 
in cases where endocarditis setsin. So far as the simple type is concerned 
we are not aware of any special features. It is said that increased rapidity 
of the heart’s action, with slight irregularity of the pulse, and a moderate 
increase in the fever of the existing disease, may be observed, also cardiac 
palpitation; but the difficulty in detecting the presence of slight murmurs 
in the horse prevents us from gaining much, if any, information from 
auscultation of the heart in the early stages of the affection. 

In the malignant type the symptoms are subject to great variations, 


DISEASES OF THE HEART: HORSE 1043 


and their intensity depends on the degree of infection of the blood, on the 
complications resulting from embolism, and on the extent of the valvular 
lesions. As in the majority of instances the disease occurs as a com- 
plication during the course of certain affections, the first symptoms 
observed may be an increase in the existing fever, marked constitutional 
disturbances, alterations in the character of the pulse, and general debility. 
But the presence of the disease can only be recognised by a physical ex- 
amination of the heart. According to Hutyra and Marek, the changes in 
the heart-sounds in some instances may be absent for a long period or 
even to the end, and beyond being somewhat feeble and dulled, no altera- 
tions can be detected. In many cases, however, auscultation reveals the 
presence of abnormal conditions, but these are subject to marked varia- 
tions; they often suggest a serious disturbance of the heart rather than 
any special valvular affection. The rate of the heart-beat is greatly 
increased, and in some cases inspection shows a well-marked pulsation 
over the cardiac region. Palpation may detect a thrill or fremitus, and 
the cardiac impulse is much increased in intensity. On auscultation it may 
be difficult to distinguish the cardiac sounds, as they appear to run 
together. An endocardial murmur, which varies in intensity, may take 
the place of either the first or the second sound, but this varies according 
to the situation of the lesions. It is not uncommon to find a number of 
abnormal sounds present, when the endocarditis affects several valves 
simultaneously. Arrhythmia is usually present; the intermittency may 
be so marked that the number of pulsations in the submaxillary artery 
is only one-half that of the heart-beats. The character of the pulse varies 
according to the situation of the lesions, but it 1s usually irregular as well 
as intermittent, and is also weak. A venous pulse may be present when 
the right side of the heart is involved. Respiratory disturbances are also 
observed, and, if the patient be forced, to move, dyspnoea occurs. Pul- 
monary cedema and dropsical swellings on the dependent parts of the 
body may be present in some cases. 

Colicky symptoms of a dull type occasionally appear, and may be 
associated with diarrhoea. According to Cadéac, the pain is due to the 
presence of infarcts in the liver, spleen, and intestinal walls, or to an 
cedematous condition of these organs. 

The other symptoms which may be met with during an attack of 
malignant endocarditis, depend on associated lesions in certain organs, 
due to the presence of emboli therein. Thus evidences of pneumonia, 
purulent nephritis, acute meningitis, etc., may be observed. Spinal 
symptoms may occur in some cases, such as weakness in the hind-limbs 
and a staggering gait. Hmboli may obstruct the main bloodvessel of a 


1044 SYSTEM OF VETERINARY MEDICINE 


hind-limb and cause paralysis of the latter, associated with coldness and 
insensibility of the part. | 

According to W. Williams*, endocarditis presents symptoms similar to 
those of pericarditis, the difference being that the bellows murmur takes 
the place of the to-and-fro friction sound. This author was also of opinion 
that clonic spasms of the superficial muscles, especially of the cervical and 
pectoral regions, with hurried breathing and a tendency to syncope if the 
head be suddenly elevated, or the animal in any way disturbed, are more 
marked in endocarditis than in any other cardiac affection. 

In the case recorded by Wilkinson and Craig, already alluded to (see 
p. 1041), the patient was an aged heavy cart gelding, whose previous history 
was healthy. He was sent on grass, and later on was brought in prepara- 
tory to commencing work again. In a day or two after returning to the 
stable the following symptoms were presented: Although in good con- 
dition and feeding well, the animal was dull, disinclined to move, and unfit 
for work. (idematous swellings appeared on the limbs. The pulse was 
small and frequent, but not irregular. The temperature was 105:2° F., and 
the rise of temperature continued throughout the attack. The cardiac 
impulse was very marked on the left side, and was evident to casual inspec- 
tion. No jugular pulse was present. The heart-sounds were very 
exaggerated, and could be heard very distinctly over the upper portion of 
the chest wall. The duration of illness was from November 6 to 14; the 
animal died suddenly on the morning of November 14. The temperature 
varied from 105:2° F. to 103°6° F., and the pulse from 74 to 86. The 
lesions are described on p. 1041. 

CoursE.—Malignant endocarditis runs an irregular course and is very 
fatal. The duration of a case may be one or two weeks, but the presence 
of complications has a material effect in this direction, and death may 
occur earlier from a variety of causes. 

In the simple form, although it is said that perfect recovery may result, 
yet in most instances chronic lesions develop in the valves. 

Procnosis.—This is always grave, even in what might seem to be the 
mild type of the disease, as the malignant form may set in at any time. 

DIFFERENTIAL D1aGNnosis.—We have already drawn attention to the 
fact that the symptoms presented are very variable, and, moreover, the 
complications which occur render the clinical picture a difficult one to 
interpret. The presence of fever and of marked constitutional disturb- 
ance will assist in differentiating acute endocarditis from chronic valvular 
disease. But it must be remembered that an acute attack may be grafted 
on a chronic process, and also that an animal suffering from chronic 


* “ Principles and Practice of Veterinary Medicine.” 


DISEASES OF THE HEART: HORSE 1045 


valvular disease may contract influenza. The history of the case is of im- 
portance, as by means of repeated careful physical examinations of the heart 
during an attack of influenza or acute rheumatism we may detect the early 
symptoms of a cardiac affection, and when such occur in a comparatively 
short space of time, the evidence is in favour of acute endocarditis. 

The differentiation of the simple or verrucous form from the malignant 
type presents many difficulties. According to Hutyra and Marek, the 
presence of high fever, marked circulatory disturbance, and severe con- 
stitutional symptoms, especially when occurring in connection with 
purulent processes in any part of the body, is suggestive of the malignant 
or ulcerous type of the disease. On the other hand, milder symptoms 
associated with acute rheumatism point to the simple or verrucous type. 

For the differential diagnosis of endocarditis from pericarditis, see 
p. 1016. 

TREATMENT.—Perfect rest is essential. In cases where marked cardiac 
disturbance and vascular excitement are prominent symptoms, some 
authors advise the application of an ice-bag to the cardiac region; but 
Cadéac states that such treatment is useless, and if applied in cold weather 
it predisposes the patient to pneumonia. He advises repeated sinapisms, 
applied to a large extent of the thoracic wall, during the early stages of the 
malady. We have never observed any benefit from counter-irritation, 
and may remark that.it interferes materially with the physical examina- 
tion of the heart. 

When the temperature is high, antipyretics are indicated, and of these 
quinine is preferable. In cases associated with rheumatism, salicylate of 
soda should be given. Drenching should be avoided, and the medicines 
are best administered in the form of electuary. Digitalis or strophanthus 
is advised by some authors when the action of the heart is rapid and 
irregular. Cadéac believes that iodide of potassium has the effect of 
preventing fibrous organisation of the exudate on the valves, and pre- 
scribes this agent with digitalis so as to prevent the depressing action of 
the former drug on the heart. When cardiac weakness is present, similar 
treatment to that advised for myocarditis should be carried out (see 
p. 1033). Cadéac remarks that no form of treatment has any influence in 
preventing the occurrence of embolism. 

Malhenant endocarditis generally proves fatal in spite of treatment. 


Chronic Endocarditis—Chronic Valvular Disease. 


Although some authors describe chronic endocarditis and chronic 
valvular disease under separate headings, we do not consider that such an 
arrangement is desirable from a clinical point of view, as the former con- 


1046 SYSTEM OF VETERINARY MEDICINE 


dition is in the majority of instances associated with valvular disease. No 
doubt other conditions may, by interfering with the efficient working of 
the valves, produce valvular insufficiency, even in the absence of distinct 
lesions of the valves themselves. For example, diseases of the myo- 
cardium interfering with the normal contractions of the heart, and 
associated with dilatation of the auriculo-ventricular opening, may bring 
about insufficient closure of the auriculo-ventricular valves. Again, 
morbid conditions of the aorta, such as dilatation of this vessel close to 
the heart, may produce insufficiency of the aortic semilunar valves. 
Injuries to the valves, tumours, and congenital heart lesions, may also be 
etiological factors; these will receive consideration later on. 

Here it will be necessary to direct attention briefly to the morbid 
changes occurring in chronic endocarditis, and then to consider in a general 
manner the effects of lesions of the valves before proceeding to describe 
the phenomena occurring when the morbid process is localised in certain 
regions. 

EtroLtocy.—Chronic endocarditis is in very many instances secondary 
to an acute attack of endocarditis or recurring attacks of a subacute type. 
Rheumatism, influenza and pneumonia are often the primary etiological 
factors. But many cases are met with in which there is no history of 
acute symptoms, and the disease progresses in an insidious manner; often, 
indeed, the presence of the lesions is only discovered at autopsies. 
According to Hutyra and Marek, chronic endocarditis may develop in 
connection with chronic endoarteritis and arterio-sclerosis; these are 
regarded as important etiological factors in the human subject. Severe 
and long-continued exertion is said by some authors to be a cause of the 
disease. Old age is admitted by all observers to be a predisposing factor. 

Morsip ANnaTtomMy.—An inciease in the connective tissue of the valves, 
followed by sclerosis, is one of the prominent morbid phenomena of the 
disease. This leads to thickening, shrinking, and rigidity of the valves, 
and occasionally to adhesion of the cusps, and in many cases to the de- 
position of lime salts; while the chord tendinewe may be shortened and 
thickened. Vegetations of a verrucous, polypoid, or cauliflower-like 
character, may be found on the borders of the valves which face the blood- 
stream. In the aortic valves the primary alteration may be in the 
vicinity of the corpora aurantii, and consists of a slight degree of thicken- 
ing associated with the presence of nodules. When the sclerotic changes 
increase, the fibrous tissue contracts, with the result that thickening and 
deformity of the segments occur; the edges of the latter become round and 
curled so that perfect closure of the valve becomes impossible. In some 
cases distinct narrowing of the segments is observed, without special de- 


DISEASES OF THE HEART: HORSE 1047 


formity, so that insufficiency occurs without any narrowing of the arterial 
orifice. In the auriculo-ventricular valves similar changes may occur. 

Lesions may be found on the parietal layer of the endocardium (mural 
endocarditis), such as patches of a greyish-white appearance, resembling 
cicatrices; these may be associated with myocarditis. 

Gunmrat REMARKS ON CHRONIC VALVULAR DisEAsE.—In order to 
understand the effects of lesions of the valves and the methods of diag- 
nosis, it is essential to be thoroughly acquainted with the structure and 
functions of the heart. Space will not permit us to refer to physiological 
matters in detail, but for full information on such points the student should 
consult F. Smith’s work on “ Veterinary Physiology.”’ 

With reference to the incidence of chronic valvular disease in the horse, 
as already mentioned in our introductory remarks, some writers hold the 
opinion that such affections are uncommon. We are inclined to believe, 
however, as the result of clinical observation and post-mortem evidence, 
that chronic valvular disease occurs more frequently than is imagined. 
But it is often overlooked owing to the obscure character of the symptoms 
in many instances, and to the fact that horses suffering from the disease 
often perform work without manifesting any evidences of its presence; 
moreover, we must remember that a careful physical examination of the 
heart is not carried out in practice as often as is desirable, while post- 
mortem examinations are not always conducted with that degree of 
accuracy which is essential to discover the presence of certain cardiac 
lesions. 

On referring to the Report of the Army Veterinary Service for 1911-12, 
we find that six cases of valvular disease were admitted for treatment. In 
the Report for 1912-13 four cases of the disease were admitted. Nocard 
found valvular lesions in forty-two aged horses used for the purpose of 
teaching practical surgery. 

As regards the most common seat i the lesion in the pane many 
observers agree that the aortic valves are most frequently affected. Of 
the forty-two cases of valvular disease observed by Nocard, and mentioned 
above, thirty-eight showed lesions of the aortic valves, in the remaining 
four the mitral and aortic valves were involved. Hutyra and Marek 
found the aortic valves frequently affected. In Robertson’s experience 
the mitral or the aortic valves were most liable to disease. 

According to Friedberger and Frohner, in fifteen cases of chronic 
valvular disease seven were affected on the left side, five on both sides, and 
three on the right side. These authors found that mitral insufficiency was 
the commonest of all valvular defects in horses, while insufficiency of the 
aortic valves was rather frequently observed. Cadiot and Ries observed 


1048 SYSTEM OF VETERINARY MEDICINE 


in fourteen cases of valvular disease that the aortic valves were affected in 
ten, the mitral valve in one, while in the remaining three both valves were 
involved. | 

Stockman* found that tricuspid incompetence with dilatation of the 
right ventricle is the most common cause of cardiac murmurs in the horse 
(see p. 1061). Horace L. Roberts, F.R.C.V.S., informs us that in his 
experience mitral insufficiency is the most common valvular lesion met 
with in farm horses in the county of Suffolk. | 

EFFECTS OF VALVULAR LEsions.—A consideration of these in a general 
manner will explain the symptoms met with in the various localizations 
of the lesions, and thus prevent repetition. Anexplanation of the terms 
insufficiency and stenosis as applied to valve lesions will first be necessary. 

Insufficiency, or incompetency, is one of the results of the sclerosis and 
- other morbid changes in a valve. It may occur alone or be associated 
with stenosis. The leading feature in insufficiency per seis the imperfect 
closure of a valve so that the blood-current is permitted to take an ab- 
normal course. When, however, vegetations have formed on the valve, 
or the latter has become very rigid, or its segments adherent to each other, 
then stenosis is associated with insufficiency. 

Stenosis consists in a narrowing of the orifice, and arises from the causes 
Just mentioned. The result is a difficulty in expulsion of the normal 
amount of blood through the narrow orifice. 

A good example of insufficiency and its effects is found in incompetency 
of the mitral valve. During systole blood is regurgitated from the left 
ventricle into the left auricle, owing to the imperfect closure of the mitral 
valve. Under such a condition the left auricle receives blood from two 
sources—viz., from the pulmonary veins and from the left ventricle, and 
the result is overfilling and dilatation of the auricle. Again, with each 
systole of the left auricle a larger amount of blood is forced into the left 
ventricle, the latter also becomes dilated. 

In order to overcome the dilatation the walls of the heart become 
hypertrophied, this process bemg known as compensation. This com- - 
pensatory hypertrophy occurs in various valvular lesions, and on either 
the left or the right side of the heart, according to the valves which are 
affected. So long as the compensation is maintained, the functions of the 
heart are carried out in an efficient manner, and no symptoms are pro-. 
duced; but when from any cause compensation fails, serious results follow. 

The effects of a valvular lesion are remote as well as immediate. For 
example, mitral insufficiency not only interferes with the functions of the 
left side of the heart, but also with the pulmonary circulation, and finally 


* Journal of Comparative Pathology and Therapeutics, 1894. 


DISEASES OF THE HEART: HORSE 1049 


lesions of the right side of the heart are produced. Hence combined 
valvular lesions are not uncommonly met with. 

Draenosis.—The diagnosis of valvular disease is based on a physical 
examination of the heart, and in connection with this procedure ausculta- 
tion by means of the stethoscope or phonendoscope occupies the most 
important position (see p. 1005). The presence of certain abnormal sounds, 
known as murmurs, their relation to the normal sounds of the heart, the 
time at which they occur—z.e., whether systolic or diastolic, and the 
regions where they are best detected—may be regarded as the essential 
features in the differential diagnosis of the various forms of valvular 
lesions. No doubt there are other phenomena which also prove of assist- 
ance, such as the character of the pulse and the presence of venous 
pulsation, and these must also be carefully studied by the clinician. 

And, although it is easy to describe the various points in the differen- 
tiation of one form of valvular disease from another, it is quite another 
matter to put them into practice. In many instances it may even be 
difficult to give a definite opinion as to the presence of a valvular lesion, 
irrespective of its site. No doubt in far advanced cases the diagnosis can 
be made without the necessity for a high degree of skill in the employ- 
ment of the stethoscope, and, moreover, there are associated symptoms 
which are very suggestive. But considerable skill is required in less 
marked cases, and special care must be exercised so as to avoid mistaking 
a functional cardiac disorder for one of organic disease. When we come 
to differentiate the valvular lesions from each other, or to decide whether 
the abnormal sounds detected by the stethoscope depend on valvular 
disease or on serious morbid alterations of the myocardium, then, indeed, 
we must admit that, as compared with human medicine, we are placed at 
a great disadvantage. The reasons for this we have already alluded to 
(p. 1005), but at the same time we are of opinion that, with more accurate 
observation and more careful attention to auscultation of the heart, it 
will be possible to improve our practical knowledge of the diagnosis of 
cardiac disease in the horse. W. Williams* devoted but a very short space 
to chronic valvular diseases, and remarked that such affections were 
exceedingly difficult of diagnosis. The only points mentioned by this 
author in the differential diagnosis of the various lesions were as follows: 
‘A bellows murmur with the first sound indicates mitral disease or in- 
sufficiency, a bellows murmur with the second sound indicates aortic 
insufficiency.” He also repeatedly found the cardiac sounds modified, a 
distinct venous pulse, and irregularity of the heart’s action in various 
conditions unassociated with valvular disease. 


* “Principles and Practice of Veterinary Medicine,”’ 1909. 


1050 SYSTEM OF VETERINARY MEDICINE 


Cadéac remarks that the abnormal sounds or murmurs per se are 
uncertain signs, as they may be absent even in the case of well-marked 
valvular lesions, or when the valves are completely destroyed, or but 
slightly altered, also when the contractions of the heart are too feeble to 
bring about a sufficiently energetic impulsion to the blood so as to produce 
murmurs perceptible to auscultation. Hutyra and Marek also state that 
the absence of murmurs does not exclude the presence of a valvular lesion, 
because in the case of slight lesions, especially when the animal is at rest, 
the murmurs produced are not of sufficient intensity to be transmitted to 
the walls of the chest. In severe insufficiency murmurs may not be 
produced, as the regurgitation occurs through a wide slit. Again, when 
compensation fails, the cardiac contractions are feeble and the murmurs 
may disappear. Hence it is advisable to examine such cases after 
exercise, The same authors point out that murmurs may occur in the 
absence of valvular lesions, and that such are nearly always systolic. 

From a practical point of view the differentiation of the various forms 
of chronic valvular disease is not of great importance, as a horse suffering 
to any extent from such lesions rarely repays the cost of treatment, and 
is only suitable for slow work. The crucial point to decide is the exist- 
ence of a chronic valvular affection, or of an equally serious myocardial 
lesion, such as dilatation or fatty degeneration. It must be remembered 
that in cases of aortic aneurism murmurs similar to those heard in valvular 
lesions may be present. 

In order to appreciate the relation of the phenomena of valvular 
disease to the normal cardiac cycle it is necessary to draw attention briefly 
to the normal physiology of the heart so far as the working of the valves 
is concerned. During the long pause, or period of diastole, the auriculo- 
ventricular valves are open, and the blood from the ven cave enters the 
right auricle and also the right ventricle, while the blood from the pul- 
monary veins enters the left auricle and left ventricle. The systole of the 
auricles completes the filling of the ventricles. The systole of the ven- 
tricles next occurs, and the blood is propelled into the aorta and pulmonary 
artery respectively, this being accompanied by the first sound of the 
heart, by the closing of the auriculo-ventricular valves, and the opening 
of the aortic and pulmonary semilunar valves. A brief pause follows, and 
the semilunar valves (aortic and pulmonary) close, this corresponding to 
the second sound of the heart. This is followed by the long pause. 

According to Martius, the contraction of the ventricles takes an 
appreciable period of time—viz., ;45 of a second—to overcome the strong 
arterial pressure which keeps the aortic and pulmonary semilunar valves 
tightly closed. “ This closure-time is the only brief period in the cycle 


DISEASES OF THE HEART: HORSE 1051 


in which both the auriculo-ventricular valves and the semilunar valves 
are shut, the former as a result of the beginning of the systole, the latter 
until the intraventricular has overcome the aortic pressure. With this 
closure time correspond the first sound and the heart-beat. In the second 
period of the ventricular systole the blood is driven into the arteries— 
the expulsion time—and this corresponds with the beginning of the aortic 
pulse. ... Following the ‘ expulsion time’ there is a brief period—the 
‘waiting time ’—before the diastole begins.’ Clinically, the murmur of 
mitral insufficiency coincides, at any rate in its beginning, with the closure 
time; the murmur of aortic stenosis with the expulsion time. The semi- 
lunar valves close at the moment when the ventricles begin to relax, and 
with this coincides the second sound. At the same moment the auriculo- 
ventricular valves open. The murmur of aortic insufficiency is heard 
through the first part of the diastole, sometimes more, while the murmur 
of mitral stenosis corresponds with the latter part of the diastole of the 
ventricles and with the systole of the auricles.”’* 

The above extract explains very lucidly the relation of chronic valvular 
lesions to normal cardiac action, and as the diagnosis of the various forms 
of the disease is largely based on the position which the murmurs occupy 
in the cardiac cycle, as detected by auscultation, the points to which 
attention is drawn are of great importance. 

_We shall now proceed to deal briefly with the various forms of chronic 
valvular disease and their differential diagnosis; the treatment of these 
will receive attention at the end of the section. As previously remarked, 
the practitioner must expect to find many variations in the symptoms 
presented and in the evidences obtained from a physical examination of 
the heart. 


VARIOUS FORMS OF VALVULAR DISEASE. 


Aortic Insufficiency. 


SynonyM.—Aortic incompetency. 

In this form the aortic semilunar valve is teed by morbid 
changes, so that the valve segments do not securely close the aortic 
orifice during diastole. The primary result is regurgitation of blood from 
the aorta into the ventricle, causing an overdistension of the latter and a 
reduction in the amount of blood passing into the arterial system. Other 
results follow which we shall describe farther on. Relative insufficiency 
is occasionally met with, in which the aortic ring and the adjacent aortic 
arch are dilated. Insufficiency may be combined with various grades of 


* QOsler’s ‘‘ Practice of Medicine.”’ 


1052 SYSTEM OF VETERINARY MEDICINE 


stenosis. According to many authors aortic incompetency is the com- 
monest valvular lesion met with in the horse, especially in aged animals. 

Errotocy.—A previous attack of endocarditis is regarded as one of 
the commonest causes of the condition. According to Cadéac, rupture of 
a valve segment resulting from a severe fall or from a violent injury to the 
thoracic wall may induce aortic insufficiency ; the occurrence of the lesion 
is favoured if the valve has suffered from a previous attack of endocarditis. 
The same author recognises morbid alterations in the aorta, such as 
atheroma and aneurism, as being causes of aortic insufficiency. Lascaux 
recorded a case of primary sclerosis of the aorta, complicated with in- 
sufficiency of the aortic valve and dilatation with hypertrophy of the 
left ventricle. 7 

Morsip ANATOMY.—Various lesions of the valve have been recorded, 
including fibrous or calcareous vegetations, a deformed and thickened 
condition of the segments, indurations, aneurismal dilatations, ulcerations, 
perforations, ruptures, also adhesions between the segments or with 
adjacent tissues. The aorta may show dilatation, or an atheromatous 
condition of its walls. The left ventricle is hypertrophied to a marked 
extent, and may be dilated. The hypertrophy results from the increased 
intraventricular pressure, the latter being due to the reflux of blood from 
the aorta during diastole. The hypertrophy results from the increased 
work to which the ventricle is subjected in propelling the blood from the 
dilated and overfilled ventricle into the aorta. Later on hypertrophy of 
the left auricle also occurs, owing to the effort necessary to propel the blood 
into the ventricle, which already contains more than the normal amount. 
So long as the compensatory hypertrophy is maintained, the valve defect 
does not seriously impair the systemic or the lesser circulation, and there 
is little resistance to the blood-flow from the auricle. But in long-standing 
cases the left auricle becomes dilated as well as hypertrophied, the pul- 
monary circulation is impeded, and the right side of the heart becomes 
hypertrophied and dilated. Owing to the lowering of the blood-pressure 
in the sinuses of Valsalva, in advanced cases, the circulation in the coronary 
arteries 1s probably embarrassed. 

Symptroms.—The most important of these are obtained from a physical 
examination of the heart. 

PuysicaL Signs—Palpation.—The cardiac impulse is usually strong, 
increased in intensity, and heaving, owing to the hypertrophy of the left 
ventricle; but when extreme dilatation is present, it becomes wavy and 
indefinite. A thrill, diastolic in time, may be detected by palpation over 
the cardiac region. 

Percussion shows an increase in the area of cardiac dulness, owing to 


DISEASES OF THE HEART: HORSE 1053 


the well-marked hypertrophy. Stockman has found that the area of 
dulness may extend backwards to the seventh rib. 

Auscultation.—A murmur is detected during the diastole of the ven- 
tricles, and is due to the reflux of blood into the left ventricle. According 
to Cadéac, the murmur is soft and blowing in character, sometimes super- 
ficial, more often deep, loud at the commencement, but less marked 
towards the end of the long pause, and most easily recognised in cases 
where a small perforation is present in the valve. Hutyra and Marek 
state that the murmur is usually loud, blowing, or roaring, prolonged, 
perhaps rough or ringing, and separated from the systole by a rather short 
interval, and that it is heard in its greatest intensity at the fourth inter- 
costal space on the left side immediately below the shoulder-line,* and a 
little less clearly on the right side. This murmur may accompany the 
second cardiac sound, or take its place. Stockman found that the murmur 
was best heard near the anterior border of the fourth rib, about 84 inches 
from the keel of the sternum. It was carried downwards towards the 
apex for about 4 inches, in the area of the fourth and fifth intercostal 
spaces, and might, when loud, be propagated well forward over the 
shoulder, and one quarter way up the carotid arteries. Cadéac remarks 
that the murmur is transmitted to the aorta and carotid arteries; it may 
be double (systolic and diastolic), pointing to the coexistence of stenosis 
and insufficiency. 

_ Arteries.—Palpation of the carotid arteries and of the large arterial 
trunks may reveal the presence of a vibratory thrill. A systolic pulsa- 
tion may be visible in the larger and often in the smaller superficial arteries, 
such as the transverse facial, the posterior auricular, etc. Auscultation of 
the arteries with the stethoscope reveals, according to Hutyra and Marek, 
a “clapping” sound. Other observers state that if the artery be com- 
pressed by the instrument a double murmur can be detected, while, if no 
compression be exerted, a double “ clapping ”’ sound is heard. In severe 
cases of the disease capillary pulsation may be observed in the visible 
mucous membranes with each ventricular systole, they show redness, and 
this may be emphasised by pressing the part with the finger-tip so as to 
produce a temporary pallor (Hutyra and Marek). 

Pulse.—This shows a special character in aortic insufficiency. In 
human medicine it is termed the “ Corrigan” or “ water-hammer ”’ pulse. 
“ The pulse-wave strikes the finger forcibly with a quick, jerking impulse, 
and immediately recedes or collapses’’ (Osler). The following explana- 
tion of this phenomenon is given by Hutyra and Marek: Owing to the 


* This is an imaginary line drawn in a horizontal manner through the shoulder 
joint and extending along the ribs. 


1054 SYSTEM OF VETERINARY MEDICINE 


hypertrophy of the left ventricle an increased amount of blood is forced 
into the aorta and peripheral arteries with each ventricular systole. But 
in these vessels, owing to the reflux of blood during the preceding diastole, 
a considerable lowering of blood-pressure results. The increased 
amount of blood forced in by each systole, and the marked difference be- 
tween the systolic and diastolic blood-pressure in the vessels, produce a 
more vigorous and more rapidly increasing wave. This latter, however, 
quickly disappears, as after the termination of systole the blood flows 
tapidly to the peripheral vessels, while, owing to the insufficiency, portion 
of the blood returns to the heart, hence the quick alteration in the pulse. 

Another modification of the pulse that may be observed in aortic 
insufficiency is the existence of an appreciable interval between the beat of 
the heart and the pulsation in the posterior radial or submaxillary artery. 

General Symptoms.—Aortic insufficiency may remain unsuspected for 
an indefinite period. So long as compensation is fully maintained and the 
hypertrophy equalises the valvular defect, no symptoms may be observed. 
When, however, compensation commences to fail, cardiac palpitation and 
dyspnoea may occur after exercise or fast work. In some cases irregular 
respiration, or a double expiratory movement, as in cases of “ broken 
wind,’ may be observed, and may be accompanied by marked loss of 
condition. In far-advanced instances passive pulmonary congestion, or 
pulmonary cedema, may be present. Sudden death from syncope has 
been recorded. Unless there is coexisting disease of the mitral valve, 
cedematous swellings on the inferior aspect of the sternum and abdominal 
region are rarely observed. 

DIFFERENTIAL DraGNnosis.—This is based on the evidences obtained 
from a physical examination of the heart and arteries, and on the char- 
acter of the pulse. In mitral stenosis, although a presystolic murmur is 
present, the condition is characterised by certain features, which enable 
a differential diagnosis to be made (see p. 1060). 


Aortic Stenosis. 


In this condition there is a narrowing of the aortic orifice, due to 
certain morbid alterations in the aortic semilunar valve. It is of far 
less frequent occurrence than aortic insufficiency. Both conditions may, 
however, be combined. A certain degree of insufficiency is believed to, 
be present in every case of stenosis. 

Hit1oLocy AND Morspip Anatomy.—The aortic semilunar valve shows 
thickening and induration, the corpora aurantii being specially involved 
(Cadéac). In advanced cases the segments may be rigid and of a car- 
tilaginous consistence. Calcification may occur in the segments, and the 


DISEASES OF THE HEART: HORSE 1055 


aortic opening may be reduced to a small circular or slit-like passage. 
Occasionally the segments may become adherent at their surfaces of 
contact, and so rigid that during systole they cannot be pressed back 
against the aortic wall, or they may form an obstruction in the form of 
a funnel. Pedunculated or sessile vegetations may be present on the 
free edges of the segments, and cause stenosis. Some observers found 
stenosis depending on compression of the aorta by tumours, such as 
melanomata and lympho-sarcomata. 

Owing to the narrowing of the aortic orifice, the left ventricle has to 
work against an increased resistance in order to propel the blood into the 
aorta, hence its walls become hypertrophied. In the early stages dilata- 
tion is slight or absent, and even in advanced cases it may not be marked, 
as the hypertrophy may be of the concentric type. So long as compensa- 
tion is maintained, the other cavities of the heart are not affected; but 
when it fails, hypertrophy and dilatation of the left auricle results, and 
finally the right side of the heart is involved, owing to stasis in the pul- 
monary vessels. According to Cadéac, the hypertrophy of the left side 
of the heart is so well marked during the greater part of the duration of 
aortic stenosis that on post mortem the left side of the organ is far 
more prominent than the right. The systole is much prolonged, and 
so long as compensation is well established the pulse-wave may be of 
medium volume; but when compensation tends to fail, the amount of 
blood propelled through the narrowed aortic orifice is smaller than normal. 

Symproms—Puystcau Siagns—Palpation.—A systolic thrill is detected 
over the base of the heart, simultaneous with the heart-beat. The 
cardiac impulse may be slow and forcible, and may be distributed over 
a larger area than normal. 

Percussion.—A slight increase in the area of cardiac dulness is ob- 
served. : 

Auscultation.—A_ well-marked prolonged systolic murmur is heard 
chiefly over the base of the heart, diminishing in intensity towards the 
apex. According to Cadéac, it is generally rough, but may sometimes 
be of a soft character. It is propagated into the large vessels, and can 
be detected by a stethoscopic examination of the carotid arteries and 
posterior aorta. Hutyra and Marek state that the murmur of aortic 
stenosis is separated from the second sound of the heart by only a brief 
interval. It covers the first sound of the heart, and may be so intense 
that it is audible to the observer when he stands close to the patient. 
These authors also point out that the murmur is best heard over the 
fourth intercostal space, immediately below the shoulder-line, and can 
also be detected on the right side. 


1056 SYSTEM OF VETERINARY MEDICINE 


- The second cardiac sound is weakened in its aortic origin, but the 
pulmonary aortic sound is, according to the above authors, heard in 
fairly normal intensity at the third intercostal space below the shoulder- 
line in the lower half of the left lower third of the chest. 

The Pulse is small, slower than normal, regular, and usually of good 
tension. 

General Symptoms. — When compensation is maintained, no symp- 
toms may be observed; but when this fails, and degeneration of the 
myocardium occurs, mitral insufficiency may set in, and the symptoms 
of that condition are then manifested. The course of the disease is very 
slow, and in several of the recorded cases the prominent symptoms 
present simulated those generally associated with pulmonary em- 
physema. 

Vertigo may be observed in some cases, and is due to a defective 
blood-supply to the cerebrum. 

DIFFERENTIAL DraGNosis.—This is based on the rough systolic 
murmur, the systolic thrill, and the small, slow, regular pulse. 


Mitral Insufficiency. 


According to Friedberger and Froéhner, this is the most common of all 
valvular diseases in the horse. This view corresponds with our own 
experience. Stockman has found the lesion very frequently associated 
with aortic insufficiency. 

ErroLtocy.—The chief etiological factor is a previous attack of endo- 
carditis, resulting in contraction and shortening of the valve, and changes 
in the chorde tendinee. Some authors record the presence of tumours 
on the valve, such as myxomata, sarcomata, and melanomata, which 
produce insufficiency by mechanically preventing complete closure of the 
cusps of the valve. But insufficiency may also occur as the result of changes 
in the walls of the left ventricle, this condition being termed muscular 
encompetency. It includes dilatation associated with enlargement of the 
mitral orifice, so that the valve segments are unable to efficiently close 
the latter; or morbid alterations in the muscular substance, so that the 
segments are imperfectly coapted during the systole. 

Morsrp ANAToMy.—The edges of the segments of the mitral valve 
are thickened, and the chord tendinee are contracted and increased in 
thickness. Adhesion may take place between the edges of the segments, 
so that a varying degree of stenosis is present as well. In some cases the 
valve may become of a semi-cartilaginous consistency, and calcareous 
changes in it are not uncommon. 

Owing to the imperfect closure of the valve, important effects are 


DISEASES OF THE HEART: HORSE 1057 


produced upon the heart and circulation. During ventricular systole 
there is a reflux of blood from the left ventricle to the left auricle. Hence, 
at the termination of auricular diastole, the left auricle contains blood 
derived from two sources—viz., from the pulmonary veins, and by re- 
gurgitation from the left ventricle. The result is dilatation, followed by 
hypertrophy, but the latter may not be well marked. As an increased 
amount of blood is forced into the left ventricle with each systole of the 
left auricle, the former becomes dilated and subsequently hypertrophied. 
Owing to the regurgitation of the blood into the left auricle, there is 
increased pressure in that cavity, and the pulmonary veins are less 
readily emptied. Moreover, as these veins are not provided with valves, 
it happens that during auricular systole, owing to the distended auricle, 
a reflux of blood is sent into these vessels, stasis occurs in the pulmonary 
capillaries, and next in the pulmonary artery, so that the right ventricle 
becomes dilated and hypertrophied. Finally, similar changes occur in 
the right auricle. Compensation is effected by hypertrophy of both 
ventricles, and the circulation is maintained for a time. But when com- 
pensation fails, serious results ensue, both in the greater and lesser cir- 
culation. The right auricle becomes dilated, the systemic veins con- 
gested, the tricuspid valve incompetent, and passive hyperemia of the 
lungs, liver, and kidneys occurs, with dropsical effusions into the serous 
cavities, and finally pulmonary cedema,. 

SymMproms—PuysicaL Sians—Palpation.—The cardiac impulse may 
be increased in extent, but its force depends on the stage of the disease. 
During the compensation period it may be forcible, but when compensa- 
tion is disturbed it is feeble. A systolic thrill simultaneous with the heart- 
beat is said by Hutyra and Marek to be often present, and Cadéac de- 
scribes it as of a “ purring,” vibratory character. In the cases we have 
observed this has been absent, but a visible pulsation over the cardiac 
region was present in some instances. 

Percussion.—According to Hutyra and Marek, the area of cardiac 
dulness is rarely increased on the left side, but on the right side an increase 
is distinctly manifested. e 

Auscultatoon.—A systolic rurmur, which wholly or partly obliterates 
the first sound of the heart, is heard. It is caused by the reflux of blood 
into the auricle during ventricular systole. According to Cadéac, it is 
rough in character when vegetations are present on the valve, but other- 
wise it is of a soft type, especially if the insufficiency is well marked; or 
it may be of a whistling character if the reflux of the blood causes vibra- 
tion of the chorde tendinez. This author states that the murmur is 


best heard over the base of the heart, and is also transferred to the apex; 
VOL, Il, 67 


1058 SYSTEM OF VETERINARY MEDICINE 


also that it may disappear when the insufficiency is of an extreme grade, 
or if the cardiac contractions are very feeble. 

Hutyra and Marek state that the point of maximum intensity is over 
the fifth intercostal space of the left side, in the middle of the lower 
third of the chest; also that the murmur is of a prolonged blowing or 
rushing character. 

Stockman found that the murmur is best heard about the level of 
the fifth rib, and may be carried backward to the seventh rib, and also 
well down towards the apex by the ventricular wall, and upwards by the 
dilated auricle. 

The second sound of the heart is louder than normal. According to 
Hutyra and Marek, the aortic portion of this sound (second aortic sound) 
is usually normal in strength, but the pulmonic portion (second pul- 
monary sound) is much increased and clearer. This is termed “ accen- 
tuation of the pulmonary second sound.” It gives one the idea of the 
existence of three cardiac sounds, and is said to be due to increased 
pressure in the pulmonary artery, so that the column of blood is thrown 
with greater force against the pulmonary semilunar valve; it is heard 
in the left third intercostal space, in the lower half of the lower third of 
the chest. It is regarded as an important diagnostic feature of mitral 
insufficiency in the human subject, but its detection in animals is difficult. 
According to Cadéac, this symptom occurs in mitral stenosis, and is 
pathognomonic of that condition, but we have observed it in cases of 
mitral insufficiency. | 

Pulse.—During compensation the pulse may be full and regular, yet it 
is often of low tension, and when compensation is disturbed it becomes 
irregular, smal], and intermittent. 

Jugular Pulse-—This symptom is not mentioned by some authors as 
occurring in mitral insufficiency, but we have observed it in every case 
of the disease that we examined. It probably depends on dilatation of 
the right side of the heart. According to Stockman, it is not marked 
until secondary dilatation of the right ventricle has taken place. 

General Synvptoms. — Respiratory phenomena are well marked in 
far-advanced cases, such as an occasional dry cough, accelerated respira- 
tions, which may be irregular and resemble the type of breathing met 
with in “ broken wind.’ Dyspnoea may be observed, and occasionally 
a discharge of blood from the nostrils, due to rupture of some of the 
pulmonary capillaries. Cidematous swellings of the limbs, sheath, 
inferior aspect of the abdominal region and sternum, occur in the 
majority of instances, and in some cases cedema of the breast and lower 
part of the neck is present. Owing to passive congestion of the liver, 


DISEASES OF THE HEART: HORSE 1059 


an icteric tint of the visible mucosee may be observed. Occasionally 
slight colicky pains associated with diarrhoea are manifested, and depend 
on stasis in the blood-supply of the gastro-intestinal canal. 

We must, however, point out that in less-advanced cases it is possible 
for the animal to perform even severe work without manifesting any 
marked symptoms, but without any warning serious phenomena appear 
during exercise, although while at rest the existence of the affection is 
not suspected. We recorded a case in a four-year-old hunter that had 
suffered from an attack of influenza, and, when convalescent, was sent 
to be examined for soundness in December, 1910. Owing to the presence 
of a nasal discharge, slightly increased respirations, and slight oedema on 
the inferior aspect of the sternum, we postponed the examination of the 
animal’s wind. When the horse was being walked quietly home he 
staggered, and nearly came down. On examining the heart, we found 
clear evidences of mitral insufficiency, and a well-marked jugular pulse. 
The horse was treated in the infirmary for seven days, and then sent 
home, and for a long period was kept at gentle exercise. Distress in 
respiration was occasionally observed, and if the horse was cantered, a 
slight trickle of blood was noticed from the nostrils. He was sold to a 
dealer in 1911, and resold shortly after to an officer, who hunted him 
regularly during the following season. He was then sent on grass, and 
in August, 1912, was broughtin. Shortly afterwards, while being ridden 
by the owner, he staggered and fell on two different occasions, and 
emitted a neigh before going down. On being sent for to attend him, 
we found almost exactly similar symptoms to those which were present 
in December, 1910. On trotting the horse a short distance, he suddenly 
stopped, threw up his head, brought the hind-limbs well under his body, 
neighed loudly, and fell down in a helpless manner. He was destroyed, 
and the post-mortem showed extensive dilatation and hypertrophy of 
both sides of the heart. The organ weighed 24 pounds, and the mitral 
valve showed extensive thickening and contraction of the segments, with 
considerable increase in size and shortening of the chorde tendinee. 
The animal was in the best of condition. We draw attention to this case 
in order to show that mitral disease may remain unsuspected for an in- 
definite period, in a similar manner to other valvular lesions. Probably 
in this case the lesions in the first attack were acute, and were followed 
by an apparent recovery; but in reality permanent alterations remained, 
and gradually increased in extent, while compensation commenced to 
fail. 

DirFeRENTIAL DraGnosis.—This is based on the presence of a systolic 
murmur, which almost completely replaces the first sound of the heart, 


1060 SYSTEM OF VETERINARY MEDICINE 


and on the special location of this murmur (see p. 1058). When asso- 
ciated with aortic insufficiency, of course, a combination of symptoms 
will be in evidence. | 

Mitral Stenosis. 


This condition is by no means so frequently met with as mitral in- 
competence, but it may be associated with the latter lesion. Neverthe- 
less, it has been very thoroughly studied by Cadéac and other Continental 
authorities. The left auriculo-ventricular orifice is distinctly narrowed, 
owing to morbid alterations in the mitral valve. 

HrroLogy.—Endocarditis is recognised as the most common etio- 
logical factor. Occasionally the presence of tumours, such as myxo- 
mata, melanomata, and sarcomata, have been observed. 

~Morsip Anatomy.—Thickening and rigidity of the valve segments, 
with adhesion of their free borders, and contraction of the chorde ten- 
dines, are the commonest lesions met with. Cadéac remarks that the 
auriculo-ventricular orifice, viewed from its superior surface, resembles a 
rigid funnel in appearance. The opening in it is either circular or in 
the form of a slit circumscribed by thick undurated edges, and by vege- 
tations. The summit of the funnel projects into the cavity of the ven- 
tricle. Owing to the obstruction offered to the passage of blood through 
the. mitral orifice, the left auricle becomes dilated, and subsequently 
hypertrophied. The left ventricle receives a smaller amount of blood 
than normal, and hence a lessened quantity is propelled into the aorta. 
The left ventricle may not show any alterations, or its walls may become 
atrophied. Owing to stasis in the left auricle, there is increased pressure 
in the pulmonary veins and capillaries, and in the pulmonary artery and 
right ventricle. Finally, the right ventricle becomes dilated and hyper- 
trophied, and may be followed by insufficiency of the tricuspid valve. 
Passive congestion of the lungs and pulmonary cedema result, and in 
some instances pulmonary hemorrhages occur, due to increased tension 
in the bloodvessels of the lungs. 

Symproms—PuysicaL Sians—Palpation.—A_ presystolic vibratory 
thrill is detected over the base of the heart. It immediately precedes the 
cardiac impulse, and corresponds to the systole of the auricle and the 
propulsion of blood through the narrowed mitral orifice. 

Auscultation.—A diastolic murmur is heard over the posterior part of 
the cardiac region just at the apex. According to Hutyra and Marek, 
its point of maximum intensity 1s over the fifth intercostal space on the 
left side, at the middle of the lower third of the chest. Cadéac remarks 
that the murmur commences with a sound like the “ rolling of a drum,” 
which occupies the long pause, and is converted into a murmur towards 


DISEASES OF THE HEART: HORSE 1061 


the termination of diastole; hence it may be described as presystolic. 
The murmur may be heard without the “ rolling” sound when the heart- 
beats are much accelerated. On the other hand, the “ rolling ”’ sound 
may entirely replace the murmur when the heart-beats are less frequent 
and the ventricular systole is more complete. But by subjecting the 
patient to exercise the murmur can be made to reappear. When insuffi- 
ciency is present as well, the presystolic murmur is followed by a systolic 
murmur, 

The second cardiac sound shows a similar change to that mentioned 
as occurring in mitral insufficiency—viz., reduplication or accentuation 
of the second pulmonary sound. As already mentioned, Cadéac regards 
this as one of the characteristics of mitral stenosis. 

The pulse is small and soft, owing to the lessened amount of blood 
propelled into the aorta. In the later stages it becomes weak, irregular, 
and intermittent. 

General Symptoms. — The respiratory disturbances resemble those 
occurring in mitral insufficiency. The type of respiration is similar to 
that occurring in cases of “ broken wind.” | 

DirFERENTIAL D1acnosis.—The characteristics of mitral stenosis are 
the diastolic “rolling” sound, followed by the presystolic murmur, and 
the accentuation of the pulmonary second sound. 


Tricuspid Insufficiency. 


Affections of the tricuspid valve are regarded by some authors as of 
less frequent occurrence in horses than valvular disease of the left side 
of the heart. The opposite is said to hold good in cattle. According to 
Stockman,* the right auriculo-ventricular orifice is most frequently the 
seat of a murmur in the horse, and the condition is often the result of 
dilatation of the right ventricle, which may be secondary to pulmonary 
emphysema, but frequently occurs without it. He found the affection 
most commonly in animals subjected to fast and heavy work, such as 
tramcar and bus horses. Out of twelve bus-horses in one stable examined 
by him in Edinburgh, eight were found to have tricuspid incompetence. 
He also observed that dilatation of the right ventricle could arise in a 
comparatively short period of time in horses subjected to bus-work in a 
very hilly district. Dyspnoea during exertion was the first symptom 
observed, and on physical examination of the heart a murmur was 
detected, which in some instances disappeared after rest and treatment, 
but was lable to recur. From what we can gather, the opinion expressed 
by the above author as regards the frequency of this lesion was based on 


* Journal of Comparative Pathology and Therapeutics, 1894. 


1062 SYSTEM OF VETERINARY MEDICINE 


clinical diagnosis, and not on post-mortem evidence, as he has not brought 
forward any records of autopsies to verify the diagnoses. 

According to Cadéac, tricuspid insufficiency is the most serious of all 
the valvular affections of the heart, and rarely proceeds from organic 
alterations developed after birth. It can occur during foetal life, as 
during this period the right side of the heart is more subject to disease 
than the left. Benjamin, Héring, Trasbot, and others, observed the 
lesion in adult horses, occurring as the result of endocarditis, and found 
that either both auriculo-ventricular orifices were involved or the disease 
was confined to the tricuspid valve. 

Relative insufficiency is more often met with, and is observed under 
a variety of conditions, such as valvular lesions of other regions of the 
heart (especially of the mitral), which bring about distension and pro- 
oressive dilatation of the right ventricle, so that the valve is unable to 
close the orifice completely. It also occurs in cases of pulmonary em- 
physema and other chronic affections of the lung in which there is a 
certain amount of obstruction to the pulmonary circulation, and thus 
increased work for the right ventricle. 

Pericarditis and myocarditis may also be associated with relative 
insufficiency, owing to the weakening of the wall of the right ventricle 
which is induced. 

Morzsip ANAToMy.—In the majority of cases no lesions are observed 
in the valve, the condition being one of relative insufficiency. Cases are 
recorded, however, in which thickening and contraction of the segments 
were present, also instances in which vegetations were observed. 

The effects of tricuspid insufficiency are as follows: During systole 
blood regurgitates from the right ventricle into the right auricle. The 
latter, in consequence of increased tension, dilates, and eventually 
becomes hypertrophied to a slight degree. Owing to the absence of 
valves at the orifices of the venze cave, these vessels become distended 
with blood, and general venous congestion results. Passive congestion 
of the lungs, liver, and other organs occurs, with effusion into the serous 
cavities of the body. 

Symproms—PuysicaLt Signs—Auscultation.—A soft systolic murmur 
is detected, which, according to Hutyra and Marek, reaches its greatest 
intensity from the third to the fourth intercostal spaces on the right side: 
towards the middle of the lower third of the chest. These authors found 
on palpation a systolic thrill in the region of the third to the fourth inter- 
costal spaces, and on percussion there was no alteration in the area of 
cardiac dulness. Stockman detected the murmur by drawing the left 
fore-leg well forward. It was systolic in character, coincident with the 


DISEASES OF THE HEART: HORSE 1063 


pulse, and best heard at the posterior border of the third rib, about 
83 inches from the keel of the sternum, in the groove formed between the 
caput magnum and the chest wall. It was carried 14 inches backwards 
along the base of the heart, and about the same distance downwards in 
a slightly backward direction. At the third rib the murmur seemed to 
replace the first sound of the heart, which is normally feeble at this 
location; but at the fifth rib the cardiac sound is distinct, while the 
murmur is absent. The murmur was not carried to the apex, as the 
latter is formed by the left ventricle. A venous pulse following immedi- 
ately on the heart-beat is a well-marked symptom in tricuspid insufficiency, 
and is due to regurgitation of the blood into the vene cave, producing a 
systolic wave which is transmitted to the jugular veins. 

General Symptoms.— These include ascites, hydrothorax, hydro- 
pericardium, a cyanotic condition of the visible mucose, dyspneea, etc. 
Slight icterus is observed in some cases, also vertigo and evidences of 
cardiac failure. 

DiFFERENTIAL Dracnosis.—This is based on the situation of the 
murmur taken in conjunction with the well-marked jugular pulse. The 
latter is, of course, a symptom common to several forms of valvular 
diseases. 


Tricuspid Stenosis. 


- According to Cadéac, this condition is extremely rare in the horse, 
and has not been specially studied. It is described by Hutyra and 
Marek as a narrowing of the right auriculo-ventricular opening, which 
interferes with the flow of blood from the right auricle into the right 
- ventricle, and leads to dilatation, with slight hypertrophy of the right 
auricle. The effects comprise: blood stasis in the vene cave, a lessened 
supply of blood in the other cavities of the heart, while, owing to the 
diminished pressure in the right ventricle and pulmonary artery, thrombi 
tend to form therein, and may lead to pulmonary embolism. The cardiac 
impulse is weak, a murmur is present, which may be diastolic or pre- 
systolic, and is best heard on the right side between the third and fourth 
intercostal spaces in the middle of the lower third.of the chest. A small 
feeble pulse and a presystolic jugular pulse may also be observed; also 
marked dyspnoea due to blood stasis in the venous system. 

We have no experience of this lesion, but consider that a differential 
diagnosis would be difficult, especially when we read in Osler’s “ Practice 
of Medicine” that in man the diagnosis of the condition is not often 
made. 


1064 SYSTEM OF VETERINARY MEDICINE 


Diseases of the Pulmonary Valves. 


These are very rare, and probably seldom or never diagnosed in 
ordinary practice. In human medicine the pulmonic area has been 
termed by Balfour “ the region of auscultatory romance,” and, according 
to Osler, murmurs in the region. of the pulmonary valves are extremely 
common, while lesions of the valves are exceedingly rare. 

Judging by the descriptions given of the symptoms by authors who 
have met with cases of pulmonary valve lesions, we do not consider that 
it is desirable to devote much space to the subject. 

Insufficiency of the Pulmonary Valves.—In this condition, during ven- 
tricular diastole, blood enters the right ventricle from the right auricle, 
and also from the pulmonary artery by regurgitation; hence dilatation 
of the right ventricle, succeeded by hypertrophy, occurs. As the dilata- 
tion increases, relative insufficiency of the tricuspid valve is produced, 
and respiratory disturbances result. Cadéac and Cagny have met with 
cases depending on dilatation of the pulmonary artery at its origin, 
also anomalies, traumatic ruptures, and tumours of the valves, and con- 
genital malformations, such as perforation of the ventricular septum. 

The physical signs recorded are a prolonged diastolic murmur heard 
at the anterior region of the base of the heart on the left side, and a more 
distinct second aortic sound. 

The differential diagnosis from aortic insufficiency is based on the 
position of the murmur, and the absence of Corrigan’s pulse in insuffi- 
ciency of the pulmonary valves. 

Stenosis of the Pulmonary Valves.—This lesion is recorded by Huth 
and Trasbot. Cadéac regards it as a “ pathological curiosity,’ and 
states that it is either of congenital origin or results from an endarteritis 
of the pulmonary artery. Owing to the obstruction caused to the flow 
of blood into the pulmonary artery, hypertrophy of the right ventricle 
results. When compensation fails, the pulmonary circulation becomes 
affected, so that dyspnoea, cyanosis, and a small feeble pulse are observed. 

The physical signs recorded are a loud prolonged systolic murmur, 
best heard over the anterior part of the base of the heart, and taking 
the place of the first cardiac sound. 

Combined Valvular Lesions.—These are of common occurrence, and _ 
they render a differential diagnosis very difficult. Stenosis of one valve 
may coexist with insufficiency of another valve, or the two conditions 
may be combined in one valve. From the description already given, it 
can be readily understood how a lesion in one valve may be followed by 
disease in another valve, either on the same or on the opposite side of the 


DISEASES OF THE HEART: HORSE 1065 


heart. Thus, a combination of mitral and aortic lesions is common, 
while the tricuspid valve may be involved in a secondary manner. Again, 
aortic stenosis may be accompanied by mitral insufficiency. It happens 
at times that the added lesion may exert a favourable influence on the 
case—as, for example, a progressive stenosis accompanying aortic or 
mitral insufficiency may tend to lessen the regurgitation, and so prove 
beneficial. 

PRoGNosis OF VALVULAR DisEASE.—This subject requires very care- 
ful consideration. The difficulty of deciding at the first examination of 
a case whether the symptoms depend on a subacute attack of endo- 
carditis or on chronic valvular disease must be borne in mind. In the 
former instance, by rest and suitable treatment, recovery may ensue, or 
at least the horse may become fit for work for a variable period, although 
permanent alterations occur in the valves. Unless in cases where there 
are definite symptoms pointing clearly to the existence of a chronic 
valvular disease, repeated examinations are desirable before arriving at 
the conclusion that the horse cannot improve with treatment, or is use- 
less or unsafe for the work required of him. But in every instance where 
fair grounds exist for the diagnosis of valvular disease, the owner should 
be warned of the risks of subjecting the animal to severe exertion, We 
are well aware that many cases presenting tolerably clear evidences of 
a cardiac affection may perform slow work for years. On the other 
hand, horses have been known to be capable of doing even severe work 
for an indefinite period, and presenting no appreciable symptoms, yet 
they die suddenly, and the post-mortem reveals valvular disease of long 
standing. It has also happened that a horse has been condemned for 
cardiac disease, and, having changed hands, has worked for years without 
manifesting any symptoms of the primary attack. 

TREATMENT.—It is quite obvious that well-marked cases of chronic 
valvular disease do not repay the cost of treatment, nor is it advisable 
to adopt therapeutical measures, having regard to the dangers attendant 
on the animals suddenly dying, especially in the case of saddle-horses 
and hunters. Probably in the large majority of instances horses will 
not be brought for treatment until compensation commences to fail and 
symptoms of such are manifested. 

Rest is the first essential in treatment. Owing to the difficulties in 
diagnosis, it is by no means an easy matter to select the cases that are 
suitable for treatment, as opposed to those in which treatment will not 
be desirable, for the reasons already given. It is well known that the 
judicious administration of agents, such as digitalis or strophanthus, often 
produces favourable results in cases presenting what may be regarded as 


1066 SYSTEM OF VETERINARY MEDICINE 


serious symptoms. This is especially so in those that follow an attack 
of influenza, and the practitioner cannot be too careful in giving an 
opinion as to the probable result of treatment. Strophanthus is indi- 
cated in cases which show evidences of cardiac weakness, a tendency to — 
venous stasis, an irregular pulse, dyspnoea on exertion, and oedematous 
swellings on the dependent parts of the body. This agent seems in the 
majority of instances to be more suitable than digitalis, as it does not 
interfere with digestion or appetite. It may be given in 2-drachm doses 
of the tincture three times daily, either in the food or in the form of 
electuary, and is preferably combined with nux vomica. 

If after a reasonable time no improvement is observed, and well- 
marked evidences of chronic valvular disease are present, it then becomes 
a question as to whether further treatment is desirable. As already 
mentioned, many cases of valvular disease are capable of performing 
slow work, but the owner should always be informed of the possibility 
of sudden death occurring. 

When, however, the owner insists on treatment being carried out in 
cases presenting evidences of far-advanced lesions, the leading symptoms 
must be treated as they arise. 

THe Mepico-Lecat Aspect oF Carpiac DisEASES.—Owing to the 
fact that many cases of chronic valvular disease do not present any 
symptoms, and that the animals so affected may be capable of performing 
even fast work, it follows that in the examination of horses as to sound- 
ness the presence of such lesions is not detected. No doubt, if a physical 
examination of the heart was carried out as a routine procedure, and the 
same amount of attention directed to it as to the examination of the 
respiratory organs, some cases of valvular lesions at least would be 
detected. Fortunately, however, an animal suffering from such lesions, 
if able to go through the test to which he is subjected in order to ascertain 
the soundness of his wind, is not likely to die suddenly, or to exhibit 
symptoms suggestive of a cardiac disorder soon after the examination. 
Hence the existence of the disease is not detected by the purchaser, and 
the practitioner escapes blame in the matter. So long as compensatory 
hypertrophy continues, there is but a remote chance of any symptoms 
being observed. 

F. Smith* remarks: ‘‘ Valvular disease is not unknown, but so rare 
that probably there is no practitioner with a large experience in the 
examination of horses for soundness who ever thinks of examining the 
heart.” 

The latter portion of this statement represents the usual custom 


* “Veterinary Physiology.” 


DISEASES OF THE HEART: HORSE 1067 


adopted, but we are of opinion that in our present state of knowledge 
with reference to the incidence of valvular disease in the horse it is our 
duty to examine the heart according to the best means at our command. 
In a well-marked case there is no difficulty in detecting the presence of 
a murmur, and also in observing a jugular pulse. We freely admit that, 
although we may overlook the existence of cardiac disease, even by 
taking the precaution of examining the heart, yet, having done all that 
is humanly possible, we shield ourselves from the charge of negligence. 
There seems little doubt that if the existence of cardiac disease, as 
evidenced by a physical examination of the heart, was proved a short 
time after a horse had been passed as sound, and if the practitioner who 
examined the horse at the time of sale had omitted to examine the heart, 
the purchaser could hold him lable for negligence. We have experience 
of one case in which we examined a valuable hunter, and passed him as 
sound after a severe test, but did not examine the heart. In three days 
afterwards he was found-dead in his stall, and the post-mortem showed 
disease of the semilunar valves. 

We do not mean to infer that the examination of the heart (carried 
out as it would of necessity be in a rather crude manner in the short time 
allotted to an examination for soundness) would enable us to detect 
valvular lesions, unless in well-marked cases; but knowing as we do that 
a horse suffering from such lesions may go through a severe gallop with- 
out showing any general symptoms, there is no tangible excuse for neg- 
lecting to carry out a simple procedure to the best of our ability. 

Similar remarks apply to the examination of stallions and of brood 
mares for insurance. In far too many instances the question of the 
soundness of the heart is overlooked. Sudden death is by no means 
uncommon in this class of animals, especially if aged, from valvular 
disease or degenerative changes in the myocardium. : 

Of course, great discretion is necessary in giving an opinion as to the 
existence of cardiac disease, because functional disorders often simulate 
organic affections of the heart, and slight murmurs may even be detected 
in some of the former cases. Again, after recovery from affections, such 
as influenza and pneumonia, it is not uncommon to meet with temporary 
cardiac disorder. 

Another matter of importance in connection with diseases of the 
heart is with reference to the administration of chloroform for surgical 
operations. It is our experience that in practically every fatality 
from chloroform anesthesia in the horse the post-mortem showed a 
cardiac lesion, either valvular disease, dilatation, or fatty degeneration. 
Hence, in order to avoid the charge of negligence, the practitioner should 


1068 SYSTEM OF VETERINARY MEDICINE 


always examine the heart before the administration of chloroform. 
Neglect of this precaution may have unpleasant consequences in the 
event of a fatality occurring, if the owner of the horse is of a litigious 
disposition. 

Similar remarks apply to the examination of horses for insurance 
against the risks of operations. Of course, in all cases of the kind the 
clients should be informed that latent cardiac diseases may be present 
which cannot be detected by a physical examination of the heart; but 
having taken all the precautions in our power, we cannot afterwards be 
accused of overlooking the matter. 


SPECIAL PATHOLOGICAL CONDITIONS OF THE HEART. 
Congenital Affections of the Heart. 


These are of more interest to the pathologist than to the clinician, as 
in most instances the affected animal dies shortly after birth, or in the 
case of valvular lesions therapeutical measures fail to prove of any 
benefit. These affections arise either from anomalies in development or 
from congenital valvular lesions. 

Congenital Malformations.—These are of less peti) occurrence in 
animals than in the human subject. | 

Displacements of the Heart.—These include displacement of the heart 
to the right side of the thorax, displacement of the organ outside of the 
chest (ectopia cordis), owing to arrested development of the sternum, so 
that it remains in two lateral halves. | 

Pervious Foramen Ovale (Cyanosis).—The foramen ovale is an opening 
which in intra-uterine life occurs between the right and left auricle, 
but after the birth of the animal it contracts, and after a few 
days is completely closed. But when this closure fails to take 
place, venous blood from the right auricle enters the left auricle and 
mingles with the arterial blood, so that the functions of the vital fluid 
are interfered with. Owing to the admixture of the venous blood with 
the arterial, the visible mucosz assume a bluish tint, hence the condition 
is sometimes termed “ the blue disease.” In consequence of the altera- 
tions in the blood, the vital changes necessary for the production of 
animal heat are inhibited, hence coldness of the surface of the body and 
extremities results. Dyspnoea and loss of condition are also observed. 
The cases usually live but for a short time. In rare instances they reach 
maturity, but are useless. Hutyra and Marek describe as a compara- 
tively frequent anomaly the persistence of an opening in the upper 
anterior portion of the interventricular septum. 


DISHASES OF THE HEART: HORSE 1069 


Congenital Valvular Lesions.—The tricuspid valve is the most common 
seat of the lesion. According to Hutyra and Marek, the symptoms 
observed are marked weakness, inability to move about or even to stand, 
severe. dyspnoea, or cyanosis, while murmurs are generally absent, or 
occur only in cases where the pressure in the two communicating heart 
cavities is unequal, provided the insufficiency is not extreme. The 
affected animals generally succumb early. 


Aneurism of the Heart. 


This may affect one of the valves or the walls of the organ. Hither 
condition appears to be of comparatively rare occurrence. 

Aneurism of a Valve.—This may result from acute endocarditis, when 
softening and erosion occur, and owing to the pressure of the blood the 
valve becomes bulged out, generally in a spheroidal manner. The ven- 
tricular face of a sigmoid valve is the usual seat of the lesion. Rupture 
may occur, and extensive destruction and incompetency of the valve is 
produced. 

Aneurism of the Cardiac Walls.—This condition may result from 
acute endocarditis when associated with a purulent form of myocarditis. 
The weakened muscular wall bulges outwards, and may rupture. Cardiac 
aneurism may in rare instances occur in connection with acute myocar- 
ditis. More commonly it results from chronic myocarditis. The cardiac 
wall becomes weakened, and a circumscribed bulging is produced. The 
left ventricle in the vicinity of the apex is found to be the most common 
seat of the lesion in man. 

Symptoms.—There are no symptoms by which the presence of the 
lesions can be detected. 


Rupture of the Heart. 


According to F. Smith, the most common seat of this lesion is the 
right auricle, where the wall is thinnest. Robertson found that the usual 
situation was at the conus arteriosus of the left ventricle at the junction 
of the aorta with the ventricle, and this was also Gamgee’s experience. 
According to Cadéac, there is no special seat for the lesion. Hutyra and 
Marek state that rupture is often found in the walls of the ventricles, and 
less frequently in those of the auricles. 

Errotocy.—External injury may produce the lesion, such as violent 
contusions of the thoracic walls, or severe falls, or accidents resulting from 
casting horses for operations. It is probable that in many of such cases 
the resistance of the cardiac muscle is lessened by degenerative changes. 
Gamgee quoted a case recorded by Parker in which a pony while in 


1070 SYSTEM OF VETERINARY MEDICINE 


harness bolted down a hill and came into violent contact with the wheel 
of a cart, striking it with his right shoulder. The animal fell, and was 
unable to rise, and was shortly afterwards destroyed. The post-mortem 
showed a rupture of the base of the right auricle, the latter being separated 
from the right ventricle. Robertson quoted an instance in which two colts 
that were cast and secured for the operation of castration died suddenly. 
The post-mortem showed an extensive rupture of the interventricular 
septum in one case, and in the other a rupture of the auricular wall. 

In most instances, however, rupture occurs owing to degenerative 
changes in the myocardium, such as fatty degeneration. Cardiac dilata- 
tion and aneurism of the heart also predispose to rupture of the organ. 
Aneurism of the coronary arteries is regarded as a very rare cause of 
cardiac rupture by some authors, but Cadéac states that lesions of these 
vessels often play an important part by bringing about a limited 
degeneration and attenuation of the myocardium. Severe exertion 
may lead to rupture when the cardiac wall suffers from degeneration. 
Acute gastric or intestinal tympany may also induce the lesion by in- 
creasing the blood-pressure in the heart. Robertson met with a case in 
a foal in which rupture of one of the fleshy pillars of the ventricle and of 
some of the chorde tendinesx attached thereto occurred. The lesion was 
associated with suppurative myocarditis and pyemia. Parasites in the 
cardiac wall are also regarded as a cause of cardiac rupture. 

Morzsip ANatomy.—The length of the rupture varies. It may be 
from 1 to 2 inches, or so small that it will only with difficulty admit a 
probe. Cases are recorded in which a number of ruptures have been 
observed. On the external aspect of the heart the edges of the rupture 
are jagged, and the passage formed towards the interior of the organ 1s 
irregular. The pericardium contains a variable amount of blood (hemo- 
pericardium), but if the rupture occurs in the interventricular septum, 
as in the cases recorded by Dieckerhoff, hemorrhage into the pericardium 
does not take place. In rare instances rupture of the pericardium may 
occur simultaneously with the cardiac rupture, and the blood then enters 
the pleural cavity. 

SyMproms.—When the rupture is of a fair size, the symptoms appear 
suddenly. The animal, if at work, stops suddenly, may attempt to rear, 
may neigh or utter a loud cry, then staggers and falls, and after a few. 
convulsive movements dies in a few minutes. Death is believed to result 
from compression of the heart by the blood surrounding the organ. 

In cases where the rupture is small in extent death does not occur so 
rapidly, and symptoms of internal hemorrhage are observed, such as 
pallor of the visible mucose, imperceptible pulse, coldness of the surface 


DISEASES OF THE HEART: HORSE 1071 


of the body and extremities, and convulsions. When the rupture is 
incomplete, the case always terminates by the occurrence of a complete 
rupture and death. 

TREATMENT.—It is obvious that no treatment can be adopted for 
this condition. 


Wounds of the Heart. 


These are usually the result of puncture by the shaft of a vehicle 
during a collision, and they prove rapidly fatal. More frequently one of 
the large vessels is wounded. Sharp-pointed foreign bodies entering the 
heart are rarely met with in the horse. 


Tumours of the Heart. 


According to Hutyra and Marek, these tumours are rarely met with, 
and in consequence of the lack of diagnostic symptoms they cannot be 
recognised during life, hence they are of little interest to the clinician. 
They include fibromata, fibromyxomata, myxomata, lipomata, sarcomata, 
etc. According to Cadéac, the tumours generally occur in the vicinity 
of the heart, or as secondary growths. Myxomata may develop in the 
interventricular septum or in the ventricles chiefly in the vicinity of the 
valves. They are usually small, but in some cases may assume a large 
size, and occur in the form of either pedunculated polypi or lardaceous 
masses. Sarcomata of secondary origin are said by the above author to 
be comparatively common, and are found in the wall of the auricles or 
ventricles, and sometimes on the visceral pericardium, but rarely in the 
endocardium. Melano-sarcomata are of frequent occurrence in the 
cardiac septum, the walls of the auricles or ventricles, and the valves. 
They may sometimes produce obstruction of the auriculo-ventricular 
orifices or the vene caves, or cause displacement of the pulmonary artery, 
and compress the vagi, the recurrent, or the phrenic nerves. The entire 
heart may be invaded by melanotic tumours of varying dimensions. 

Symptoms.—In many instances the symptoms resemble those met 
with in cases of tumours of the mediastinum (see p. 997). Arrhythmia, 
a venous pulse, oedematous swellings on the dependent parts of the body, 
hydrothorax, hydropericardium, etc., may be present. In some cases a 
fremitus can be detected on palpation, and a systolic murmur on ausculta- 
tion. Dyspneea, irregular respiration, and a double expiratory move- 
ment may be observed. In the case of malignant tumours loss of con- 
dition and cachexia supervene. 

No treatment can be adopted. 


1072 SYSTEM OF VETERINARY MEDICINE 


Parasites of the Heart. 


See section on Parasites. 


ANGINA PECTORIS. 


Synonyms.—Stenocardia; Breast pang. 

This condition is pies by a sudden attack of canal 
pain in the region of the heart, which in some cases extends to the left 
fore-leg, and causes acute lameness. Cases have been recorded by Cagny 
(1883), Butti (1884), Cadiot, Johne, Pécus, and others. W. Williams 
described a case of the affection which, judging by the symptoms given, 
was associated with chronic valvular disease of the heart. 

Errotocy.—According to Cadéac, the condition generally depends on 
stenosis of the coronary arteries, which causes ischemia of the myo- 
cardium, and has much analogy with the claudication of one of the iliac 
arteries resulting from an embolism in one of these vessels. In Johne’s 
case a microbial thrombus of one coronary artery followed the operation 
of tenotomy. Rigollat observed an instance depending on a rupture of 
the right coronary artery. Cadiot recorded cases due to thrombosis of 
one of the coronary arteries depending on the presence of parasites in the 
vessel (sclerostomes). Other observers found arterio-sclerosis and calcifi- 
cation of the coronary arteries associated with atheroma of the aorta. 
The causes mentioned interfere to a certain extent with the blood-supply 
of the myocardium, and although no symptoms are observed while the 
animal is at rest, if he is subjected to exertion, the imperfect supply of 
blood to the heart muscle produces the symptoms of the affection. This, 
however, is only a theory. The disease is of comparatively common 
occurrence in man, yet, according to Osler, “no completely satisfactory 
explanation of the phenomena of the angina attack has yet been offered.” 
According to the “intermittent claudication” theory of Allan Burns, 
when the coronary arteries, owing to obliterative endoarteritis, do not 
admit sufficient blood for increased work, the contractile function of the 
cardiac muscle is disturbed, and pain results. 

According to Cadéac, angina pectoris may also result from the action 
of toxins, such as those originating in cases of infectious pneumonia. In 
such instances the condition depends on a neuritis or an intoxication of’ 
the cardiac plexus. 

Symptoms.—These are manifested when the horse is subjected to 
quick work or severe exertion. The animal stops suddenly, and cannot 
be got to move. He staggers and neighs loudly, while the countenance 
shows extreme anxiety. After a short rest he can be removed to his 


DISEASES OF THE HEART: HORSE 1073 


stable, but in some instances he has to stop several times before accom- 
plishing even a short homeward journey. Pécus has observed an intense 
lameness of the near fore-limb, which he considered was analogous to the 
referred pain occurring in the left arm and in the neck of man when 
suffering from an attack of angina pectoris. Various authors have ob- 
served a tumultuous action of the heart, a thready, irregular, almost im- 
perceptible pulse, and a well-marked venous pulse during the attack, but 
did not detect any murmurs. In the case described by W. Williams, 
when the animal was excited by work or exercise, the most acute pain 
was manifested in the near fore-limb, the muscles of which, more espe- 
cially the pectorals and those of the neck, became violently convulsed, 
the limb itself being fixed by muscular contraction and paralysed. When 
forced to move, he dragged the limb, and sometimes fell to the ground. 
The paroxysms seldom occurred while the animal was at rest, but a con- 
tinual spasmodic twitching of the muscles mentioned above was observed. 
Evidences of aortic insufficiency were detected on auscultation of the 
heart. This case depending on valvular disease is, of course, on a different 
basis to the affection recognised as angina pectoris by other observers. 

In the cases recorded, the attacks occurred in animals apparently in 
perfect health, and only when subjected to exercise. The attacks recurred 
at variable intervals, and it was not uncommon for the animal to fall 
down suddenly at the first manifestation of the affection. In some cases 
death resulted from syncope, and not infrequently from rupture of one of 
the coronary arteries. 

TREATMENT.—The treatment advised by Cadéac is the administra- 
tion of vaso-dilator agents, such as chloral hydrate, also inhalations of 
amyl nitrite. Sedatives, such as subcutaneous injections of morphine, 
are also recommended. 


DISEASES OF THE BLOODVESSELS. 
CHRONIC ENDOARTERITIS. 


Synonyms.—Arterio-sclerosis; Chronic inflammation of the arterial 
wall; Atheroma. 

Under this heading are included morbid conditions of the arteries in 
which their coats are thickened and affected by degenerative changes, 

VOL. II, 68 


1074 SYSTEM OF VETERINARY MEDICINE 


which may be diffuse or circumscribed. In the larger arteries the process 
leads to the condition known as atheroma. In man a diffuse arterio- 
sclerosis is a well-recognised condition, and is often associated with high 
tension: in the bloodvessels. This diffuse form is, however, seldom met 
with in animals, but we must point out that the question of a morbid 
increase in the blood-pressure has not been studied to any extent in 
veterinary practice. The majority of authors state that in animals the 
large arterial trunks are the chief seat of endoarteritis. According to 
Hutyra and Marek, four cases of diffuse arterio-sclerosis (periarteritis 
nodosa) were observed by Liipke in deer, and even the smallest blood- 
vessels were affected. . 

Cadéac recognises arterio-sclerosis distinct from atheroma as occurring 
in the horse, and affecting the coronary arteries, and also the medium- 
sized or small arteries. The internal and external coats of the vessels 
are simultaneously thickened and sclerosed, but the lesions are less 
appreciable than the atheromatous changes. He points out that arterio- 
sclerosis plays the chief part in the production of atheroma by obliterating 
the vasa vasorum. 

As regards the frequency of endoarteritis of the aorta, Kitt found 
that it was a common lesion in old horses; and Schmidt stated that, out 
of 2,069 autopsies, he met with 0°5 per cent. which showed endoarteritis 

of the aorta. Other observers also found the lesion comparatively often, 

and the subject has been specially studied by Rohr, Pécus, Sandrin, Ball, 
Sequens, and Caparini. In the Reports of the Army Veterinary Service 
for 1911-12 and 1912-13 we find no mention of the disease. 

F. Smith* remarks that very little of the hard life of a horse falls on 
his arteries, but with age the vessels become more rigid. This author, 
however, points out, owing to strain arising in the hunting field or under 
similar circumstances, changes may occur in the walls of the external 
and internal iliac arteries, in consequence of which a thrombus forms in 
the vessels, and they become partly or completely obliterated. 

Errotogy.—Nothing is known with reference to the etiology of 
chronic endoarteritis in animals. A circumscribed form of the disease 
is not uncommon owing to parasitic invasion of certain vessels by the 
larvee of Sclerostomum vulgare, especially in the anterior mesenteric 
artery. 

Morzip Anatomy.—lIn arterio-sclerosis the aorta may show hyaline 
changes in the tunica media, while the tunica intima may present slight 
elevated areas of an opaque white colour, and in these atheromatous 
changes are observed. In the smaller arteries the walls are thickened, 


* “Veterinary Physiology.’ 


DISEASES OF THE BLOODVESSELS: HORSE 1075 


this change being especially due to an increase in the subendothelial 
connective tissue. The muscular coat after a primary hypertrophy 
undergoes hyaline and calcareous changes. 

Atheroma.—In this condition fatty and calcareous degeneration of 
the walls of the arteries occurs. The lesions are observed especially 
where large vessels turn or bend, or at the points of bifurcation. The 
common seats of the disease are the common aorta, the posterior aorta, 
and the iliac arteries. : 

The affected vessel loses its elasticity, and becomes more or less rigid. 
On laying it open, lesions are found in the tunica intima in the form of 
small elevations or plaques, generally few in number; but in some instances 
they are numerous, and form a linear series. Cadéac recognises three 
varieties—viz., grey, yellow, and calcareous—and describes them as 
follows: | 

The grey occur in the form of small cup-shaped depressions, with a 
smooth aspect, and of a greyish-red colour. The tunica intima is con- 
siderably thickened, while the other tunics are thin in proportion. 

The yellow represent the stage of fatty degeneration, and the change 
is a gradual one. Grey plaques can be observed showing the initial 
fatty changes in the centre, which gradually increase until the entire 
plaque becomes of a yellow colour. 

‘The calcareous is the final stage in the morbid process. The plaques 
are of a yellowish-white colour, the surface is rough, the consistency 
hard and brittle. The alteration depends on the deposition of lime salts. 
The aorta may be literally “ paved ” with these plaques, the external coat 
thickened and sclerosed, and the vessel transformed into a rigid tube. 

The sequele of atheromatous degeneration are aneurism, thrombosis, 
embolism, hypertrophy and dilatation of the left side of the heart, and 
rupture of the aorta. The cardiac hypertrophy results from the extra 
work thrown on the heart, as, owing to the rigid condition of the aorta, 
an increased effort is necessary in order to propel the blood into the 
arterial system. Rupture of the aorta occurs at the base of the vessel 
close to the semilunar valves. The rupture varies in extent, but is 
usually small, and, according to Saint Cyr, it is generally longitudinal 
and irregular, and rarely circular. In some instances it may be V-shaped, 
the branches being widely divergent, and the point directed towards the 
heart. According to Cadéac, the rupture occurs in the centre of an 
atheromatous plaque. In periarteritis nodosa, a nodular thickening of 
the arterial wall is observed, and the lumen of the vessel is lessened or 
may be almost obliterated. In some instances dilatations are observed 
which contain thrombi. 


1076 SYSTEM OF VETERINARY MEDICINE 


Symproms.—There are no characteristic symptoms, and the lesion is 
generally discovered post mortem. Hutyra and Marek state that in 
generalised arterio-sclerosis, if affecting superficial vessels, the latter 
are found by palpation to be rigid, and sometimes show an uneven 
firmness. According to Pécus, examination of the heart may show 
the presence of a fremitus, a reduplication of the cardiac sounds, 
an accentuated second sound, and a rough systolic murmur, which is pro- 
longed to the vessels of the neck. This latter results from alterations of 
the internal coat of the aorta, which give rise to abnormal vibrations in 
the blood-stream. This phenomenon, however, is not constant. 

Aortic insufficiency may be associated with atheroma of the aorta, 
and a double murmur is then detected, which may be mistaken for aortic 
stenosis complicated with the insufficiency. When the coronary arteries 
are involved, evidences of angina pectoris may be manifested (see p. 1072). 

The course of the disease is slow. When rupture of the aorta occurs, 
death takes place suddenly, and is said to depend on compression of the 
heart caused by the sudden distension of the pericardium with blood. 
If the rupture is small in extent, death occurs less rapidly, with symp- 
toms of internal hemorrhage, such as sweating, pallidity of the visible 
mucose, tumultuous action of the heart, staggering, and finally the animal 
falls down, and after a few convulsive movements expires. 

TREATMENT.—Obviously, no treatment can be of any avail in this. 
affection. 


ANEURISM. 


This is a dilatation or pulsating tumour in direct communication with 
the lumen of an artery, containing fluid or partly coagulated blood, and 
generally depending on morbid alterations in the walls of the vessel. 
The following varieties are recognised: 

True Aneurism.—lIn this the wall of the tumour is formed by one or 
more of the arterial coats. The aneurism may be of various shapes, such 
as fusiform or cylindrical, these being limited to a certain portion of the 
vessel, and sometimes termed dilatation aneurisms. In other instances 
the lesion may affect an entire artery and its branches, and is termed a 
cursoid aneurism. It may be cercumscribed or saccular, such as com- 
monly occurs in aneurism of the aorta; or what is termed a dissecting 
aneurism may be met with, in which the tunica media is lacerated or 
split, and the remaining coats form the wall of the sac. This is of rare 
occurrence in animals, and, when present, it usually affects the aorta. 

False Aneurism.—This results from a wound or rupture of an artery 
or of a true aneurism. The blood becomes circumscribed in the sur- 


DISEASES OF THE BLOODVESSELS: HORSE 1077 


rounding areolar tissue, forming a hematoma. In some cases the hema- 
toma may be of a diffuse type. W. Williams recorded cases of diffuse 
false aneurism resulting from a wound of the external thoracic artery 
inflicted by the point of a pair of scissors, and occurring in the days when 
horses were clipped by means of this instrument. The blood accumu- 
lated in the loose areolar tissue, and formed a diffuse tumour, which on 
palpation gave evidence of pulsation. The vessel was exposed and liga- 
tured at both ends, and recovery followed. 

Arterio-Venous Aneurism.—In this form there is either a direct com- 
munication established between an artery and a vein, or the communica- 
tion between the vessels occurs by the intervention of a sac, and the 
lesion is known as a varicose aneurism. When the communication is 
direct, without the intervention of a sac, the condition is termed aneurismal 
varie. | 

W. Williams stated that the latter was not uncommonly met with in 
the days when venesection was frequently practised. Owing to the em- 
ployment of too large a fleam, or too deep an incision with the lancet, 
the jugular vein was accidentally punctured on its posterior aspect, as 
well as on its anterior aspect, and the carotid artery was wounded at the 
same time, so that a communication was formed between the two vessels. 
A saccular dilatation occurred in the vein, which was swollen, and a thrill 
was detected on palpation of the part. The condition did not appear to 
cause the animal any inconvenience. 

Kit1oLogy.—Sudden and violent muscular efforts are regarded as 
etiological factors in the production of aneurism, and are believed to 
bring about laceration or splitting of the tunica media. When the 
laceration is small in extent, a local bulging of the tunica media occurs, 
and a sac is gradually produced. In other instances a dissecting aneurism 
may form, or the laceration may heal completely. Again, cases may be 
observed in the aorta, in which, owing to either acute inflammatory 
changes or to atheroma, a gradual diffuse distension of the vessel is 
produced. 

Direct injuries are said to produce aneurism of the posterior aorta, 
such as a blow on the region of the back, but it is very probable that in 
such instances the wall of the vessel was previously in an abnormal con- 
dition. Parasitic invasion by the Sclerostomum vulgare is a common cause 
of aneurism of the anterior mesenteric artery and of its main branches. 

Occasionally, when the lumen of a vessel is permanently obstructed 
by an embolus, an aneurism may form on the proximal side of the vessel. 
Infective emboli may produce inflammatory and degenerative changes in 
the wall of the vessel, and thus favour the occurrence of aneurism. 


1078 SYSTEM OF VETERINARY MEDICINE 


Morsip ANAToMY.—The most common types of aneurism met with 
are—(1) Fusiform or cylindrical dilatations of the lumen of the vessel; 
(2) a sacculated form, which may be cup-shaped, or may resemble a 
cylindrical tumour communicating with the vessel by a narrow orifice. 

Various degenerative changes are found in the walls of the aneurism, 
such as atheroma, etc. They may be thickened or atrophied in an 
alternate manner, and show calcified deposits. The contents of the sac 
consist of fibrinous coagula, which may undergo organisation. Occa- 
sionally purulent changes may be observed. Rupture may occur, and 
the hemorrhage will be found in the thoracic or abdominal cavity, 
according to the vessel which is affected. The aneurism may be very 
large in extent, and may contract adhesions with organs in its vicinity, 
and exert compression on the latter. 

The vessels most commonly affected are the anterior mesenteric 
artery and the posterior aorta, but other vessels may at times be the seat 
of the lesion. Cases of multiple aneurisms in the same animal have been 
recorded. Thus, Rigot met with an instance in which aneurisms were 
present in the anterior mesenteric, the carotid, and the pulmonary 
arteries. Raymond recorded a case in which aneurisms occurred in the 
root of the broncho-cesophageal trunk, the first intercostals, and the 
bronchial arteries. These multiple aneurisms are believed to depend on 
the presence of inflammatory foci in various vessels simultaneously. We 
shall now describe briefly the special points in connection with aneurism 
affecting certain vessels. 

Aneurism of the Aorta.—The posterior aorta, especially in the vicinity 
of the trunk of the anterior mesenteric artery, is the chief seat of the 
lesion. It may also occur close to the terminal extremity of the pos- 
terior aorta. Only in exceptional cases is the common aorta or the 
thoracic aorta the seat of aneurism. ‘The lesion may be either cylindrical, 
in which the vessel is evenly dilated, or it may be fusiform or sacculated. 
The sacculated form may attain a very large size. It is generally single, 
but in rare instances several aneurisms may occur along the aorta. In 
the interior of the sac fibrinous blood-clots are found, which are formed 
of stratified layers, indicating that the process is a gradual one. The 
lumen of the vessel may be almost completely obstructed by the deposi- 
tion of layers of fibrin on its walls. 

The fibrinous coagula are more readily formed in sacculated aneurisms 
than in the fusiform type. The formation of the clot may be regarded 
as an effort of Nature to prevent extension of the aneurism by con- 
solidating the wall of the sac. In some cases the aneurism is composed 
of a number of independent cavities, all of which communicate with the 


DISEASES OF THE BLOODVESSELS: HORSE 1079 


vessel. The vessel may communicate with the aneurism in an abrupt 
manner, or may be constricted at the point of juncture, or the aneurism 
may be in the form of a lateral pouch on the vessel. Changes may be 
found in. the walls of the aorta at the point of juncture with the sac, 
such as degeneration, thickening, or calcification. The walls of the sac, 
when examined microscopically, show an absence of the tunica media, 
and, according to Cadéac, are formed by a tissue composed of flattened 
cells arranged in a series of layers separated by a fibrillary substance. 
The latter often shows fatty granulations and calcareous plaques, while 
in some instances the walls of the aneurism are completely calcified. 

Extensive aneurisms may cause compression of organs in the vicinity, 
or contract adhesions with them. Thus, a thoracic aneurism may exert 
pressure on the trachea or on a bronchus, or on the vagus or recurrent 
rerve. A large aneurism may induce atrophic changes in one or more ~ 
of the vertebree. Schmidt recorded a case in which an aneurism of the 
thoracic portion of the posterior aorta caused almost complete atrophy 
of a dorsal vertebra. Cases have also been met with in which an aneurism 
of the posterior aorta has caused atrophy of vertebre and of the muscles 
in the vicinity. Various organs in the abdominal cavity may suffer from 
the effects of compression, such as the stomach, liver, small intestine, 
cecum, floating colon, kidney, etc. When the aneurism has contracted 
adhesions with certain organs, such as the stomach, cecum, floating 
colon, large colon, rupture of the sac may occur, and the blood enters 
the structures mentioned. Cases are recorded where the aneurism 
became adherent to the lung, rupture occurred, and hemorrhage took 
place into the pulmonary tissue and bronchi. In ordinary cases the 
hemorrhage is found either in the thoracic or the abdominal cavity, 
according to the location of the rupture. 

Symproms.—In the majority of instances the presence of aneurism 
of the aorta is not recognised until sudden death occurs from rupture and 
internal hemorrhage, and the lesion is discovered at-the autopsy. 

In some cases certain symptoms are manifested which are suggestive 
of the lesion, and lead us to examine the circulatory organs, and also by 
rectal examination to detect the presence of aneurism of the posterior 
aorta by palpation when the lesion is within reach of the hand. These 
symptoms are as follows: Partial loss of power in the hind-limbs, observed 
when the horse is exercised. In some cases only slight weakness of the 
hind-quarters is present. When the disease is of some duration, wasting 
of the muscles of the loins and croup may be observed. These phenomena 
depend on stenosis of the aorta, which generally accompanies aneurism. 
In other cases the symptoms may resemble those occurring in throm- 


1080 SYSTEM OF VETERINARY MEDICINE 


bosis of the terminal end of the posterior aorta or of the external iliac 
arteries—viz., sudden lameness in one or both hind-limbs when the 
horse is put to work, marked constitutional disturbance, sweating, and 
coldness of the limbs due to interference with the circulation; while, if 
only one external iliac artery be involved, the lameness is confined to the 
hind-limb of the corresponding side (see p. 1084). These symptoms lead 
the practitioner to make an examination per rectum, and if the aneurism 
be within reach it will be recognised as a pulsating tumour situated 
below the vertebral column. It may be elongated or spherical in shape, 
it varies in size, and may be continued into the iliac arteries. It is 
firm or slightly elastic to the touch, and may exhibit a fremitus or thrill 
with each pulsation. Hutyra and Marek point out that in cases in 
which the aneurism is in the form of an cedematous swelling, or sur- 
rounded by firm connective tissue, the nature of the enlargement cannot 
be exactly determined. The same authors direct attention to an im- 
portant diagnostic point—viz., that pulsation in the swelling does not 
per se prove the presence of an aneurism, because a tumour or a mesen- 
teric abscess in close relation with the aorta or one of its branches may 
show a similar pulsation. The differential diagnosis is carried out by 
grasping the swelling, and if it becomes harder and larger with each 
pulsation a diagnosis of aneurism may be given. 

We once saw in consultation a case in a young thoroughbred mare 
that showed weakness of the hind-limbs during progression, and dull 
colicky pains which were continuous for long periods. After a time 
there was marked atrophy of the muscles of the hind-quarters. A rectal 
examination revealed the presence of a large pulsating tumour in the left 
lumbar region close to the aorta. The tumour was tense to the touch 
and painful. The aorta at its termination appeared normal to palpa- 
tion, but the pulsation in the left external iliac artery seemed much 
weaker than normal. On the external aspect of the left flank a distinct 
localised swelling could be detected. The diagnosis lay between an aneurism 
and a mesenteric abscess. The autopsy showed the presence of two large 
mesenteric abscesses, which had contracted adhesions to the intestines. 
One of these abscesses was closely related to the posterior aorta, hence 
the occurrence of pulsation therein. In this case, owing to the size and 
shape of the tumour and the location, it was not possible to grasp it 
sufficiently in order to observe whether it became harder and larger with 
each pulsation. There was no history of strangles in connection with the 
case. 

The circulatory disturbances in connection with aneurism depend on 
the situation of the lesion. One of the phenomena is that the pulsations 


DISEASES OF THE BLOODVESSELS: HORSE 1081 


in certain vessels are retarded—7.e., the pulse is not synchronous with 
the beats of the heart, but is felt after the latter. According to Hutyra 
and Marek, this is observed only when considerable thrombosis is present. 

The explanation given is that the deposit of fibrin causes a narrowing 
of the lumen of the affected vessels, hence the flow of blood towards the 
periphery is impeded, and although the systolic blood-pressure is in- 
creased, the pulse-beat reaches the peripheral vessels at a distinct in- 
terval after the cardiac impulse. When the aneurism is situated at the 
origin of the aorta, the retardation of the pulse occurs in all the arteries 
of the body. In the case of aneurism of the posterior aorta, the retarda- 
tion of the pulse is observed only in the arteries of the posterior half of 
the body. Cadéac points out that in the aneurism mentioned the pulsa- 
tions in the metatarsal arteries are not synchronous with those of the 
vessels of the fore extremities; also the pulse in the submaxillary artery 
may be strong, full, and accelerated, while the pulsations in the efferent 
arteries from the posterior aorta at and beyond the seat of the aneurism 
may be feeble or scarcely perceptible, owing to interference with the free 
passage of blood through the vessel. According to Hutyra and Marek, 
the pulse may not be synchronous in the two corresponding lateral halves 
of the body—e.g., when an artery branching out from the aneurism has 
its lumen narrowed, the pulsations in this vessel and its branches will be 
weak. We have observed in some cases that the pulse showed a well- 
marked thrill. 

According to Cadéac, when the aneurism occurs in the anterior aorta, 
and the horse is subjected to severe exertion, he may fall down suddenly, 
and present evidences of an epileptiform attack. The head is forced in 
a backward direction, and tetanic extension of the limbs is observed, 
these symptoms continuing for fifteen minutes. The same author states 
that in aneurism of the posterior aorta, in addition to symptoms sugges- 
tive of thrombosis of this vessel, paralysis of the hind-quarters may be 
observed, owing to interference with the circulation in the muscles of 
this region. Cases are also observed in which surcharge and stasis 
occurs in the broncho-cesophageal trunk, owing to interference with the 
free flow of blood in the posterior aorta, and as a result pulmonary con- 
gestion and dyspnea are produced. 

Cardiac lesions occur in some cases. These include hypertrophy of 
the left side of the heart, which is observed when the lumen of the aorta 
becomes narrowed owing to the presence of thrombi. When the aorta 
is dilated at its origin, relative insufficiency of the aortic valves may be 
produced. 


Occasionally the presence of aortic aneurism can be detected by 


1082 SYSTEM OF VETERINARY MEDICINE 


palpation externally, and also by auscultation. 'Tombari observed a pul- 
sating tumour in the sacral region which was hard and painful on palpa- 
tion, and on auscultation a rough blowing murmur was detected. Schmidt, 
in a case of aneurism of the first portion of the posterior aorta, detected 
a humming sound synchronous with the heart-beats. Réhling observed 
pulsations in the vicinity of the lumbar region and the last ribs. The 
pulsations were synchronous with the heart-beats, but did not corre- : 
spond with the submaxillary pulse. 

Cadéac points out that such pulsations cannot be detected when the 
lesion is not accessible to palpation, or when numerous clots are present 
in the aneurism. He also states that auscultation of the aorta by means 
of a stethoscope introduced into the rectum will enable the examiner to 
detect a friction sound and a murmur at each arterial pulsation. Cases 
are recorded in which dull colicky pains are manifested. These depend 
on the existence of adhesions between the aneurism and the intestines, 
which bring about stenosis of portions of a bowel, owing to the pressure 
exerted by the tumour or by the peri-aneurismal fibrous tissue. The 
colicky pains may also depend on thrombosis of the arteries of the small 
intestine. Similar pains are observed in the case of a mesenteric abscess 
(see p. 1080). 

Labat records cases in which the aneurism became adherent to the 
small intestine or to the large and small colon, and ultimately ruptured 
into the lumen of the bowel, giving rise to the passage of black foetid 
feeces. 

CouRSE AND TERMINATION.—The course is slow and progressive. 
Some authors record rare instances in which spontaneous recovery re- 
sulted by cicatricial contraction and obliteration of the sac of the aneurism. 
The termination is generally fatal, death generally taking place from 
rupture of the aneurism and internal hemorrhage. Compression of the 
organs in the vicinity of the aneurism is also regarded as a cause of 
death. 

DIFFERENTIAL Dracnosis.—This is only possible in cases where the 
aneurism can be palpated. The differentiation between aneurism of the 
posterior aorta and mesenteric abscess is described on p. 1080. 

TREATMENT.—Nothing can be done in the way of treatment. 

Aneurism of the Anterior Mesenteric Artery.—This is of compara- 
tively common occurrence, and depends on the presence of the larvee of 
Sclerostomum vulgare. The aneurism may attain a very large size, and 
may be associated with thrombosis of one or more of the main branches 
of the anterior mesenteric artery. For a consideration of the effects 
produced, see Embolic Colic (p. 280); also the section on Parasites. 


DISEASES OF THE BLOODVESSELS: HORSE 1083 


Aneurism of the Lumbar Arteries.—This condition has been met with 
by Videlier and Cadéac. The aneurism may attain a large size, and may 
produce a distinct enlargement in the lumbar region. It may be asso- 
ciated with thrombosis of the posterior aorta and of the iliac arteries. 
Cadéac remarks that the condition may be mistaken for a tumour, but 
the differential diagnosis is carried out by the employment of a trocar 
and cannula. If the case is one of aneurism, a jet of blood issues from 
the cannula when the trocar is withdrawn. 

Aneurisms of Other Bloodvessels in the Abdominal Cavity.—These are 
of rare occurrence. Cases are recorded of aneurism of the cceliac axis, 
the posterior mesenteric artery, and the hepatic artery. 

Aneurism of the Coronary Arteries.—A case of this lesion is recorded 
by Cadiot in an ass, and sudden death resulted. Itis of very rare occur- 
rence in animals, 

Aneurism of the Arteries of the Hind-Limb.—King met with a 

calcified aneurism of the external iliac artery, which produced an 
ovoid tumour the size of a melon on the croup, and developed slowly. 
Queripel recorded a case of aneurism of the femoral artery at the 
origin of this vessel. Straube met with an aneurism of the digital 
artery. . 
Aneurism of the Carotid Artery.—This has been recorded by various 
authors. The lesion may occur at the origin of the vessel. Laurent 
met with an instance in which the aneurism became adherent to the 
oesophagus, and caused perforation of the latter. Cases are recorded in 
which the aneurism was complicated with thrombosis of the temporal 
and of the maxillary artery. Cadéac observed an arterio-venous aneurism 
which resulted from a dilatation of the vasa vasorum of the artery and of 
the maxillo-muscular vein. The lesion occurred as a tumour situated on 
the right side of the facial region, which on palpation revealed a systolic 
and a diastolic thrill. A case of anetrism of the posterior auricular 
artery was recorded by Peters. 

Aneurism of the Pharyngeal Artery. ee lesion was described: by 
Blase. The symptoms observed were cedema and ulceration on the 
region of the head and neck, swelling of the tongue and gums, salivation, 
and evidences of pharyngitis. The case terminated by rupture of the 
aneurism into the cavity of the pharynx. 

- Aneurism of the Palatine Artery.—This is a very rare condition, 
although, according to Cadéac, atheroma of the vessel is occasionally 
met with. The symptoms recorded are a soft, elastic, pulsating swelling 
on the course of the artery, which may diminish in size or even tem- 
porarily disappear when pressure is applied to it. The treatment sug- 


1084 SYSTEM OF VETERINARY MEDICINE 


gested is to inject a 2 to 3 per cent. sterilised solution of gelatin into the 
cavity of the aneurism. 

Aneurism of the Pulmonary Artery.—This has been observed by — 
Mouquet, Rigot, and Lustig and Hartmann. The lesion occurs at the 
origin of the vessel. The symptoms recorded were dyspnea, attacks 
of vertigo, and evidences of dilatation of the right side of the heart. 
Sudden death occurs when the aneurism ruptures. Rupture may 
take place into one of the large bronchi, and the animal succumbs from 
hemoptysis. | 

Aneurism of the Spermatic Artery has been recorded by Cocu and 
Hue; and 

Aneurism of the Utero-Ovarian Artery has been observed by Hugel. 


THROMBOSIS. 


This term signifies obstruction, either partial or complete, of a blood- 
vessel by a thrombus (blood-clot), which generally originates at a point 
in the interior of the vessel where morbid alterations have occurred. It 
may also commence by an embolus becoming wedged in a vessel, and 
gradually increasing in size by the deposition of new layers of fibrin. 
Thrombosis may occur either in an artery or in a vein. We shall first 
consider arterial thrombosis. 

The lesion, when due to the presence of the larvee of the Sclerostomum 
vulgare, is most frequently found in the anterior mesenteric artery; also 
at the termination of the posterior aorta and its terminal branches— 
viz., the external and internal iliac arteries, the femoral artery, etc. 
Occasionally it occurs in the axillary artery or in the first portion of the 
aorta. Thrombosis may also occur in the absence of parasites, and then 
depends on similar causes to those which bring about chronic endo- 
arteritis; but in many instances it is impossible to ascertain the etio- 
logical factor. In some cases of verminous aneurisms associated with 
thrombosis a number of vessels may be simultaneously affected. 

Thrombosis of the Posterior Aorta and of the Iliac Arteries.—This 
lesion is of special clinical interest in consequence of the peculiar form of 
lameness which it produces. The terminal portion of the posterior aorta 
may be affected, either alone or associated with thrombosis of one or 
both of the external iliac arteries. More commonly one of the external 
iliac arteries is involved. Cases are recorded in which the internal iliac 
arteries were affected (see p. 1087). In the majority of instances the 
obstruction to the lumen of the vessel is not complete, but, should such 
occur, a collateral circulation becomes established. 


DISEASES OF THE BLOODVESSELS: HORSE 1085 


Morsip Anatomy.—The thrombus is generally attached to the 
altered tunica intima, and is usually arranged in successive layers. As 
already remarked, the obstruction to the lumen of the artery is seldom 
complete. In some cases it 1s localised, and lessens the calibre of the 
vessel (parietal thrombus); in others, it extends to the periphery, and a 
central canal occurs in the longitudinal axis (tubular thrombus). The 
result is an impaired circulation in the parts supplied by the affected 
vessel, which may not produce any effects while the animal is at rest, 
but proves insufficient when the animal is exercised. The thrombus is 
usually of a greyish or yellowish-white colour in the larger trunks, but 
in vessels of smaller size it is found of a pink or red colour streaked with 
yellow. It is firm and elastic in consistency. The portion adherent to 
the vessel is rough, irregular, and shreddy, while the non-adherent 
portion is smooth. In some cases the stratified layers can be readily 
separated by means of a scalpel. In the smaller peripheral vessels, 
especially when the lesion commences as an embolus, a proliferation of 
connective tissue from the vessel wall takes place, in addition to the 
thrombus, and the artery may become transformed into a firm cord of 
connective tissue. This process is termed “ organisation of the thrombus.” 
In some cases interrupted thrombi are found in the vessels. 

Certain changes are observed in the wall of the aorta, such as thick- 
ening, dilatation, atheroma, etc. According to Cadeéac, vegetations, 
either soft and partly formed, or voluminous and resistant, accompany 
the endoarteritis. Hemorrhages may be observed in the interstices of 
the muscles or between the muscular fascicull. 

As regards the seat of the lesions in the posterior aorta and its branches, 
the thrombus may occur at the terminal end of the aorta, or in one of 
the external iliac arteries. Cases are recorded in which the thrombus 
was prolonged into the internal iliac, the obturator, the iliaco-femoral, 
and even to the sacral and coccygeal arteries. In some of these cases 
the femoral artery may not be involved in the greater part of its extent. 
In other instances the femoral artery may be the primary seat of the 
lesion. -In others, again, the thrombus extends into this vessel from the 
posterior aorta and the external iliac artery. Cases are recorded in which 
simultaneous thrombosis of the posterior aorta, the anterior mesenteric 
artery, and the portal vein were observed; also instances where all the 
arterial ramifications and associated venous roots showed alterations in their 
walls with thrombosis and embolism. Craig recorded a case in a mare 
of thrombosis of the last 3 inches of the posterior aorta. The thrombus 
extended backwards for a distance of about 6 inches into both of the 
internal iliac arteries and their terminal branches. A small projection 


1086 SYSTEM OF VETERINARY MEDICINE 


of the thrombus passed into the lumen of each of the external iliac arteries. 
In the posterior aorta the thrombus caused only partial obstruction, but 
in the internal iliac arteries and their branches it occupied almost the 
entire lumen of the vessels, and was firmly attached. 

Symproms.—These depend on the obstruction to the blood-supply 
to certain muscles, the result being that their function is disturbed. 
As complete obstruction is exceptional, and even when present the 
formation of a collateral circulation makes up for the deficiency, no 
symptoms may be observed while the animal is at rest. But when 
subjected to exertion, the circulation in these muscles becomes 
insufficient, oxygenation is interfered with, the products of metab- 
olism accumulate in the muscular tissue, and lead to increased 
fatigue of the muscles. This is termed “intermittent claudication.” 
After a short period of rest, the circulation is re-established, and the 
muscles return to their normal condition. The symptoms recur when 
the animal is again subjected to exertion. The intensity of the symp- 
toms depends on the vessels obstructed and on the degree of occlusion. 
In thrombosis of the posterior portion of the aorta, when the horse is 
exercised, weakness in the hind-quarters is observed, also dragging of the 
hind-limbs, staggering, sweating, distress, then inability to move farther, 
and if the animal be forced by means of the whip he falls to the ground, 
but after a time gets up and is able to walk. During the attack, coldness 
of the surface of the hind-limbs is perceptible on palpation, and the pulse 
in the peripheral arteries cannot be felt. | | 

When the lesion occurs in the external iliac or femoral artery, acute 
lameness is observed in the hind-limb, corresponding to the affected 
vessel, when the animal is subjected to exercise. If he is forced to move 
farther, he may fall on the affected side. When the affection is bilateral, 
the symptoms resemble those occurring in thrombosis of the posterior 
aorta. After a short period of rest the lameness disappears. 

Constitutional symptoms are generally well marked. Acute pain and 
distress are manifested, with profuse sweating. This latter does not 
occur in the region supplied by the affected vessel, and when the posterior 
aorta or both external iliac arteries are involved, sweating is observed 
only in the parts anterior to the lesion. Coldness of one or both limbs 
and absence of pulsation in their peripheral vessels are also observed, 
according as the affection involves one external iliac artery, or the pos- 
terior aorta, or both external iliac arteries. In some cases the horse 
stands with one hind-leg advanced and the other hind-leg placed diagon- 
ally behind it. 


The respirations are accelerated, and the visible mucose are injected. 


DISEASES OF THE BLOODVESSELS: HORSE 1087 


Occasionally a distinct thrill is observed in the pulse. Sensibility is 
dulled or completely absent in the affected limb or limbs. On examina- 
tion per rectum, the presence of the lesion is discovered by palpating the 
termination of the posterior aorta and the external iliac arteries. Pulsa- 
tion may be very feeble or even absent in the affected vessels, and in 
some cases a distinct thrill is detected. 

According to Hutyra and Marek, a partial thrombosis sometimes 
produces no symptoms whatever, and Gratia records a case of a horse 
with partial thrombosis of the posterior aorta which two days prior to 
the autopsy performed a long journey (130 kilometres). 

In thrombosis of the internal iliac arteries, causing complete occlusion 
of the vessels, paralysis of the bladder, rectum, and tail generally 
occurs. In the case recorded by Craig to which we have already referred, 
the leading symptoms observed were lameness, particularly of the off 
hind-leg after exertion, both hind-limbs were raised in a peculiar jerking 
spasmodic fashion, occasionally the animal knuckled over at the hind- 
fetlocks, and was unable to proceed farther. Profuse sweating was 
observed, which did not extend beyond the angles of the haunch; also 
marked uneasiness was manifested, and when the animal was placed in 
a stall, she lay down and rolled. The symptoms disappeared after about 
an hour, but reappeared on the following day when the animal was sub- 
jected to exertion. No symptoms were shown during walking exercise, 
but when trotted or galloped for fifteen or twenty minutes the lameness 
appeared. Rectal examination proved of no assistance in the diagnosis. 
The terminal portion of the posterior aorta was slightly firmer than normal, 
and pulsation was detected in it and also in the external iliac arteries. 
There was no paralysis of the bladder, rectum, or tail. 

Course.—According to Hutyra and Marek, in occasional instances 
softening or contraction of the thrombus may occur, so that the obstruc- 
tion to the circulation may be more or less overcome, or this may be 
attained by the establishment of a collateral circulation, but complete 
recovery is very rare. Softening of the thrombus may give rise to the 
detachment of an embolus, which is carried by the circulation to other 
parts of the body, and lesions in vital organs are produced, such as 
embolism of the brain, kidneys, etc. Atrophy of the muscles supplied by 
the affected vessel may occur, owing to insufficient nutrition. In rare 
instances, when complete obstruction is present, gangrene of the muscles 
of one of the hind-limbs may be observed, as in a case recorded by Cadéac 
and Malet, in which thrombosis of the femoral artery was present. In- 
stances are met with in which the limb supplied by the affected vessel 
showed a well-marked cedema, accompanied by induration and thickening. 


1088 SYSTEM OF VETERINARY MEDICINE 


DIFFERENTIAL D1aGNosis.—This is based on the history of the case, 
on the evidences obtained from a rectal examination, the absence of 
pulsation in the vessels within reach, the coldness of the affected limb, etc. 

When the symptoms occur for the first time, and if the horse has 
been idle for some days previously, the case may be mistaken for one of 
azoturia, unless a rectal examination be carried out; but the alterations 
in the urine and the hard, prominent condition of the gluteal muscles 
in the latter affection are important diagnostic features. But Cadéac 
points out that in thrombosis of the external iliac artery the muscles of 
the croup and thigh may be voluminous and prominent. According to 
Hutyra and Marek, horses affected with thrombosis of the arteries of the 
extremities appear to be predisposed to azoturia. The character of the 
lameness in the early stages of azoturia will be of assistance in diagnosis, 
as it simulates that of crural paralysis—viz., a sudden sinking of the 
angle of the haunch, extreme flexion of the hock, and “ dropping ”’ of 
the stifle when weight is placed on the limb. It must be remembered 
that in some cases of azoturia the alterations in the colour of the urine 
may not be well marked. 

TREATMENT.—According to some authors, gradual walking exercise 
may occasionally succeed in bringing about improvement. Bayer advises 
that the animal be led about daily at a walk until the first symptoms of 
lameness appear. The exercise should be gradually increased. Massage 
of the thrombus, when it is within reach, is advised by some observers 
with a view to hastening absorption, but this practice is condemned by 
others as likely to give rise to embolism. Iodide of potassium has no 
effect on the thrombus. 

Thrombosis of the Axillary Artery.—This lesion is of comparatively 
rare occurrence. It has been observed to follow an attack of contagious 
pheumonia or acute endocarditis, and occasionally it results from the 
presence of the larve of sclerostomes. M. Chuchu recorded a case of 
thrombosis of the right axillary and humeral arteries associated with an 
osseous tumour on the second rib. The horse was cast for the operation 
of firmg, and struggled violently. On rising, the right fore-limb was 
found paralysed and unable to bear weight, and felt cold to the touch. 
On the twelfth day evidences of gangrene were apparent in the meta- 
carpal and digital regions. The horse was destroyed, and on post-mortem 
the axillary and humeral arteries were found to be plugged throughout 
their entire length by a fibrinous coagulum which extended for some 
distance into the various trunks to which they give origin. A large 
tumour was found on the lower third of the second rib. It was suggested 
that during the struggles of the animal while cast, the axillary artery 


DISEASES OF THE BLOODVESSELS: HORSE 1089 


may have got bruised between the costal tumour and the humerus, or 
more probably that the vessel had been previously diseased, and had only 
become completely obstructed at the time of operation.* 

M. Georget recorded a case of thrombosis of both axillary arteries in 
a draught-horse aged eighteen years. The symptoms observed were 
sudden attacks of acute lameness while at work, violent trembling of the 
fore-limbs, convulsive movements of the head and neck, dyspnoea, and 
profuse sweating, but the skin of the fore-limbs was dry and cold. The 
symptoms disappeared during rest. 

Symproms.—Lameness is manifested in the limb supplied by the 
affected vessel when the horse is exercised. No weight can be borne by 
the limb, and if forced to move the animal drags the toe on the ground. 
Convulsive movements of the head and neck from one side to the other 
may be observed, also trembling of the caput muscles. The foot of the 
affected side is cold to the touch, and there is an absence of pulsation in 
the digital arteries. The symptoms disappear after a short period of 
rest. In cases of long standing, atrophy of the muscles of the forearm 
may occur. 

Thrombosis of the Carotid Arteries and their Principal Branches.— 
This condition has been observed in connection with tumours causing 
compression of these vessels, various infections followed by endoarteritis 
of the carotids, suppurative phlebitis of the jugular vein, etc. Various 
lesions occur as the result of interference with the blood-supply to the 
brain and other organs supplied by these vessels and their branches. 
They include cedema of the brain, dropsy of the lateral ventricles, etc. 
When the lingual arteries are involved, the muscles of the tongue become 
atrophied, and undergo degeneration. The pharyngeal and laryngeal 
muscles may show similar lesions, and difficulty in deglutition and 
respiration result. | 

The symptoms depend on the vessels chiefly involved. Weakness 
and staggering may be observed, the animal falls down and exhibits 
convulsive muscular movements, nystagmus, and dyspnoea. The symp- 
toms improve after a long rest, but again become exaggerated when the 
horse is exercised. Gléckner observed difficult deglutition, respiration 
was accompanied by a whistling sound, and later on evidences of pul- 
monary emphysema appeared. Siegen recorded a case of thrombosis of 
the left carotid and internal carotid artery in which the symptoms 
presented were epileptiform convulsions, which appeared after the horse 
had been subjected to trotting exercise for twenty to thirty minutes, 
The symptoms continued for about twenty minutes. 


* “ Recueil de Méd, Vét.,”’ 1862, + Ibid. 
VOL, II. 


1090 SYSTEM OF VETERINARY MEDICINE 


Thrombosis of the Pulmonary Artery.—According to Hutyra and 
Marek, this lesion is not very rare. It may depend on various causes, 
of which the following are the most important: Emboli from the right 
side of the heart, which may have originated in this region, or reached 
the cavity from distant parts of the body. In rare instances the thrombus 
is formed as the result of foreign bodies, such as hairs entering the jugular 
vein during the operation of venesection (Zschokke), portions of broken 
hypodermic needles entering during intravenous injections, also a cannula 
entering the jugular vein during a similar procedure (Prévost). Kappel 
found thrombosis of the pulmonary artery in 9 per cent. of the slaughtered 
horses he examined. The animals were generally old. The emboli 
causing the lesion originated in most cases from thrombosed veins in the 
posterior extremities and in the sheath. The seat of predilection was the 
right divisions of the main branches of the artery. According to Cadéac, 
all diseases of the venous system accompanied by thrombosis predispose 
to pulmonary embolism. 

Symproms.—Thrombosis of some of the smaller divisions of the pul- 
monary artery may not give rise to any symptoms. When the larger 
branches are involved, sudden marked dyspnoea is observed, or even 
asphyxia, which may prove fatal. Cases of rupture of the pulmonary 
artery are recorded. In other instances the symptoms are moderated 
when the animal is at rest, or may disappear; but relapses occur due to 
fresh attacks of embolism. Again, cases are met with in which the 
animal is unable to perform any work, loses his appetite, and becomes 
emaciated. A double expiratory movement resembling that occurring 
in broken wind may also be observed. 

Thrombosis of the Renal Arteries.—Endoarteritis and thrombosis of 
a renal artery sometimes occurs as a sequel to aortitis, depending on the 
presence of sclerostomes, or associated with infectious diseases. Gradual 
atrophy of the kidney results, and complications occur when the other 
kidney fails in its function. 

Symptroms.—According to Cadéac, when only one renal artery is 
involved, no symptoms may be observed, as the unaffected kidney under- 
goes compensatory hypertrophy, and performs the functions of both 
organs. If, however, the second kidney becomes affected, albuminuria, 
cedematous swellings of the limbs and dependent parts of the body, and 
uremia occur. Pulmonary gangrene has been observed asa complication. 

’ Thrombosis of the Venee Cavee.—This is a comparatively rare condi- 
tion. The anterior vena cava or the posterior vena cava may be affected. 
The lesion may be induced by compression of the vessel, such as by 
enlarged lymph glands, tumours, or abscesses. Albrecht recorded a case 


DISEASES OF THE BLOODVESSELS: HORSE 1091 


of thrombosis of the anterior vena cava due to compression of the vessel 
at its entrance to the right auricle by a strangles abscess. Cuny met 
with an instance of thrombosis of the posterior vena cava due to com- 
pression exerted by melanotic tumours in the spinal region. Ciattoni 
described a case of tricuspid insufficiency complicated with thrombosis 
and rupture of the anterior vena cava. According to Basset, trauma- 
tisms involving the region of the chest may cause injury to the walls of 
the anterior vena cava, followed by phlebitis and thrombosis. Accord- 
ing to Cadéac, thrombosis of the posterior vena cava may result from 
extension of a similar lesion in a collateral vessel, such as a subhepatic 
vein or a renal vein. The condition may also arise from an infectious 
phlebitis, which causes alterations in the endothelium of the vessel. 

Symproms.—Thrombosis of one vena cava causes venous stasis of 
those parts of the body from which it returns the blood to the right 
ventricle. The obstruction in the vessel is rarely complete. 

When the anterior vena cava is involved, the veins of the head, neck, 
anterior extremities, and thorax, become overfilled with blood, and 
cedematous infiltration of the region of the neck, shoulder, and sternum 
as far as the xiphoid cartilage is observed, also a presystolic jugular 
pulse is present. 

When the posterior vena cava is the seat of the lesion, oedematous 
swellings appear in the hind-limbs and on the inferior abdominal region, 
and if the obstruction occurs between the heart and the liver, ascites is 
produced. According to Colin, complete occlusion of the ven cave is 
followed by death. Owing to softening and disintegration of the thrombus, 
emboli may enter the circulation, reach the lungs, and bring about 
embolic pneumonia. Various authors have recorded cases in which 
ulceration occurred in the walls of the affected vein, and during exertion 
or as the result of a fall rupture of the vessel took place. 

Thrombosis of the Cavernous Sinus.— Bouley* recorded a case of inter- 
mittent paralysis of both fore-limbs due to'a thrombus in the posterior 
part of the cavernous sinus, which surrounded almost entirely the trunk 
of the internal carotid artery. It extended forward to the posterior 
aspect of the pituitary body. The transverse anastomosing branch 
between the internal carotids passed through the centre of the clot. The 
animal was a four-year-old, well-bred gelding. While being exercised 
he suddenly fell, and was unable to rise for several minutes. If he was 
trotted sharply for three or four minutes, he suddenly lost control over 
his fore extremities, and quickly fell to the ground head foremost. The 
animal, after being several times subjected to this test, remained down 

* ** Recueil de Méd. Vét.,’”’ 1863. 


1092 SYSTEM OF VETERINARY MEDICINE 


for some hours, but the same evening seemed as well as ever. This con- 
dition continued for five months, and the animal succumbed to an attack 
of pneumonia. 

Thrombosis of the Portal Vein.—This Jesion was observed by Colin, 
Goubaux, Cabaret, Gratia, and Rolland. Complete obstruction of the 
portal vein due to thrombosis causes death within a few hours. If, how- 
ever, the circulation becomes re-established, or the obstruction is not 
complete, the animal may live for an indefinite period. Dumas recorded 
a case of thrombosis and rupture of the subhepatic vein, followed by 
rupture of Glisson’s capsule. 

Symproms.—These depend on the degree of obstruction present. 
Owing to venous stasis in the intestines, rapid emaciation occurs, as 
absorption is interfered with. Evidences of enteritis or gastro-enteritis 
are observed, and in some instances vertigo. (iidema of the inferior 
aspect of the abdominal region occurs after a time. The rapidity with 
which death occurs depends on the degree of obstruction present in the 
portal vein. There are no diagnostic symptoms. 

Thrombosis of the Nasal Veins.—This lesion may occur as a complica- 
tion of phlebitis of the jugular vein, and, according to Cadéae, it is mani- 
fested by a series of projections of a yellowish or greyish-red colour on the 
nasal mucose. 

Thrombosis of the Veins of the Extremities.—The occurrence of throm- 
bosis in the veins of the extremities is not rare. It is said to occur as a 
sequel to purpura hemorrhagica, contagious pneumonia, strangles, etc. 
In the fore-limb the posterior radial vein may be involved, and the 
vessel is more or less completely obstructed. In other instances the 
metacarpal veins may be affected. In the hind-limb the anterior tibial 
vein is the most usual seat of the lesion. Forgeot recorded a case of 
thrombosis of the femoral vein. According to Cadéac, in thrombosis of 
the veins of the limbs, the thrombus is not adherent to the vessel wall, 
and the changes in the latter are secondary. The lesion is believed to 
be due to morbid alterations in the blood. This author also states that 
swellings of the limbs im old horses kept without exercise may be due to 
thrombosis of the veins. Mr. Horace L. Roberts informs us that from 
clinical experience he can corroborate the above views. 

Thrombosis of the Veins of the Penis.—This lesion is described by: 
Cadéac, and also by Forgeot. The veins of the organ show small dilata- 
tions, containing a more or less old fibrinous thrombus. The thrombus 
may be short, but at other times it is long, and may extend into the 
neighbouring venous branches. Forgeot attributes the lesion to absorp - 
tion of the products of fermentation formed in the sheath. 


DISEASES OF THE BLOODVESSELS: HORSE —_ 1093 


EMBOLISM. 


This condition occurs when portion of a thrombus breaks away, and 
is carried by the blood-stream to a more or less distant vessel, whose 
calibre is too small to permit of the detached mass (termed an ‘“‘ embolus ”’) 
passing through; consequently it becomes lodged in the vessel, and 
serious results are likely to ensue. 

Embolism affects the arteries only, while thrombosis may occur in 
the heart, arteries, or veins. Embolism of the branches of the portal 
vein, however, may be observed in cases of joint-ill, following on throm- 
bosis of the umbilical vein. 

Er1oLocy.—Degenerative changes in a thrombus—e.g., softening— 
favour detachment of an embolus therefrom. Severe muscular move- 
ments, manipulations, etc., may so affect the vessel obstructed by a 
thrombus that an embolus is detached and set free. Emboli may also 
be formed by fat globules in cases of severe concussive lesions of the 
bone-marrow. Bubbles of air, by entering the jugular vein during 
operations in the neck, venesection, or during the process of intravenous 
injection, may cause air embolism (see p. 1096). Particles detached from 
atheromatous patches, ulcers, etc., may also act as emboli. 

_ Again, emboli may be formed by tumour cells, owing to the cells 
during the growth of the tumour penetrating the walls of bloodvessels, 
and being carried by the blood-stream to other parts, the result being 
that new growths are developed. 

Malignant Embolism.—In this condition pathogenic bacteria enter 
the bloodvessels, and although primarily, in consequence of their minute 
size, they do not cause mechanical obstruction, they induce similar patho- 
logical changes to those present at the point of entrance; then by develop- 
ing into masses or clumps they cause obstruction of the lumen of the 
vessel. ) 

Or the bacteria in clumps may be disseminated in the blood, and 
adhere to portions of thrombi, which are free in the blood-stream. In 
this instance both mechanical effects and specific pathological changes 
are produced. The best typical example of malignant embolism is 
found in joint-ill of foals, and in that affection known as “ white 
scour” in calves. In these the pathogenic bacteria enter by the 
umbilical vein, causing in the first place an umbilical phlebitis, and later 
on the occurrence of extensive pyogenic foci of inflammation in various 
organs. 

Parasites, such as larvee forms of Sclerostomum vulgare, may produce 


1094 SYSTEM OF VETERINARY MEDICINE 


embolism, the commonest example of which is embolism of the branches 
of the anterior mesenteric artery (see Embolic Colic, p. 280). 

Errects or Emporism—Immediate occlusion of the lumen of the 
affected vessel need not occur, as the embolus may be of an irregular 
or angular outline, and permit a restricted circulation to go on, When 
cylindrical or round in shape, the embolus is more likely to cause 
complete obstruction. Enlargement of the embolism by the deposi- 
tion of successive layers of fibrin, or by coagulation of the stagnant 
column of blood in the vicinity is also liable to bring about com- 
plete obstruction of the vessel. In such instances it is difficult to 
decide whether the obstruction is due to a primary thrombosis or to 
an embolism which has become enlarged in the manner mentioned 
above. 


The results of embolism are in part mechanical, due to the obstruc- 
tion of the blood-flow in the affected vessel, and in part specific, depend- 
ing on the nature of the embolus—e.g., on the pathogenic bacteria with 
which it is associated. The primary effect is an anemia of the organ 
or area supplied by the vessel. The subsequent results depend 
on the communications that exist between the occluded artery and 
adjacent vessels by means of anastomoses or by a collateral circulation. 
In parts where the arterial anastomoses are few or absent, the patho- 
logical condition termed “infarction”? occurs, and is met with most 
frequently in the lungs, liver, spleen, and kidneys. 

The symptoms will vary according to the organs affected. 

TREATMENT.—As in the case of thrombosis, but little can be done in 
the way of treatment. 


PHLEBITIS (INFLAMMATION OF VEINS). 


This may occur under a variety of conditions. In the days when 
venesection was frequently resorted to as a therapeutical measure, 
phlebitis of the jugular vein was by no means an uncommon occurrence. 
Probably almost every case of this nature was due to neglect of 
surgical cleanliness, as the wound suppurated, and the coats of the 
vein became inflamed. Exudation and cell proliferation occurred 
primarily in the inner coat of the vessel, followed by the formation of a | 
thrombus. Later on organisation of the thrombus took place, and the 
vessel became converted into an impervious cord. In some cases sup- 
puration occurred, and the abscess was limited by a thrombus forming 
above and below it. A peculiarity with reference to the formation of a 
thrombus in the jugular vein is that the clot extends towards the head 


DISEASES OF THE BLOODVESSELS: HORSE 1095 


—t.e., away from the heart, as well as towards the heart. Attention was 
directed to this point by Percivall and Williams. 

For further information on the subject of traumatic phlebitis, the 
reader is referred to works on veterinary surgery. 

Diffuse Phlebitis—This may result from traumatic causes associated 
with septic infection, or it may develop in connection with septic metritis, 
erysipelas, etc. The inflammatory process extends to the veins from the 
adjacent tissues, diffuse suppuration occurs, and pyemia may result (see 
Metritis, and Erysipelas). 


VARIX (VARICOSE VEINS). 


This condition is not so frequently met with in animals as in man. 
The superficial veins, especially of the extremities, are those most likely 
to become affected. The alterations in the vessel consist of dilatation 
and elongation. In some instances the dilatation is of a simple fusiform 
character; in others, along with dilatation, elongation and a tortuous 
condition are found, which extend into the venous branches. Again, 
the dilatation may be of a pouch-like character, and associated with 
thickening of the walls of the vessel. 

Et1otocy.—Various causes are believed to bring about varicose veins. 
Amongst these may be mentioned external pressure, extension of inflam- 
mation from surrounding parts, Increased blood-pressure in the vein from 
gravitation of the blood, while any condition likely to interfere with the 
normal venous circulation, or with the nutrition of the vascular walls, 
or with their innervation, may tend to produce lessened resistance and 
dilatation as a result. Williams observed varicose dilatations along 
the course of the veins of the extremities in cattle kept in wet and cold 
situations and underfed, and ascribed the condition to debility of the 
circulation and want of tone in the walls of the veins. 

Various results may occur from varicose veins, such as thrombosis 
and total occlusion of the vessel, followed by its transformation into a 
fibrous cord. Suppuration or ulceration succeeded by hemorrhage may 
also result. The vein most commonly affected is the internal saphenic 
as it passes over the internal aspect of the hock, especially observed in 
conjunction with bog spavin. We have also observed a varicose condi- 
tion of the posterior radial vein on the inside of the forearm, of the 
internal metacarpal vein, and of the spermatic veins. 

The treatment of varicose veins, when such a course becomes neces- 
sary, is essentially surgical, and the reader is directed to works on veter- 
inary surgery for information on this point. 


1096 - SYSTEM OF VETERINARY MEDICINE 


PHLEBOLITES. 


These are calcareous bodies which are occasionally found in veins, 
especially in the jugular and in the abdominal veins. Calcareous indura- 
tion of the coats of a vein has also been observed. 


AIR EMBOLISM (THE ENTRANCE OF AIR INTO THE JUGULAR 
VEIN). 


As already remarked, this may occur accidentally during the opera- 
tion of venesection, the air being drawn into the vein by the suction 
force of the heart. It may also take place when the vein is accidentally 
opened during operations in its vicinity, and during the administration 
of an intravenous injection. 

According to Kitt, moderately large quantities of air (5 to 10 c.c. in 
horses, sheep, and dogs) may be injected into the jugular vein, sometimes 
without harmful results, provided the animals are healthy and their 
blood-pressure is normal. The air disappears rapidly by absorption in 
the circulating blood. When, however, the animals have a low blood- 
pressure and a tendency for the blood to accumulate in the right heart, 
such as after operations, the occurrence of hemorrhage, etc., the bubbles 
of air tend to accumulate in the right heart, and form an elastic cushion 
of air, on which cardiac contractions have no effect beyond compression 
during systole and expansion during diastole. The result is overfilling 
of the right heart and dilatation of the right ventricle. Death is attributed 
to cardiac dilatation and also to asphyxia, as the blood cannot reach the 
lungs. 

According to Franck, it is possible that some of the air may pass 
through the lungs and reach the coronary arteries by way of the left 
heart, and thus produce embolic occlusion in these arteries.* 


RUPTURE OF LARGE VESSELS IN THE THORAX AND ABDOMEN. 


Although cases are recorded in which rupture of a large vessel has 
occurred in the absence of previous disease of its walls, in the majority of 
instances chronic endoarteritis or atheroma has been present. Judging 
by the cases reported, the vessels most commonly subject to rupture are 
the aorta at its root, or the anterior or posterior aorta, the anterior 
mesenteric artery, the pulmonary artery, the portal vein, the posterior 
vena cava. 


* Kitt, “‘ Textbook of Comparative General Pathology.” 


DISEASES OF THE BLOODVESSELS: HORSE 1097 


With reference to the etiology of the lesion, various causes are recog- 
nised, such as sudden severe exertion, parasites, morbid alterations of 
the walls of the vessel, ulceration or abscess formation in the vicinity of 
the vessel, the presence of new growths causing erosion of the vessel wall, 
the presence of aneurism, etc. A case is recorded in which rupture of 
the pulmonary artery occurred in a stallion as the result of the animal 
being cast and secured for operation. In another case rupture of the 
left axillary artery resulted from a similar cause. Rupture of the portal 
vein has followed a blow on the left side of the body, and an exostosis on 
the sixteenth dorsal vertebra caused rupture of the aorta. 

The symptoms of rupture of any of these vessels are essentially those 
of internal hemorrhage, and the lesion is only discovered post mortem. 


DISEASES OF THE CIRCULATORY ORGANS 
IN CATTLE 


By E. WALLIS HOARE, F.RB.C.V.S. 


General Remarks.—With the exception of traumatic pericarditis, 
little attention has been devoted to the diseases of the circulatory organs 
in cattle. The fact that cattle are generally kept as meat and milk pro- 
ducers, and not for the purpose of work, no doubt has some effect not 
only on the comparative rarity of cardiac diseases, but also on the latent 
character of such affections, as in the majority of instances the lesions 
are only discovered at post-mortem examinations. In the absence of 
active exertion, clinical symptoms of cardiac diseases are seldom observed ; 
and another point worthy of mention is that cattle are exempt from 
affections such as influenza, which in the horse exert such an important 
influence in the production of diseases of the heart. 

Pericarditis—For practical purposes we may consider this affection 
under two headings—viz. (1) Acute Sero-Fubrinous Pericarditis ; (2) Trau- 
matic Pericardites. 

Acute Sero-Fibrinous Pericarditis—All authors regard the primary 
form of this affection as of rare occurrence in cattle. On the Continent 
cases are recorded in working oxen subjected to cold and chills, but these 
causes must be regarded as only predisposing to microbial infection. 
Injuries and contusions of the thoracic walls, without causing open 
wounds, are regarded as etiological factors, and probably act by lessening 
the vital resistance of the pericardium and rendering it liable to infection 
by micro-organisms. 

Secondary pericarditis is generally due to Hiparouicee and ig asso- 
ciated with tuberculous lesions in the pleura and in the mediastinal 
lymphatic glands. Contagious pleuro-pneumonia is sometimes accom- 
panied by pericarditis. ; 

For a description of the lesions of tuberculous pericarditis, see Tuber- 
culosis, Vol. I. In non-tubercular cases the lesions resemble those met 
with in the horse, and the symptoms are also similar. The differential 
diagnosis from traumatic pericarditis is based on the history of the case 


and on the nature of the effusion. In ordinary pericarditis there are no 
1098 


DISEASES OF THE CIRCULATORY ORGANS: CATTLE 1099 


premonitory symptoms of digestive disturbance, and on an exploratory 
puncture with a trocar and cannula the effusion is sero-fibrinous in 
character, while in the traumatic form it may be foetid or purulent 
(see p. 1100). 

The treatment is to be adopted on similar lines to those advised for 
the analogous affections in equines. 

Traumatic Pericarditis —This is an affection of comparatively fre- 
quent occurrence in cattle, especially in milch cows kept in town dairies, 
and fed by female attendants; also in animals having access to kitchen 
or house refuse. The disease depends on the entrance into the peri- 
cardial sac of a sharp-pointed foreign body proceeding from the reticulum, 
which not only sets up pericarditis, but also, by puncturing the myo- 
cardium, brings about cardiac lesions as well. During the passage of the 
foreign body from the reticulum to the pericardium certain digestive 
disturbances are induced, and these are followed or complicated by 
lesions of the pericardium and heart when the foreign body reaches these 
organs. Powell* recorded a case of traumatic pericarditis in a four- 
months-old calf, due to penetration of the pericardium and heart by a 
sharp-edged flint stone the size of a broad bean. Under the heading of 
Traumatic Indigestion (see p. 368) the lesions and symptoms produced by 
the migration of the foreign body through the stomach and diaphragm 
are fully described. Here it will only be necessary to direct attention to 
the ultimate intrathoracic lesions induced, and to the symptoms usually 
presented. ) 

Morsip Anatomy.—The proximity of the reticulum to the posterior 
‘surface of the diaphragm, and of the pericardium to the anterior surface 
of this structure, facilitates in a marked manner the passage of the 
foreign body from the stomach to the heart. Sharp-pointed foreign 
bodies, such as needles and pieces of wire, may in some cases pass very 
rapidly from the reticulum to the pericardium without producing any 
serious lesions in the stomach or surrounding tissues during their migra- 
tion. If, however, the foreign body is of unequal diameter, or provided 
with a head, such as a large pin ora nail, the process of migration is much 
delayed, and the course taken is variable. 

The reticulum may be adherent to the posterior surface of the dia- 
phragm, and the anterior surface of the latter may be adherent to the 
pericardium. According to Cadéac, a thick cylindrical fibrous band or 
a fibrous enlargement may unite the pericardium, the diaphragm, and 
the reticulum, and sometimes the adhesion may extend to the posterior 
mediastinum and the lung. On section of this fibrous band or growth, 


* Veterinary Record, vol, xviil., p. 294. 


1100 SYSTEM OF VETERINARY MEDICINE 


a fistulous track is observed, through which the foreign body has passed. 
from the reticulum to the pericardium. According to Moussu, the 
fibrous band occurs only in cases where the foreign body is of some — 
length, and the period of migration is delayed. This fistula may com- 
munciate at one end with the pericardial sac, and extend to the reticu- 
lum, and occasionally it communicates with the latter. In most instances 
the original opening into the reticulum becomes filled up by granulations, 
and is cicatrised. In some cases, when the foreign body has met with 
some obstruction to its migration, or when a number of foreign bodies 
are present, multiple fistula are formed. The walls of the fistula may 
be greyish-red or even of a blackish colour, and hard in consistence, 
while in cases of long standing they may become calcified. 

Abscess formation may occur, and either one or more abscesses are 
observed, which may communicate with the pericardial sac, or with the 
fistula, or may remain encapsuled. When a large abscess develops in 
close proximity to the pericardium, it exerts compression on the latter, 
and gives rise to symptoms simulating those of pericarditis. This con- 
dition is termed ‘“‘ pseudo-pericarditis ”’ by Moussu and other writers. 

The situation of the foreign body varies. It may be found at the 
termination of the fistula, or free in the pericardial sac, or it may enter 
the heart itself. In some cases it may leave the pericardium, and becomes 
lodged between the latter and the thoracic wall, or an abscess may form 
in an intercostal space, and the foreign body escapes from the thorax by 
this route. Again, the foreign body may not enter the pericardium, but 
instead re-enters the reticulum; or it may, if composed of metal, become 
oxidised, and finally disintegrated, so that it cannot be discovered post 
mortem. In some instances the fistula traverses the myocardium, and 
even gains entrance to one of the cavities of the heart, an abscess then 
forms in the cardiac wall, which may rupture into one of the ventricles 
or into the pericardial sac. The pus which surrounds the foreign body 
varies in character according to the nature of the infecting agent. Thus 
it may be creamy and inodorous, or greyish and foetid. A circumscribed 
or diffuse pleurisy is frequently present, with false membranes and a 
more or less abundant sero-fibrinous effusion. In some cases the latter 
is purulent. 

The pericardium shows marked alterations. It is greatly distended 
by effusion, and occupies a large extent of the thoracic cavity. The 
parietal pericardium is much thickened, and in cases of long standing is 
considerably indurated. It may contract adhesions to the lung and also 
to the diaphragm. The effusion is generally purulent, foetid, and of a 
yellowish-grey or greenish-yellow colour. It may contain putrid gases 


DISEASES OF THE CIRCULATORY ORGANS: CATTLE 1101 


derived from the stomach. In some cases it is hemorrhagic and of a 
brownish-red colour, and in rare instances may be clear and limpid. 
The amount varies from 10 to 15 pints or even more, and the fluid holds 
in suspension blood-clots and fibrinous flocculi. The false membranes 
assume a firm character in cases of some standing, and the pericardial 
sac may be divided into irregular compartments by masses of fibrin. 
The visceral layer of the pericardium may be covered by fibrinous exudates 
of a villous character, giving rise to the pathological condition known as 
“cor villosum.”’ The two layers of the membrane may be joined together 
either in places or completely, so that cardiac symphysis is produced (see 
p. 1105). In cases of long standing, calcification of the exudates and of 
the pericardium may occur, and the heart may be surrounded by a thick 
calcareous covering. 

Lesions of the myocardium and of the endocardium may be observed. 
Atrophy of the heart results from the compression produced by the 
exudate. Myocarditis is not uncommon. The organ shows degenera- 
tive changes, and it is softened and of a yellowish colour. According to 
Cadéac, numerous small miliary abscesses may occur in the myocardium. 
In other cases abscesses of larger size are found in the auricles. 
These may remain encapsuled, or may rupture, leaving suppurating, 
ulcerating, or gangrenous foci. This author has also met with instances 
in which several ulcerous foci were found in the heart, due to the move- 
ments of the foreign body, brought about by the contractions of the 
organ, etc. He has also observed cases in which the foreign body pene- 
trated one of the cavities of the heart, giving rise to hemorrhage and the 
formation of blood-clots, either located in the vicinity of the puncture or 
free in the pericardial sac. Ulceration of the endocardium may occur in 
some cases, the interventricular septum being sometimes involved. An 
immediately fatal result is prevented by the formation of a clot and an 
inflammatory exudate, which fill up the solution of continuity. But, 
owing to the micro-organisms introduced by the foreign body, a general 
infection of the blood is produced, and abscesses are formed in various 
organs, such as the brain, kidneys, spleen, etc., as well as in the sub- 
endocardial tissue. 

Pulmonary lesions are produced when the foreign body enters the 
lung, purulent foci and metastatic abscesses being observed. Amongst 
other lesions we may mention an extensive oedema of the dewlap, sternal 
and inferior cervical regions, and intermaxillary space, dilatation of the 
jugular veins, passive congestion of the liver, pulmonary cedema, ete. 

Symptoms.—The phenomena observed during the migration of the 
foreign body from the reticulum to the diaphragm have been described 


HD SYSTEM OF VETERINARY MEDICINE 


under the heading of Traumatic Indigestion (p. 371). In order to present 
a complete clinical picture we recapitulate these symptoms as follows: 
A capricious appetite, a tendency to remain in the standing posture for 
long periods, grunting if forced to move about, intermittent attacks of 
tympany of the rumen, gradual loss of condition, accelerated respirations 
of the costal type owing to inertia of the diaphragm, the inertia depend- 
ing on puncture of this structure, and adhesion of its posterior surface to 
the reticulum. This stage is slow in progress, and a period of from two 
to six weeks is said to elapse before symptoms attributable to pericardial 
lesions are manifested, but this is subject to marked variations. Ac- 
cording to Hutyra and Marek, evidences of primary digestive disturbance 
may be absent in some cases, and the length of time that elapses between 
the ingestion of the foreign body and the development of pericardial 
symptoms depends on the nature of the foreign body, the manner in 
which the animal is kept and fed, and also on accidental factors—e.g., 
parturition, which tends to shorten the period of migration. 

When the pericardium becomes involved, febrile symptoms develop, 
and the respiratory and digestive phenomena become accentuated. 
Rigors, with coldness of the surface of the body and extremities, may 
be observed. The degree of fever varies, and its intensity is believed to 
depend on the virulence of the infection introduced by the foreign body. 
Roberts and Powell have observed that the temperature is always raised 
to 105° or 106° F. even before cedematous swellings are manifested. 
The pulse is accelerated, and continues strong until effusion takes place 
into the pericardial sac. The cardiac impulse is irregular and tumultuous, 
the visible mucose are injected, the respirations are irregular and accom- 
panied by a moan or grunt, and if the animal be forced to move, dyspnoea 
is produced. A short intermittent cough is also observed. Rumination 
is irregular, and frequent eructations of foetid gas occur. Constipation, 
alternated with diarrhoea, may be present in some cases. The animal 
shows an anxious expression of countenance. When in the standing 
posture the elbows are turned out, and the head is slightly extended on the 
neck, When in the recumbent position the animal lies on the right side. 

PuysicaL Signs.—Palpation shows a tumultuous cardiac impulse, 
which becomes weaker when effusion occurs, and may be difficult to 
detect. 

Percussion reveals an increased area of cardiac dulness depending on 
the presence of effusion. When gas is present in the pericardial sac, as 
well as fluid (pneumo-pericardium), a tympanitic resonance is detected. 

Auscultation.—A variety of abnormal sounds are described as occur- 
ring in traumatic pericarditis. According to Cadéac, in the early stages 


DISEASES OF THE CIRCULATORY ORGANS: CATTLE 1103 


a “rumbling ” sound is heard, or a metallic bruit. When effusion occurs 
these brwits are replaced by splashing or gurgling sounds, which vary in 
character. Thus, owing to the movements of the heart agitating the 
gas-containing fluid, a sound resembling that of a mill-wheel worked by 
water is produced (brudt de moulin), or a sound like that caused by the 
fall of a solid body on a liquid surface may be detected, or a gurgling 
sound resembling that produced when water is poured from a bottle into 
an empty vase may be heard. A metallic tinkling sound is also described, 
which may be due to the presence of partitions formed by adhesions 
between the pericardium and the heart, so that, when fluid is splashed 
up, it enters there, and then drops slowly to the dependent part of the 
sac. In some cases these sounds are intermittent. They may be accen- 
tuated by forcing the animal to walk, and they may disappear when the 
pericardial sac is extremely distended by fluid. They may occasionally 
be heard while the practitioner stands by the side of the patient, and 
some authors state that instances occur in which the sounds are detected 
with more facility on the right side than on the left. Symptoms attribut- 
able to venous stasis depending on compression of the heart by effusion, 
and also on myocardial lesions, are always present. Qidema of the inter- 
maxillary areolar tissue and pharyngeal region, and of the inferior aspect 
of the neck, extending to the dewlap, is a prominent symptom. In 
advanced cases the ceedema may extend along the abdominal wall, and 
involve the udder and the fore- and hind-limbs, and, according to some 
authors, the mesentery and the intestines are also involved by this 
cedematous infiltration. A venous pulse is present, and in some cases 
the jugular veins are enormously engorged with blood. The visible 
mucose show a cyanotic tint, and nervous phenomena may result from 
congestion of the venous sinuses of the brain. Myocarditis adds to the 
circulatory disturbances; while endocarditis, when present, causes various 
complications, such as embolism, cerebral lesions, paralysis, arthritis, 
etc. . 

In pseudo-pericarditis—i.e., compression of the pericardium and heart 
owing to circumscribed abscess formation not involving the interior of 
the pericardial sac—similar circulatory symptoms may be observed, but 
the peculiar bructs are absent, and certain phenomena may be manifested 
which depend on the situation of the circumscribed abscess. Moussu 
points out that if the abscess is subpericardial, it may cause upward dis- 
placement of the heart, so that the attenuated cardiac sounds are heard 
above the usual location; or if the abscess be subpleural and laterally 
situated, the heart may be displaced towards the right side. The sounds 
are attenuated by the compression, but each ventricular systole transmits 


1104 SYSTEM OF VETERINARY MEDICINE 


an impulse to the abscess, which impulse is reflected to the intercostal 
spaces in the vicinity, and may lead to an erroneous diagnosis of aneurism 
at the base of the large arterial trunks. Owing to pressure exerted on 
the lung, this organ is displaced upwards, and the normal respiratory 
murmur is absent on the affected side. 

In some cases of traumatic indigestion important pulmonary and 
pleural complications occur. When the foreign body does not enter the 
pericardium, but penetrates the base of the lung, traumatic pneumonia 
and a limited pleurisy result, and the lung may be joined by adhesions 
to the anterior surface of the diaphragm. A gangrenous pulmonary 
abscess may be produced, which, according to Cadéac, is revealed by a 
eurgling sound on auscultation, and a slight oedema of the thoracic wall. 
In other instances pleurisy and pneumonia may be associated with 
traumatic pericarditis, and produce a complicated clinical picture. 

Coursr.—This is generally insidious. It depends on the nature of 
the foreign body and the rapidity with which it reaches the pericardium, 
also on the lesions which are produced. Temporary improvement may 
occur in some cases, to be followed by a reappearance of the symptoms. 
The duration varies within wide limits, and no definite period can be 
stated with reference to the time occupied by the foreign body in migrating 
from the reticulum to the heart. 

When pericardial symptoms are manifested, a fatal termination may 
occur in from fourteen days to two months; but in cases where perfora- 
tion of the heart results, or septic infection of the pericardium, lung, or 
pleura occurs, death takes place in a short period of time. Begg has 
met with cases in which sudden death occurred as the result of puncture 
of the heart (see p. 373). 

Occasionally the foreign body returns to the reticulum, or finds its 
way to the surface of the skin of the thoracic wall, and is discharged by 
means of a superficial abscess, a spontaneous recovery resulting. 

DirFERENTIAL D1aGNnosis.—As pointed out in the section dealing 
with Traumatic Indigestion (p. 373), the diagnosis is attended with con- 
siderable difficulty, and until the advent of pericardial effusion the most 
experienced clinician may fail to recognise the true nature of the case. 

The history of the case must be carefully considered, and special 
attention directed to the physical examination of the heart. According 
to Meyer and Hber, in the diagnosis of a commencing traumatic peri- 
carditis the high pulse-rate (100 to 110 per minute), with a normal or a 
maximal normal temperature, is suggestive. Eber states that in these 
rare cases, in which the temperature rises more or less during the initial 
stage, the question can be decided by the administration of antifebrin, 


DISEASES OF THE CIRCULATORY ORGANS: CATTLE 1105 


as, if the case be one of traumatic pericarditis, the increased pulse-rate 
persists, although the temperature is lowered by the action of the drug. 
Otto has observed a peculiar muscular trembling in the vicinity of the 
elbows, more especially after the animal has been standing for some 
time (Hutyra and Marek). 

For further details with reference to the differential diagnosis in the 
early stages, see Traumatic Indigestion (p. 373). 

TREATMENT.—Lhe principles of treatment for the disease in the early 
stages are described on p. 374. In all cases where a definite diagnosis 
is possible, and the animal is in good condition, the advisability of 
slaughtering for food must be considered, and probably this will prove 
to be the most economical course. But in the case of a valuable animal 
treatment may be demanded by the owner, or it may be undertaken 
with a view to alleviate the distressing symptoms and to get the animal 
into good condition for the butcher. Extraction of the foreign body 
and removal of the exudate by means of an opening into the thoracic 
cavity is condemned, as it necessitates an incision through the pleura, 
and a purulent pleurisy is likely to result. It only proves successful when 
the pericardium is adherent to the wall of the chest, but there is 
marked difficulty in ascertaining whether this has taken place. Moussu 
advises as the safest and most efficient surgical treatment puncture 
of the pericardium in the vicinity of the xiphoid cartilage by means 
of a trocar and cannula, from 10 to 12 inches in length, and removal of 
the exudate is thus carried out. For details of the technique of the 
operation, the reader is referred to “ Diseases of Cattle, Seen: and Pigs,” 
by Moussu and Dollar. 

Cardiac Symphysis.—This term is applied to the Raannlere ‘union by 
adhesions of the visceral and parietal layers of the pericardium. It is a 
common lesion in tuberculosis of the pericardium, but is occasionally 
met with in ordinary pericarditis, and, according to some authors, it 
may occur in young animals as the result of mild umbilical infections. 

Symptoms. — There are no characteristic symptoms. Dyspnea, 
cardiac palpitation, a weak pulse, distension of the jugular veins, and a 
jugular pulse, may be observed. Physical examination of the heart 
reveals a weakened cardiac impulse, increase in the area of cardiac 
dulness, and indistinct cardiac sounds. 

The course of the affection is slow, and a fatal termination results 
either from dilatation of the heart or cardiac thrombosis. 

Treatment of any kind is useless. 

Rupture of the Pericardium.—Cases of this lesion have been recorded 


by Friend, Cuthbert, and Dupont. The usual etiological factor is per- 
VOL. II, 70 


1106 SYSTEM OF VETERINARY MEDICINE 


foration by a foreign body which has migrated from the reticulum. 
Occasionally perforation of the pericardium has resulted from external 
wounds and from parasites. There are no diagnostic symptoms. 

Tumours of the Pericardium.—These include carcinomata and lympho-- 
sarcomata. Carcinoma of the pericardium is generally secondary, and 
is associated with similar lesions in other organs. Primary carcinoma of 
the pericardium is described by Kitt, Ostertag, Moussu, and other ob- 
servers, and occurs in the form of a vegetating tumour involving the 
myocardium. Dubois recorded a case in which the interauricular septum 
was the seat of the lesion. Lympho-sarcomata of the mediastinum may 
extend to the external aspect of the pericardium, and cause extensive 
thickening of the membrane. 

The symptoms of tumours of the pericardium resemble those met with 
in traumatic pericarditis, but there is an absence of phenomena attribut- 
able to the digestive system. The course is more or less rapid, and 
cachexia is present, which terminates fatally. A differential diagnosis 
is seldom possible. 

Myocarditis.—In cattle this lesion may occur in connection with the 
following affections: Foot and mouth disease, contagious pleuro-pneumonia, 
traumatic pericarditis, puerperal metritis, omphalophlebitis, tuberculosis, 
piroplasmosis, and parasites (cysticerci and echinococci). 

Various forms are met with, such as diffuse, suppurative, and sclerotic. 

The dzffuse occurs in connection with infectious diseases, and the 
lesions are similar to those met with in the analogous affection in equines. 

The suppurative is characterised by the presence of one or more 
abscesses in the myocardium, which ultimately rupture into one of the 
cavities of the heart, and give rise either to pulmonary emboli or to 
pyxmia and septicemia. 

The sclerotec produces an increase in size of the heart. The myo- 
cardium is hard in texture, and of a whitish or greyish-white colour. 

Kitt describes the presence of dry necrotic foci in the myocardium, 
due to the bacillus of necrosis. 

Symproms.—When the affection depends on the presence of a foreign 
body, the symptoms resemble those met with in traumatic pericarditis. 
In other instances circulatory disturbances are manifested, such as 
arrhythmia and a small, weak pulse, but no special symptoms are ob- 
served; and unless these phenomena are associated with infectious 
diseases, the presence of the condition is not suspected. 

TREATMENT.—On economical grounds treatment is not desirable. 

Hypertrophy of the Heart.—According to Cadéac, this is a rare con- 
dition in cattle, owing to the fact that these animals are not subjected 


DISEASES OF THE CIRCULATORY ORGANS: CATTLE 1107 


to hard work, and are seldom affected by valvular lesions. It may be 
associated with tuberculosis and pulmonary emphysema. Amongst rare 
causes may be mentioned congenital affections of the heart, myxomata. 
of the ventricular septum, compression of the aorta by lympho-sarcomata 
or tuberculous growths, and hydronephrosis. 

There are no special symptoms, and the lesion is usually found as a 
surprise at post-mortems. 

Dilatation of the Heart.—According to some authors, this lesion is 
frequently met with in fat cattle, and is associated with fatty infiltration 
of the myocardium, leading to a loss of contractile activity in the mus- 
cular fibres. It also occurs in connection with pulmonary emphysema 
and tuberculosis. With reference to the latter, Cadéac states that tuber- 
culosis induces degeneration of the muscle fibres, while the presence of 
tubercles in the lungs interferes with the pulmonary circulation, and 
brings about blood-stasis in the right auricle and ventricle, resulting in 
dilatation of these cavities and attenuation of their walls. Amongst 
other causes we may mention enlarged mediastinal and sublumbar 
lymphatic glands, which exert compression of the aorta, and lead to 
dilatation of the left ventricle. Also the presence of parasites (ecchino- 
cocci) and purulent foci or cysts in the myocardium, all of which cause 
weakness and attenuation of the cardiac walls. 

-Symptoms.—Increase in the area of cardiac dulness on percussion, 
and weakness of the cardiac sounds on auscultation, are observed, but 
without the special physical signs of pericarditis. The above symptoms 
are not so well marked in cardiac dilatation as in pericarditis. The 
history of the case and the associated disease must be carefully con- 
sidered. 

Nothing can be done in the way of treatment. 

Fatty Heart.—The most common form of this lesion in cattle is an 
excessive deposit of fat around the heart. The fat may extend between 
the muscular fibres of the myocardium, separating and compressing them, 
and in some instances inducing atrophy. The condition is associated 
with an accumulation of fat in other parts of the body. The cardiac 
contractions are interfered with to a varying extent, and forced 
exercise may produce dyspnoea, but in the majority of instances no 
symptoms are observed. Fatty degeneration may induce similar symp- 
toms to those described as occurring in equines (see p. 1035). 

Acute Endocarditis—EtioLocy.—According to Moussu and Dollar, 
this affection is often overlooked, and only discovered at post-mortem 
examinations. The secondary, malignant, or infective form is the one 
usually occurring in cattle, and is associated with infectious diseases, 


1108 SYSTEM OF VETERINARY MEDICINE 


Hutyra and Marek state that it develops most frequently in the course 
of pyeemia, of articular rheumatism, and rarely of tuberculosis. Accord- 
ing to Cadéac, the acute endocarditis of cattle depends on either rheuma- 
tism or on infectious diseases. Several observers recognise the connec- 
tion between endocarditis and rheumatism, and find that the cardiac 
lesions occur subsequently to the rheumatic attack; but occasionally both 
affections develop simultaneously. In rheumatic endocarditis the left side 
of the heart, especially the mitral valve, is found to be the seat of pre- 
dilection of the lesion. This is in marked contrast to infective endo- 
carditis, in which the right side of the heart is usually involved. In 
some cases endocarditis is associated with pericarditis. 

Infective endocarditis depends on various micro-organisms, and may 
be associated with septic metritis, malignant catarrh, omphalophlebitis, 
etc. It is also met with in connection with malignant foot and mouth 
disease and cattle plague. Traumatic pericarditis may be complicated 
with endocarditis when the foreign body enters the myocardium. 
Luginger observed cases due to a parasite, which he termed the Streptothrix 
valvulus destruens bovis; and Cadéac and Scherzer found the Coryne- 
bacillus renalis in the deposits on the affected valves. 

Traumatic causes are also recognised. Thus Ebinger met with a case 
of endocarditis following fracture of a rib due to an injury sustained from 
the horn of another animal. 

Morpip Anatomy.—The lesions resemble those described as occurring 
in endocarditis of equines, but in cases not depending on rheumatism 
the tricuspid valves are more frequently involved in cattle. In cases 
associated with uterine infection or the entrance of a foreign body into 
the myocardium, subendocardial abscesses, with thick fibrous walls, may 
be observed. These abscesses may, owing to their situation, interfere 
with the movements of the tricuspid or mitral valves. In some instances 
large papilliform vegetations may occur in the vicinity of the right auriculo- 
ventricular orifice, or at the opening of the pulmonary artery, and cause 
narrowing or obturation of these orifices. Secondary lesions may, as in 
the horse, occur in the endocarditis of cattle. 

Symproms.— When the affection depends on rheumatism, the articular 
symptoms may disappear, and be succeeded by well-marked cardiac 
phenomena, such as a tumultuous action of the heart, the beats of which 
can be heard while standing at the side of the animal. On auscultation, 
the first sound of the heart may be accentuated, and followed by a series 
of sounds. When the tricuspid valves are involved, auscultation of the 
right side of the cardiac region may reveal a systolic murmur. The 
symptoms are by no means regular or characteristic. A venous pulse is 


DISEASES OF THE CIRCULATORY ORGANS: CATTLE 1109 


generally present, also a thrill may be observed on palpation of the 
cardiac region. When the endocarditis is associated with septic metritis, 
the symptoms of the latter affection are first observed. 

TREATMENT.—In the majority of instances, from an economical point 
of view, treatment will not be advisable; but if it be demanded, the 
measures described for the analogous affection in equines (see p. 1045) 
may be carried out. 

Chronic Valvular Diseases.—These are of comparatively little im- 
portance to the clinician, as obviously it is not desirable to treat such 
cases in cattle. Moreover, a differential diagnosis of the various valvular 
affections possesses little interest from a clinical point of view. They 
generally occur as the result of an acute attack of endocarditis, but may 
also arise from tuberculosis, hydatid cysts, tumours (sarcomata, myxo- 
mata, lympho-sarcomata). 

Tuberculous lesions in the form of vegetations may aflect the aortic 
and pulmonary orifices, and cause stenosis. The tumours mentioned 
may induce stenosis of the auriculo-ventricular valves, and in some 
instances of the aortic and pulmonary semilunar valves. 

Incompetency of the tricuspid valves may be due to the presence of 
vegetations. A relative insufficiency may depend on traumatic peri- 
carditis associated with myocarditis, as, owing to weakness of the mus- 
cular wall of the right ventricle, dilatation of the cavity of the latter is 
produced, and also an increase in diameter of the auriculo-ventricular 
orifice. 

Symproms.—Most authors agree that chronic valvular diseases have 
not been sufficiently studied, and that consequently a differential diag- 
nosis of the various lesions is rarely possible. | 

Tricuspid Insufficiency is generally regarded as the most common 
valvular lesion in cattle. The symptoms resemble those described as 
occurring in the analogous disease in the horse—viz., distension of the 
jugular veins, a jugular pulse, cedematous swellings on the dependent 
parts of the body, ascites, hydrothorax, etc. The physical signs are 
similar to those met with in equines. According to Cadéac, the maxi- 
mum point of intensity of the murmur is found in the region of the 
anterior third of the heart on the right side, close to the caput muscles, 
when the limb is extended as far as possible. The murmur is systolic in 
time. 

Tricuspid Stenosis is found to be more common than mitral stenosis, 
and is evidenced by a diastolic “ rolling” sound, which, during the con- 
traction of the auricles, is altered to a murmur, best heard over the an- 
terior third of the heart. The general symptoms include a widespread 


1110 SYSTEM OF VETERINARY MEDICINE 


venous stasis, evidences of passive congestion of the liver and kidneys, and 
cedematous swellings on the dependent parts of the body. Attacks of 
dyspnoea and a cyanotic condition of the visible mucose are also observed. 

Aortic Stenosis—According to Cadéac, this is not a rare lesion. 
Moussu states that it is the commonest form of chronic valvular lesion in 
cattle. The symptoms are similar to those occurring in the horse. 

Mitral Stenosis, Mitral Regurgitation, and Stenosis of the Pulmonary 
Semilunar Valves have also been met with, but there are no special symp- 
toms distinct from those described for similar conditions in equines. 

TREATMENT.—If a diagnosis of chronic valvular disease can be 
definitely arrived at, destruction of the animal is the most economical 
course to adopt. 

Rupture of the Heart.—This lesion may depend on a diminution of 
the thickness and resisting power of the myocardium, resulting from 
various causes, such as abscess formation, a parasitic invasion by ecchino- 
cocci, traumatic pericarditis associated with perforation or necrosis of 
the myocardium. Cases are recorded in which foot-and-mouth disease 
caused degenerative changes in the heart muscle, and death occurred 
from rupture of the left ventricle. Anaeker, Meyer, and Perdam met 
with instances in which acute tympany of the rumen caused excessive 
distension of the heart with blood, and cardiac rupture resulted. In 
these cases the seat of the rupture was either the right auricle or the 
right ventricle. When the lesion is the result of perforation by a foreign 
body, the edges of the rupture show suppurative or necrotic changes. 
In many instances death occurs very rapidly, but not infrequently symp- 
toms of internal hemorrhage are manifested prior to the fatal termina- 
tion. Horace L. Roberts informs us that he has on several occasions 
met with cases of rupture of the heart due to perforation of the organ 
by a foreign body. The usual history is as follows: The cow has suffered 
from intermittent attacks of indigestion, and is kept on by the owner 
until she has calved. The animal is then promptly sold by auction, and 
is apparently in good health and a good milker. In about two to four 
days after the sale she refuses food, and the flow of milk is diminished. 
She assumes the recumbent position, and is unable to rise. The owner 
does not suspect the seriousness of the case, but the next morning the 
cow is found dead in the stall. The post-mortem shows that either a ' 
needle or a nail has penetrated the heart. Probably the straining at 
parturition, although not sufficient at the time to do injury, yet has 
greatly hastened the passage of the foreign body towards the heart. 

Tumours of the Heart.—According to Cadéac, one of the commonest 
neoplasms in connection with the heart in cattle is myxoma. It may be 


DISEASES OF THE CIRCULATORY-ORGANS: CATTLE 1111 


located in the vicinity of the valves, or on the internal wall of the ven- 
tricles, and occurs in a pedunculated form when in contact with the blood- 
stream. Cases are recorded in which the neoplasm occurred at the origin 
of the anterior or posterior vena cava, in the right auricle, the right 
ventricle, and the left ventricle. Dubois observed sarcomata in the right 
auricle and in the interauricular septum in animals affected with similar 
lesions in the pericardium, or in other regions of the body. 

Parasites of the Heart.—Ecchinococcosis of the heart is of compara- 
tively frequent occurrence (see section on Parasites). 

Chronic Endoarteritis—The most common lesion in this affection is 
calcification. Atheroma is rarely met with. The majority of chronic 
diseases of the arteries are, according to Cadéac, due to tuberculosis. 

In the aorta the tunica intima presents a granulating surface, is 
studded with calcareous plaques, and also granulations undergoing 
calcification. The diseased process extends to other arteries of the body. 
Cases are recorded by Piot-Bey in which rupture of the aorta at the 
vicinity of the sigmoid valves occurred as the result of degenerative 
changes in the wall of the vessel. 

There are no diagnostic symptoms. Huynen and Besnoit met with 
instances in which the cerebral arteries were involved, and well-marked 
nervous phenomena resulted, such as muscular inco-ordination. 

-Aneurism.—This is a comparatively rare lesion in cattle. It is said 
to be more common in Egypt, as in that country cattle are kept alive 
until they arrive at a very advanced age. Piot-Bey records three cases 
of aneurism of the left coronary artery, followed by rupture of the vessel 
and death. The same writer met with a triple aneurismal dilatation of 
the posterior aorta at the origin of the first intercostal arteries, also a 
case of aneurism of the internal thoracic artery. Walley recorded an 
instance of aneurism of the spermatic artery, also of aneurism of the 
utero-ovarian artery. 

Other observers met with aneurism of the vertebral artery, the 
ischiatic, and an arterio-venous aneurism of the internal saphenic artery 
with its satellite vein. 

In cattle, aneurism is of more interest to the pathologist than to the 
clinician. 

Thrombosis.—Gualducci and Haas recorded cases of thrombosis of 
the posterior aorta and of the external iliac and femoral arteries. Fordie 
met with an instance of obliteration of the femoral artery due to throm- 
bosis. The symptoms are similar to those occurring in the analogous 
affection in the horse. Cases of thrombosis of the posterior vena cava 
and of the portal vein are recorded. The causes included carcinoma of 


1112 SYSTEM OF VETERINARY MEDICINE 


the sublumbar lymphatic glands, neoplasms, or tuberculous growths of 
the liver and of the glands in the vicinity. The above cause compres- 
sion, followed by thrombosis of the vessels involved. 

Rupture of the affected vessel may result, followed by death from 
internal hemorrhage. In some cases the thrombus is very extensive, 
and it may completely fill the greater part of the posterior vena cava. In 
others it is pedunculated, and only occupies a portion of the lumen of 
the vessel = 

There are no recognised symptoms in connection with this condition. 


DISEASES OF THE CIRCULATORY ORGANS 
IN SHEEP, GOATS, AND SWINE 


By G. MAYALL, M.R.C.V.S. 
SHEEP AND GOATS. 


VERY little seems to be known with reference to diseases of the cir- 
culatory organs in these animals. | 

Acute Sero-Fibrinous Pericarditis.— According to Cadéac, sero- 
fibrinous pericarditis has been observed in sheep by Anacker and Trasbot 
in the form of an enzodtic infectious malady, which proved fatal in a few 
days, but was not specially studied. Kowalewski has met with a similar 
affection associated with endocarditis and pneumonia. Hutyra and 
Marek state that in the cases mentioned the disease was evidently not 
primary, but was a partial manifestation of hemorrhagic septicemia. 
Pericarditis may also be associated with variola. 

Traumatic Pericarditis—This has been observed in the sheep and 
goat, but less frequently than in cattle. 

Rupture of the Heart.—Duncan has recorded a case of rupture of 
the heart in a sheep, associated with traumatic pericarditis and myo- 
earditis. 


SWINE. 


Diseases of the heart and bloodvessels seldom occur as primary aflec- 
tions in swine, but are generally secondary to infectious maladies. 

Acute Sero-Fibrinous Pericarditis.—This affection is of common occur- 
rence in connection with swine fever, swine erysipelas, tuberculosis, and 
rheumatism. It may also be associated with parasitic affections of the 
heart (cysticerci and ecchinococci). Cadéac observed an endemic disease 
in young pigs, the animals dying in fifteen days after birth, and the post- 
mortems showed only well-marked lesions of fibrinous pericarditis. 
According to Rieck, rheumatic fibrous pericarditis is frequently met with 
in the pig, and in some cases may be complicated with pleurisy and 
peritonitis. 

Symproms.—These are by no means characteristic, in consequence of 


the difficulty of carrying out a physical examination of the heart in pigs, 
»elils 


1114 SYSTEM OF VETERINARY MEDICINE 


and the thick layer of adipose tissue which covers the ribs in these 
animals, 

High fever, dyspnoea, depression, and loss of appetite have been 
observed. 

TREATMENT.—On economical grounds it is advised to slaughter 
affected animals in the early stages. If treatment be deemed desirable, 
the medicinal agents indicated are digitalis and subcutaneous injections 
of caffeine. ‘ 

Traumatic Pericarditis—Cases of this affection are recorded by Teetz 
and by Nietschke, in which a needle was found to be the cause of the 
lesions. In Teetz’s case the course of the foreign body could not be 
traced, but in the other instance the needle had migrated from the 
stomach to the pericardium.* 

Dilatation of the Heart.—This is occasionally met with, and some- 
times causes the sudden death of fat pigs while being driven some dis- 
tance to market. 

Fatty Heart may be observed in the case of very obese animals. 
There are no symptoms by which its presence can be detected. 

Acute Endocarditis.—This is of common occurrence, both in old and 
young pigs. The majority of infectious maladies in swine are compli- 
cated by endocarditis. Swine erysipelas is very frequently associated 
with endocarditis, the lesions of the latter being due to the bacillus of 
the former disease. The left side of the heart is generally affected, 
especially the mitral valve. In the chronic form of swine erysipelas the 
verrucose type of endocarditis often occurs as a sequel. Endocarditis 
may be associated with swine plague. The affection may also depend on 
various micro-organisms, such as streptococci, micrococci, etc., and is 
observed in connection with acute rheumatism, pyemic infections, and 
tuberculosis. 

Morsip Anatomy.—As already mentioned, in cases following swine 
erysipelas the mitral valve is chiefly involved, but not rarely the aortic 
semilunar valves are affected. Occasionally the tricuspid valve is at- 
tacked. In some cases all the valves are affected, and the vegetations 
may be large in extent. When the endocarditis is due to streptococci 
or micrococci, the tricuspid valve is usually involved, but the vegetations 
are of smaller size than those found on the mitral valve. 

Symproms.—These may be manifested in an insidious manner, or if 
associated with an infectious disease, the symptoms of the latter may 
mask the cardiac phenomena. Itis not uncommon for a pig convalescent 
from swine erysipelas to succumb later on to endocarditis. According 


* Berliner Tierarztl. Wochenschr., 1907. 


DISEASES OF THE CIRCULATORY ORGANS: SWINE 1115 


to Hutyra and Marek, weakness of the hind-quarters or of one hind-limb 
may occasionally be observed, depending either on stenosis of the aortic 
valves, or embolic obstruction of the arteries, or general debility. If the 
animal can be kept sufficiently quiet, an examination of the heart will 
reveal great acceleration of the cardiac beats and the presence of mur- 
murs. 

TREATMENT.—On economical grounds treatment cannot be advised. 

Chronic Valvular Diseases.—According to Friedberger and Frohner, 
chronic valvular diseases of the heart are of common occurrence in the 
pig, and may occur in the absence of a preceding attack of swine erysipelas, 
which, as already mentioned, is so common a cause of acute endocarditis. 
According to Hutyra and Marek, the valves of the left side of the heart 
are those most frequently affected, especially the mitral valve. Horace 
L. Roberts has found that the chief symptoms exhibited in chronic val- 
vular disease in the pig are capricious appetite, dyspnoea, slight elevation 
of the temperature (103°5° F.), and in those cases in which ascites is not 
present, forcible contraction of the abdominal muscles during the respira- 
tory effort is most noticeable. 

The above symptoms, together with the discoloration of the skin of 
the extremities of white pigs, are almost conclusive evidence of chronic 
valvular disease. It has been observed by Roberts and others that the 
discolorations at the tips of the ears, snout, and tail, and on the skin of 
the perineum, are of a claret hue; and though an animal has been con- 
sidered in a dying state for several days, the patches remain discrete and 
sharply marked off from the adjacent parts, and there is no tendency for 
them to extend over the surface of the body. 

The post-mortem examination generally reveals a sero-fibrinous peri- 
carditis, hypertrophy of the myocardium, which often shows degenerative 
changes, vegetations on the mitral and sometimes on the aortic valves, 
extensive oedema of the parenchyma of the lungs, with considerable 
effusion into the interlobular septa. Occasionally ascites is present. 


DISEASES OF THE CIRCULATORY ORGANS 
IN THE DOG AND CAT 


By E. WALLIS HOARE, F.R.C.V.S. 


General Remarks.—Cardiac affections in the dog have been studied 
to a far greater extent than is the case with reference to the larger 
animals. Moreover, the facilities for diagnosis are far greater in canine 
medicine, and, owing to the fact that less importance is attached to the 
commercial element, and more to the sentimental value of dogs, prac- 
titioners have better opportunities of studying the clinical aspect of 
cardiac diseases in these animals. 

All authors agree that cardiac affections are of common occurrence in 
the dog. According to Cadiot, 5 per cent. of all dogs whose age 1s above 
one year suffer from valvular lesions. This is also the experience of 
H. Gray. Miller remarks that it is quite common to hold post-mortem 
examinations on dogs, and to find cardiac lesions, although during life 
- the animals were apparently healthy. 

Pericarditis.—This 1s met with in two forms—viz., acute sero-fibrinous 
pericarditis and chronic pericarditis—but the symptoms of both will be 
considered together. | 

1. Acute Sero-Fibrinous Pericarditis.—In the large majority of cases 
this occurs as a secondary affection. A primary type is recognised, and 
is said to depend on the action of chills, injuries to the cardiac region, _ 
etc.; but such causes probably lower the vitality of the pericardium, and 
render it vulnerable to the influence of micro-organisms. The majority 
of cases of pericarditis are associated with tuberculosis. The pericardium 
may be involved alone, but more frequently it is accompanied by tuber- 
culous lesions of the pleura and mediastinal lymphatic glands. Occa- 
sionally pericarditis occurs as one of the lesions of canine distemper. 

Purulent pericarditis may occur in connection with septicemia and 
pyzemia, and also as the result of perforation of the pericardium by a 
foreign body. Petit recorded a case in which a needle penetrated the 
pericardium, and was found fixed in the myocardium. Instances have 
been met with in which a sharp portion of bone has penetrated the 


cesophagus, and then entered the pericardial sac. 
1116 


DISEASES OF THE CIRCULATORY ORGANS: DOG, CAT 1117 


Morsip ANAToMy.—The effusion in the pericardium may be exten- 
sive. It is sero-fibrinous in character, and may be of a reddish colour 
or sanguinolent. Cases are met with in which the inflammation is of the 
hemorrhagic type, and the effusion contains clots of blood. False mem- 
branes are observed on the visceral and parietal pericardium. For a full 
description of the morbid alterations in connection with the heart in 
tuberculous pericarditis, the reader is referred to Tuberculosis in the Dog 
(Vol. I.). 

2. Chronic Pericarditts.—This may occur as a sequel to the acute 
form, or the lesions may assume a chronic aspect from the outset. It is 
generally associated with tuberculous pleurisy, and is the most common 
type met with. For a description of the lesions, see Tuberculosis of the 
Dog (Vol. I.). In cases depending on septicemia or pyemia, minute 
miliary abscesses may be found in the myocardium. 

Pericarditis may be complicated with endocarditis, the mitral and 
aortic valves being covered by vegetations. Other complications include 
hydrothorax, ascites, cedematous swellings on the dependent parts of the 
body, passive congestion of the liver, and fatty degeneration of the 
kidneys. | 

Symproms.—The disease is seldom recognised in the early stages, so 
that a marked rise in temperature is not observed. Probably the first 
symptom to attract attention is dyspnoea, the intensity of which depends 
on the extent of effusion present. When the effusion is large in amount 
it causes compression of the heart and also of the lungs. The animal 
may assume the recumbent position, and if forced to walk, distension of 
the jugular veins may be observed. The pulse is frequent and generally 
irregular, but later on becomes small and weak. 

On palpation of the cardiac region after effusion has occurred, the 
cardiac impulse is found to be weak; and when the effusion is extensive, 
the cardiac beats may not be detected. 

Percussion reveals an increase in the area, of cardiac dulness, which, 
according to Hutyra and Marek, may extend from the second to the 
sixth or seventh intercostal space. 

Auscultation in the early stages may enable us to detect the presence 
of friction sounds, but when effusion has occurred; the sounds of the 
heart are muffled, and can only be heard with difficulty. 

The course of the disease is generally slow, and some cases may last 
for an indefinite period. Complications, such as hydrothorax and ascites, 
may occur at any time, and give rise to more urgent symptoms. (ide- 
matous swellings on the dependent parts of the body and of the hind- 
limbs are also observed. The animal has an anxious expression of coun- 


1118 SYSTEM OF VETERINARY MEDICINE 


tenance, and stands with the elbows turned out, and shows a depression 
in the dorsal region (‘‘ saddle back”). Finally, death occurs from ex- 
haustion or from syncope. 

DIFFERENTIAL D1aGnosis.—This is carried out by a consideration of 
the physical signs in a similar manner to that described for the analogous 
affection in the horse. The diagnosis of tuberculous pericarditis is based 
on the results obtained by the tuberculin test, or by a bacteriological 
examination of a portion of the fluid removed from the pericardial sac 
by aspiration. 

TREATMENT.—In tuberculous pericarditis treatment should not be 
undertaken. 

In other forms of the disease the principles of treatment are similar 
to those advised for pericarditis in the horse. In the febrile stage aspirin 
may be prescribed. Digalen administered by subcutaneous injection 
in a dose of 4 to 8 minims (according to the size of the dog) is advised 
to combat cardiac weakness. Subcutaneous injections of normal saline 
infusion are also indicated. When an extensive effusion is present, the 
fluid should be removed by means of an aspirator. 

Rupture of the Pericardium.—Cases are recorded of this lesion oc- 
curring in connection with a hemorrhagic tuberculous pericarditis, and 
depending on excessive distension of the pericardial sac with coagulated 
blood. It has also been observed by Nocard as the result of falls from 
a height, violent contusions of the cardiac region, and penetrating wounds. 
There are no diagnostic symptoms. 

Tumours of the Pericardium.—Myxo-sarcomata and fibro-myxomata 
have been observed as primary neoplasms of the pericardium in the dog. 

In the cat, a case of myxo-sarcoma of the pericardium has been 
recorded by Mollereau. The neoplasm was very extensive, and caused 
displacement of the heart and lung in a backward direction, so that 
traction was exerted on the large vessels. The symptoms observed were 
cough, dyspnea, and attacks of syncope. 

Myocarditis.—This lesion may occur in connection with septicaemia 
and pyzemia, distemper, purulent metritis, and tuberculous pericarditis. 
The following lesions are described by Cadéac: The heart is enlarged, and 
its cavities are dilated. The surface of the organ shows a large number 
of small round or oval spots of a yellowish-red colour, either irregularly: 
distributed or arranged in a series of lines. The myocardium is of a 
yellowish-red, copper colour, or “ faded leaf” colour. The yellow spots 
represent inflammatory foci composed of embyronic cells surrounding 
cardiac fibres which have undergone fatty degeneration. In some cases 
minute abscesses are found in the myocardium, and are represented by 


DISEASES OF THE CIRCULATORY ORGANS: DOG, CAT 1119 


yellowish-white spots the size of a pin’s head. In tuberculous cases the 
walls of the auricle or ventricle show prominences due to tuberculous 
growths, and the valves may be covered by granulations of the same 
nature. 

Symproms.—These are by no means diagnostic. The cardiac beats 
are accelerated in the early stages, and later on the cardiac impulse 
becomes weakened. The action of the heart is intermittent and irregular, 
and the first cardiac sound becomes indistinct. Dyspnoea due to pul- 
monary cedema and passive congestion of the lungs is observed. The 
above symptoms, needless to remark, occur in various cardiac disorders. 
Moreover, the symptoms of the primary malady will also be present. 

TREATMENT.—The indications for treatment are to administer agents 
with a view to sustain the action of the heart. Digalen with caffeine 
administered by hypodermic injection sometimes gives good results. 

Hypertrophy of the Heart.—This condition is of frequent occurrence 
in the dog. It is met with especially in greyhounds. Similar causes to 
those mentioned in the analogous condition of horses may produce the 
lesion in the dog, but chronic nephritis is not uncommonly associated 
with hypertrophy of the left ventricle in the latter animal. In hyper- 
trophy without dilatation the cardiac impulse is strong and forcible, and 
the area of cardiac dulness is increased. In eccentric hypertrophy symp- 
toms of cardiac dilatation will be present, and similar treatment is indi- 
cated (see below). 

Cardiac Dilatation.—The remarks we have made with reference to 
the etiology and morbid anatomy of cardiac dilatation in the horse will 
also apply to this affection in the dog. 

Symptoms.—Palpation reveals an alteration in the cardiac impulse. 
Instead of being localised, itis diffused over a large surface of the cardiac 
area. | 

Percussion shows an increase in the area of cardiac dulness. On the 
left side it may extend to the sixth intercostal space, and in an upward 
direction. On the right side the cardiac dulness is also greatly 
increased. 

On auscultation, the sounds of the heart may be more or less feeble. 
According to Cadéac, a tricuspid murmur may take the place of the first 
sound, and the point of maximum intensity is found on the right side at 
the fifth intercostal space. This author has also observed in some cases 
a reduplication of the first sound, and the presence of a presystolic mur- 
mur, followed by a mitral and aortic murmur. Dyspncea, a dry cough, 
a tendency to hydrothorax and to attacks of syncope, are present in 
some instances. 


. 1120 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—This will depend on the symptoms presented, and, 
generally speaking, the principles of treatment are similar to those 
advised for chronic valvular diseases. 

Fatty Heart.—Fatty overgrowth is observed in the case of obese dogs 
which take little or no exercise. Fatty degeneration occurs under a 
variety of conditions, such as tuberculous pericarditis, endocarditis, 
cardiac symphysis, acute myocarditis consecutive to distemper; also in 
endoarteritis of the coronary arteries, and in chronic poisoning from 
arsenic or phosphorus. Beyond feebleness of the cardiac action, there 
are no special symptoms, and those of the primary affection are usually 
in evidence, so that fatty degeneration is seldom diagnosed. 

Rupture of the Heart.—This lesion may occur as the result of de- 
generative changes in the myocardium, and is sometimes observed in 
the final stages of chronic ulcerative endocarditis. Traumatic injuries, 
falls from a height, and perforations due to sharp-pointed foreign bodies 
in the heart, may also be etiological factors. The usual seat of the lesion 
is either the right or the left ventricle, but in the case of a sharp-pointed 
foreign body entering the heart the wall of the left ventricle may be 
involved. Youatt recorded a case in which a dog was subject to frequent . 
attacks of “fits” associated with tumultuous cardiac action. These 
symptoms almost always followed after the animal had been playing 
with other dogs. The symptoms only lasted for a few minutes, but 
finally death occurred suddenly. The autopsy showed an irregular rent 
2, inches long in the wall of the left ventricle near the base of the mitral 
valve. The latter was also ruptured. 

SymptomMs.—When the rupture is of sufficient extent to permit of 
free hemorrhage into the pericardial sac, death occurs rapidly. In the 
case of a foreign body which has perforated the heart, but mechanically 
plugs the opening of the wound, death may not occur for twenty-four 
hours (Nocard). 

Tumours of the Heart.—These include myxomata, sarcomata, car- 
cinomata, and, in very rare instances, myomata. They are of more 
interest to the pathologist than to the clinician, as no diagnostic symp- 
toms are manifested. The phenomena present may be arrhythmia, 
various murmurs, ascites, dyspnoea, etc. 

Parasites of the Heart.—See section on Parasites. . 

Angina Pectoris.—This affection 1s described by Cadéac. According 
to this author, the disease is rarely due to arterio-sclerosis of the coronary 
arteries, but generally has a nervous origin. Thus it may occur as a 
sequel to distemper, and depend on alterations of the cardiac plexus due 
to lesions of the cerebrum, medulla, and roots of the cardiac nerves; 


DISEASES OF THE CIRCULATORY ORGANS: DOG, CAT 1121 


or it may originate in a reflex manner from affections of the stomach, 
uterus, liver, and kidneys. In some instances it may be associated with 
nephritis. 

Symptroms.—The attack comes on without warning while the dog is 
running about. He suddenly stops, and seems unable to move, and has 
an anxious expression of countenance. Marked dyspncea is manifested, 
and the heart-beats are irregular and intermittent. The attack only 
lasts a few seconds, and after a few slow, deep inspiratory movements, 
all symptoms disappear. The attacks recur at irregular intervals, and 
ultimately prove fatal. 3 

TREATMENT.—The inhalation of nitrite of amyl is advised during the 
attack. A few drops of this agent are poured on a piece of cotton-wool, 
and held close to the animal’s nostrils. A hypodermic injection of 
morphine may also be given. In the intervals between the attacks 
iodide of sodium should be prescribed. If the affection is associated 
with another disease, the latter must receive suitable attention. 

Acute Endocarditis.—According to most authors, this affection in the 
dog is essentially of a polymicrobial character, and may occur as a com- 
plication in all local or general infections. It is occasionally met with 
~inthecat. The lesions may be of the ulcerative or of the verrucous type, 
but the latter is far more commonly encountered. 

Etrotogy.—The micro-organisms on which the disease depends enter 
the blood-stream by various routes. Several authors have observed cases 
to follow even insignificant wounds of the skin, also ulcers of the tip of 
the tail, and operation wounds when asepsis is neglected and suppura- 
tion results. Infection of the endocardium may result from morbid 
conditions of the mucosa of the alimentary canal, such as ulcerative 
stomatitis, ulceration due to arsenical poisoning, ulcers of the intestine. 
Purulent or septic metritis, also infections of the bile-duct and biliary 
passages, may occasionally be associated with endocarditis. The disease 
is not uncommon in connection with broncho-pneumonia, distemper, 
piroplasmosis, pericarditis, myocarditis. Fréohner has observed cases of 
a septiceemic type which spread to other dogs in a kennel. Instances of 
congenital endocarditis are recorded in which a number of puppies of 
the same litter succumbed to the disease shortly after birth. Fatigue, 
exposure to chills, etc., are regarded as predisposing causes of the malady. 
The type of the affection—.e., whether verrucous or ulcerative—is 
believed to depend on the virulence of the causal micro-organisms. The 
bacteriology of the disease is not definitely determined. Streptococci and 
staphylococci have been isolated from the lesions, and Jensen found 


ovoid bacteria present in addition to other micro-organisms. 
VOL, II, 71 


1122 SYSTEM OF VETERINARY MEDICINE 


Morprp Anatomy.—The valves on the left side of the heart are those 
generally affected, especially the mitral valve. In the foetus the tri- 
cuspid valve is usually the seat of the lesion. The morbid changes in the 
valves may be either verrucous or ulcerative in character, and resemble 
those described in acute endocarditis of the horse. In the ulcerative 
type septic emboli may be carried to distant organs, especially to the 
kidney, and set up morbid changes (infarction). Perforation of a valve 
and rupture of some of the chorde tendinew may be present. Lesions 
due to embolism in various organs may also be observed. 

Symptoms.—In the ulcerative type the course may be so rapid that 
the real nature of the case is not discovered until the post-mortem is held. 
The general symptoms which may be observed are accelerated respira- 
tions, followed by dyspnoea, a dry paroxysmal cough, loss of appetite, 
an increase in temperature, which in the ulcerative type may amount to 
hyperpyrexia, an anxious expression of countenance, a disinclination to 
move from one position, marked weakness, etc. The character of the 
pulse varies according to the valves which are involved. Thus, if the 
aortic valves are affected, giving rise to aortic insufficiency, the pulse is 
accelerated, hard, and perceptible in the smallest arteries, while in lesions 
of the mitral valve it is feeble and irregular. Renal complications are | 
not uncommon, such as acute nephritis. 

PuystcaL Siens.—Inspection may show the cardiac impulse visible 
over the cardiac region. 

Palpation reveals the presence of a well-marked “ purring” thrill 
over the region of the heart. 

Auscultation.—The first sound may be weakened. The character of 
the murmurs present will vary according to the valves that are affected, 
and for information on this point the reader is referred to Chronic Val- 
vular Diseases (p. 1123). 

In our experience the abnormal sounds heard in acute endocarditis 
are of so confusing a character that it is seldom possible to decide which 
valves are involved. According to Cadéac, it is advisable, in carrying 
out auscultation in this disease. to close the nostrils of the animal with 
the fingers, and thus to temporarily suppress the respiratory movements 
so as to eliminate the respiratory sounds. If a systolic or diastolic mur- 
mur is then detected on either the left or the right side, a definite diag- 
nosis of acute endocarditis may be given, of course having regard to the 
presence of acute general symptoms. 

CoursE.—This varies according to the type of the disease. In some 
instances the affection may be subacute, but death may occur in two or 
three days. In the severe ulcerative type the prognosis is very grave, 


, 


DISEASES OF THE CIRCULATORY ORGANS: DOG, CAT 1123 


and a fatal termination may take place in twenty-four to thirty hours, 
with symptoms of general toxemia. In the verrucous type the ordinary 
duration of the disease is from one to two weeks. It may lessen in in- 
tensity, and gradually merge into the chronic form. Perfect recovery 
very rarely takes place. Complications may occur owing to the produc- 
tion of embolism in various organs. Cases are recorded in which, owing 
to thrombosis of the main bloodvessel of a limb, either fore or hind, lame- 
ness resulted, but this was not accentuated by exercise. 

DIFFERENTIAL D1aGnosis.—Owing to the symptoms of the primary 
disease or of the complications predominating the scene, the cardiac 
phenomena may be overlooked unless a careful physical examination of 
the heart be carried out. wee Me 

TREATMENT.—The indications for treatment are similar to those 
described for the analogous affection in the horse. Some authors advise 
the application of an ice-bag to the region of the heart. When the fever 
is high, either quinine or antifebrin may be prescribed. In order to 
reduce the irritability of the heart, bromide of soda is advised. When 
cardiac weakness is present, subcutaneous injections of normal saline 
solution should be administered. In addition to their action as a cardiac 
stimulant, they facilitate the elimination of toxic products from the 
system. Complications must be treated as they arise. 

Chronic Valvular Diseases.—These are of very common occurrence in 
the dog. According to Cadiot, 5 per cent. of dogs over twelve months 
of age show valvular disease on post-mortem. Johne found in 793 
autopsies chronic endocarditis in 4°3 per cent. The most common val- 
vular lesion is mitral insufficiency, and, according to Gray, very few 
aged dogs are free from it. Hutyra and Marek state that mitral insuffi- — 
ciency is observed most frequently, then the simultaneous affection of 
the mitral and tricuspid valves, and about half as often disease of the 
tricuspid valve alone. Lesions of the aortic valves are rare, especially 
aortic stenosis. | 

Mitral Insufficiency—Puysicat Sians.—Palpation reveals a “ purring” 
fremitus. Auscultation detects a systolic murmur on the left side, the 
maximum point of intensity being towards the apex and the posterior 
part of the heart. The prominent general symptoms are dyspnea, 
panting, a dry paroxysmal cough, cardiac palpitation, and in some cases 
an cedematous swelling along the abdomen, and swollen limbs. 

It must be remembered that, so long as compensatory hypertrophy 
continues, no symptoms may be observed. Gray has met with a case 
of mitral insufficiency in a kitten, in which a “ purring” thrill on palpa- 
tion of the cardiac region was a very marked symptom. 


1124 SYSTEM OF VETERINARY MEDICINE 


Mitral Stenosis—PuystcaL Siens.—Auscultation reveals a diastolic 
‘rolling’ or booming sound, which is succeeded by a presystolic mur- 
mur. The point of maximum intensity is on the left side towards the 
apex. A reduplication of the second cardiac sound is also heard. Dysp- 
noea, a cyanotic condition of the visible mucose, and chronic bronchitis 
occur as complications. : 

Aortic Insufficiency—Puysicat Sians.—Auscultation detects a dias- 
tolic murmur, of which the maximum point of intensity is at the base of 
the heart on the left side. The general symptoms observed are cardiac 
palpitation, dyspnoea, and evidences of a weakened circulation. 

Aortic Stenosis.—This lesion is very rarely met with. The physica] 
sign, according to Cadéac, is a systolic murmur heard at the level of the 
fourth intercostal space on the left side towards the base of the heart. 

Tricuspid Insufficiency—PuysicaL Sians.—Palpation reveals a fremi- 
tus, especially when the animal has been exercised. Auscultation detects 
a systolic murmur on the right side in the fifth intercostal space or over 
the third rib. Itis often associated with extra-cardiac murmurs origi- 
nating from the lung, and depending on compression of the latter by the 
hypertrophied heart. The general symptoms include dyspncea when the 
animal is subjected to exercise, ascites, scanty and albuminous urine, 
dilatation of the jugular veins, and a jugular pulse. 

Tricuspid Stenosis—PuysicaL Stens.—Auscultation reveals a systolic 
and diastolic murmur, which has its maximum point of intensity on the 
right side over the fourth and fifth intercostal spaces. The general 
symptoms include hydrothorax, ascites, and dyspneea. 

Insufficiency of the Pulmonary Semilunar Valves.—This is very rarely 
observed. The physical sign is said to be a diastolic murmur on the right 
side at the level of the pulmonary orifice of the ventricle. 

Stenosis of the Pulmonary Semilunar Valves.—This lesion may result 
from the presence of parasites, either in the pulmonary artery or close 
to the valves. It may also be due to compression of the vessel by a 
tumour of the lung. The physical sign is the presence of a systolic 
murmur on the left side, heard anteriorly over the fourth intercostal 
space. On the right side the murmur is heard over the base of the 
heart. The general symptoms are attacks of dyspnoea, a dry paroxysmal 
cough, and death may occur from syncope or from pulmonary hemor- 
rhage. 

TREATMENT OF VALVULAR Lxesions.—The indications for treatment 
are similar to those mentioned for the analogous conditions in the horse 
(see p. 1065). The leading symptoms present must receive attention, and 
in the case of failing compensation digitalis or strophanthus is indicated 


DISEASES OF THE CIRCULATORY ORGANS: DOG, CAT 1125 


but should be prescribed with discretion. Complications must be treated 
as they arise. When cardiac weakness is present, hypodermic injections 
of caffeine prove useful. Digalen has been found to give good results in 
such cases, and is preferable to other forms of digitalis. In mitral or 
tricuspid insufficiency associated with ascites, paracentesis abdominis 
should be carried out, and iodide of potassium given internally. 

Chronic Endoarteritis.—According to Cadéac, the commonest cause 
of this condition in the dog is the presence of parasites. The vessels 
chiefly affected are the aorta and the pulmonary artery. Cases of 
endoarteritis of one of the carotid arteries with aneurisma! dilatation 
have been recorded. 

There are no diagnostic symptoms. Vertigo and syncope may be 
observed, and sudden death may occur from rupture of the affected 
vessel. 

Aneurism.—This lesion has been observed in the trunk of the aorta, 
in the carotid artery, the mesenteric artery, and occasionally in the 
pulmonary artery. The commonest cause of the condition is the presence 
of parasites. Endoarteritis and arterio-sclerosis are also regarded as 
etiological factors. W. Williams recorded a case of aneurism of the 
posterior aorta in the dog. The forcible pulsation of the vessel could be 
felt by laying the hand on the abdominal wall; a thrill was communicated 
to the femoral artery; weakness of the hind-limbs and general debility 
were also observed. Other authors also record similar cases in this 
animal, in which the symptoms observed were gradual emaciation, weak- 
ness, a ravenous appetite, dyspnoea after slight exertion, and, finally, 
paralysis of the hind-limbs. Nocard observed in a young dog an aneurism 
of the aorta associated with a similar lesion in the pulmonary artery. 


DISEASES OF THE CIRCULATORY ORGANS 
IN BIRDS | 


By E. WALLIS HOARE, F.R.C.V.S. 


Pericarditis.—This affection is observed as a complication of fowl 
cholera or fowl plague, and occasionally in connection with tuberculosis. 
It also forms part of the lesions of pneumo-pericarditis in turkeys (see 
Vol. I., p. 483). The lesions comprise an abundant sero-fibrinous effusion 
and extensive formation of false membranes. 

Symproms.—Intense dyspnoea, the beak is held open, the bird falls 
if forced to move. Death may occur from syncope. The autopsy may 
show degeneration of the heart, and occasionally rupture of the peri- 
cardium. 

Nothing can be done in the way of treatment. , 

Hypertrophy of the Heart.—Obstruction to the circulation caused by 
tuberculous growths in the liver or in the mesenteric glands is regarded 
as the chief etiological factor in the production of cardiac hypertrophy 
in birds. The lesion is only discovered post mortem. 

Horace L. Roberts has observed hypertrophy and dilatation of the 
heart in fowls and cage-birds which had suffered for several months from 
rheumatic arthritis. He has met with extensive hypertrophy and dilata- 
tion of the heart in a canary which suffered from gout. The prominent 
symptoms observed by the owner were dyspnoea and a well-marked 
*“ noisy breathing.” 

Fatty Degeneration of the Heart.—This lesion may be observed in all 
species of birds. 

Rupture of the Heart.—According to Kaupp, this may occur in the 
case of overfed fowl, and the symptoms observed are blanching of the 
comb and of the visible mucose, followed by coma and death. The 
lesion is not uncommon in small birds, and may be due to fright. 

Endocarditis.—According to Hutyra and Marek, acute endocarditis 
occurs very rarely in birds. Kaupp states that the affection is not 
infrequent during the course of certain diseases of the blood in fowl. 
Cadéac found that the verrucous type of the disease was not rare in 


birds, and frequently observed in the right side of the heart, small nodules 
1126 


DISEASES OF THE CIRCULATORY ORGANS: BIRDS 1127 


either arranged in a linear or an irregular manner in the vicinity of the 
valves or on the musculi papillares. These abnormal growths may attain 
sufficient size to interfere with the function of the valves. Their nature 
has not been determined.* 

Chronic Valvular Diseases.—According to Larcher and Hartl, val- 
vular diseases are not infrequent in fowl, although symptoms of cardiac 
disturbance are comparatively rarely observed. The valves of the right 
ventricle are usually affected. Hartl frequently found in chickens chronic 
endocarditis, but could not determine the origin of the affection. 

Chronic Endoarteritis —According to Hutyra and Marek, calcification 
of the aortic wall occurs frequently in old birds. In pigeons the Hypo- 
dectes columbarum, which exists as a. parasite in the vicinity of large 
vessels, may give rise to similar changes. 


* Hartl, ‘ Endocarditis of Fowl,’ Zettschrift fir Thiermedecin, 1902. 


DISEASES OF THE NERVOUS SYSTEM 
IN THE HORSE 
By B. H. MELLON, F.R.C.V.S., anp E. WALLIS HOARE, F.R.C.V5S. 


THESE diseases will be considered under the following headings: 


1. Diseases of the Brain and its Membranes. 

2. Diseases of the Spinal Cord and its Membranes. 
3. Diseases of the Peripheral Nerves. 

4, Functional Diseases of the Nervous System. 


DISEASES OF THE BRAIN AND ITS MEMBRANES 


GENERAL REMARKS. 


In equine practice diseases of the brain, although of comparatively 
common occurrence, have not been studied either clinically or pathologic- 
ally to the extent that is desirable. Many reasons might be adduced to 
account for this apparent lack of interest in the subject. In the first 
place, the horse is an animal destined for the purpose of work, and as 
chronic diseases of the brain render him practically useless, it follows that, 
once the symptoms have developed, the destruction of the animal is 
found to be the most economical course to adopt. Again, the acute 
affections of this organ generally run a rapid course, and, owing to the 
violent nature of the symptoms, which are succeeded by fatal coma or 
paralysis, early destruction is the usual rule. The symptoms presented 
in the various forms of brain lesions are very similar, a differential | 
diagnosis is attended with extreme difficulties, the post-mortem examina- 
tion is a tedious process, the recognition of the morbid alterations requires 
the aid of a skilled pathologist, and, finally, therapeutical measures, 
either medical or surgical, are notoriously unsuccessful. 

The net result is that the clinician does not get an opportunity of 
adding any material amount to pene knowledge on the subject. 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE = 1129 


He finds that his skill is imited to determining in a definite manner the 
presence of a brain affection, and he must admit his inability to locate the 
lesion or to prescribe treatment with any probability of success. 

It is quite true that many Continental workers have made a special 
study of these affections, and several authors give full descriptions of the 
lesions and symptoms of various diseases of the brain. But we must 
admit that in the majority of cases these diseases are of more interest 
to the pathologist than to the clinician, as the differential diagnosis can 
but seldom be carried out, and the lesions are only determined at  post- 
mortem examinations. It is not uncommon to find that, although the 
most intense and violent symptoms may be observed, yet the macro- 
scopical morbid appearances of the brain after death may be very slight, 
and in some instances no lesions can be discovered. The post-mortem 
examination, involving as it does the removal of the brain from the 
cranial cavity, is a delicate undertaking. Again, in order to detect the 
lesions an intimate knowledge of the anatomy of the brain and of the 
normal appearance of the structures is essential. A series of symptoms 
are common to a variety of diseases of the brain. Of these the most 
common are, In some cases, excitement, interference with vision, a 
staggering gait, constant movement, delirium, often amounting to a 
maniacal condition, during which it is dangerous for the attendant to 
approach the animal. In many instances the animal rushes wildly 
against surrounding objects, and may seriously injure himself. This 
stage of excitement is followed by a comatose condition. Other cases are 
characterised by a dull, sleepy condition from the outset and a staggering 
gait, the so-called “‘ sleepy staggers.”’ Again, cases are met with in which 
a temporary recovery may take place, to be followed at irregular intervals 
by a fresh attack. It is not uncommon also for the practitioner, on his 
first attendance on the case, to find the patient in the recumbent position, 
unable to rise, and presenting violent convulsive movements of the fore 
and hind limbs, also ocular symptoms such as nystagmus. 

Spinal lesions are often associated with disease of the brain, and it is 
by no means an easy matter to determine which was the primary con- 
dition. It must be remembered that violent symptoms attributable to 
the brain may be observed in some cases of gastric disorder, and recovery 
may take place with suitable treatment, hence care is essential in the 
diagnosis so as to avoid the error of mistaking a curable condition for 
one of disease of the brain (see p. 96). 

With reference to the incidence of didadess of the encephalon, 
F. Smith* remarks that the brain is relatively lowly organised in animals, 


* “Veterinary Physiology.” 


1130 SYSTEM OF VETERINARY MEDICINE 


while the spinal cord is relatively highly organised, hence brain disease is 
not so frequent as disorders of the spinal cord. 

In the Reports of the Army Veterinary Service, 1911-12 and 1912-13, 
the number of cases of various affections of the brain admitted for 
treatment was as follows: . 


1911-12. 1912-13. 
Meningitis for 2 2 
Hemorrhage of brain .. 1 1 
Concussion of brain 5 6 
Apoplexy 1 — 
Hemiplegia .. 1 s 


These figures, as compared with experience in private practice, appear 
very small. On the other hand, the number of cases of spinal diseases 
recorded in the Reports is more in accordance with the experience of the 
private practitioner. 

The term staggers is one which is widely made use of in veterinary 
practice, and seems to be applied to a number of affections which present 
as leading features, a staggering gait, a more or less well-marked loss of 
control over voluntary movements, and either a dull sleepy condition or 
excitement with delirium. Various types of staggers were described by 
the older authors. Thus, “stomach staggers’ was applied to a gastric 
affection (usually gastric impaction), associated with nervous phenomena 
(see p. 97). We have already pointed out that the term is an unfortunate 
one, and that it is more rational to regard the nervous symptoms in this 
condition as being reflex in origin. 

“Sleepy staggers’’ was applied to a condition characterised by a 
somnolent appearance of the animal, a tendency to push the head against 
the wall or manger, partial loss of control over the limbs, etc. As a 
chronic affection it is now believed by many authors to depend on chronic 
hydrocephalus (dropsy of the lateral ventricles). It is important, how- 
ever, to point out that similar symptoms may occur in connection with 
impaction of the stomach, and when the latter affection is overcome, the 
nervous phenomena may disappear. Or, on the other hand, the nervous 
symptoms may continue, and assist in bringing about a fatal termination. 

The term “‘mad staggers”? was employed to describe the violent 
symptoms occurring in acute meningitis, encephalitis, etc. We have 
already remarked that similar phenomena may occasionally accompany 
gastric affections, and may yield to treatment, but such cases are the 
exception. 

Another condition to which “ staggers ” is sometimes applied is that 
peculiar affection known as “‘ megrims,” in which a horse, apparently in 
perfect health, is suddenly attacked while at work by general muscular 


a 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE 1131 


spasms, temporary loss of vision, a tendency to run against surrounding 
objects, and in many instances to fall without warning. After a short 
interval the animal recovers, and is able to resume his journey. The 
attacks recur at irregular intervals. Some authors attempt to establish an 
analogy between this condition and Meniére’s disease in man (see p. We 

Again, cases are met with in which the symptoms of “ megrims ” in a 
modified form occur, but after the administration of a purgative, and 
attention to diet no further attacks are observed for a long period. Such 
cases are usually regarded as depending on gastric disorder, the nervous 
phenomena being due to reflex causes. 

From these remarks the reader will gather that the term “ staggers ”’ 
is not expressive of any definite condition, and should be expunged from 
veterinary nosology. 

French veterinarians employ the term ‘“ immobilité”’ to describe a 
sroup of symptoms depending on disturbance of the functions of the 
brain, and associated with various lesions of this organ. The symptoms 
include a dull sleepy appearance, a tendency to cross the fore-limbs while 
at rest, a difficulty in “ backing,” and a lack of control over voluntary 
movements. The condition is believed to be most commonly due to 
chronic hydrocephalus, but is also associated with tumours of the brain, 
chronic pachymeningitis, etc. 

In order to comprehend the effects of the various diseases of the brain 
it is necessary to be familiar with the functions of the different parts of 
this organ. At the same time we may remark that the diagnosis of brain 
affections, at any rate in the larger animals, can never be carried out 
with the same degree of accuracy as obtains in man, and, for the reasons 
already g given, the subject cannot be regarded as of the same importance 
in veterinary as in human medicine. 

Those readers who desire to make a special study of affections of the 
brain are advised to consult F. Smith’s “ Veterinary Physiology” for 
full details of the functions of the encephalon. 

The following points merit consideration in connection with the 
diagnosis of affections of the brain: 

The symptoms displayed in affections of the brain depend more on 
the size than on the character of the lesion. A partial destructive local 
lesion will give rise to symptoms according to its situation, whereas a 
tumour at first sets up localised phenomena by causing pressure on the 
neighbouring structures, but it ultimately leads to increased intracranial 
pressure on account of its growth, thus setting up symptoms of com- 
pression which would not have arisen had the tumour confined its evil 
effects to simple local pressure—e.g., a tumour of the cerebellum, in 


6¢ 


1132 SYSTEM OF VETERINARY MEDICINE 


addition to setting up disturbances in equilibrium and co-ordination, may 
press on the motor paths leading from the cerebrum, and cause some form 
of paralysis. Increased intracranial pressure is due to increase in the 
size of the brain substance itself, as in tumour formation, to the pouring 
out of inflammatory exudatesas in meningitis, or to hemorrhage from the 
cerebral vessels. Transient increase or decrease of intracranial pressure 
depends somewhat on the quantity of blood present in the cerebral 
vessels. 

Serious cerebral disease is evidenced by the appearance of profound 
motor and sensory disturbances, such as perverted consciousness, 
dulness, varying degrees of stupor, even leading later to complete coma, 
with or without some degree of anesthesia, analgesia, paresis, or paralysis. 
These symptoms may be persistent or intermittent. The onset of 
symptoms is sudden in such conditions as hemorrhage and fracture, but 
at other times their appearance is gradual, as in acute encephalitis and 
meningitis, in tumour formation, and in parasitic disease of the brain. 
They may be acute or chronic in their course. 

Occasionally in disease of the brain discovered on a post-mortem 
eXamination no symptoms were exhibited during life, and then it 1s con- 
cluded that the lesion is confined to the so-called doubtful-areas of the 
brain. 

Temporary loss of consciousness is suspected when the animal, with- 
out apparent cause, falls to the ground during progression, especially when 
a speedy return to the normal condition occurs. 

Acute cerebral disease may be ushered in by rigors, great excitement, 
and disturbed perception. Respiration is sometimes profoundly altered, 
no doubt due to the respiratory centre becoming implicated. Such 
abnormal form of respiration as that described as ‘‘ Cheyne-Stokes ”’ is 
occasionally observed. It appears to be due to an abnormal rhyth- 
micity of the respiratory centre, and is always regarded as a grave 
sign. Other abnormal forms of respiration sometimes arise during 
morbid processes occurring intracranially. Sometimes reflex action 
is exaggerated, diminished, or may be entirely absent. Exaggerated 
reflex action shows itself by the fact that only a slight stimulus is re- 
quired to call forth its exhibition, and the muscle spasm is much more 
extensive and prolonged than normal. It is difficult to estimate dimin- 
ished reflex spasm on account of the fact that voluntary muscular move- 
ments may be made during the process of examination. If disturbance 
of consciousness is profound, an insufficient quantity of food may be 
taken, and so give rise to loss of condition. 

Increase in intracranial pressure may cause an alteration in the con- 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE 1133 


dition of the vagus nerve, giving rise to a slowing of the pulse-rate. Under 
other circumstances the pulse becomes more frequent or even irregular. 
Venous congestion of the optic disc is a common symptom of increased 
intracranial pressure, and is always present during the growth of tumours 
nside the cranial cavity. | 

In lesions causing irritation of the motor areas convulsions may be 
observed, and are sometimes of the same type as those described under 
the title of Jacksonian epilepsy. This condition is really clonic spasm 
of groups of muscles, sometimes occurring all over the body at variable 
intervals, and occasionally accompanied by loss of sensation over a 
definite area. Spasm of the muscles supplied by the cranial nerves may 
also arise under similar conditions. 


ATAXIA. 


Ataxia should, strictly speaking, be reserved for those conditions in 
which there is want of co-ordination of body movements due to disease 
of the sensory nerve tract. The expression, however, is applied loosely 
to conditions in which paralysis exists, thus giving rise to irregular mus- 
cular movements, this being by far the most common form of ataxia in 
the lower animals. In ataxia due to cerebral disease there is an absence 
of the faculty to determine the requisite amount of muscle contraction 
necessary to carry out a certain evolution, so that a greater or lesser 
amount of force is used than is necessary. Cerebellar ataxia depends on 
lesions of the cerebellum. 


HEMIPLEGIA. 


Hemiplegia is a condition in which there is motor paralysis of one- 
half of the body. All the muscles are, however, not usually paralysed 
to the same extent. Monoplegia or paralysis of one limb or group of 
muscles is a much more common condition. Diplegia, or symmetrical 
paralysis of groups of muscles, is sometimes seen. 

ErroLocy.—Hemiplegia may be caused by a lesion involving either 
directly or by pressure the pyramidal tract at any part of its course 
from the cortex to the medulla. The resulting paralysis occurs on the 
opposite side of the body to that of the lesion on account of the decussa- 
tion in the medulla. An extensive lesion of the cortex over the motor 
area controlling the limbs may cause hemiplegia, but monoplegia is much 
more likely to be set up in such cases. 

The most frequent causes of hemiplegia are cerebral hemorrhage, 
embolism or thrombosis of cerebral vessels, infective encephalitis, 
lesions of the pons or of the crura cerebri, tubercular or suppurative 


1134 SYSTEM OF VETERINARY MEDICINE 


meningitis, abscess formation, tumours, meningeal hemorrhage, injuries 
to the surface of the brain from blows, or depressed fracture occurring 
in the newly-born animal during delivery. 

Symproms.—The condition may be slow in its onset if due to chronic 
irritation or tumour formation, but is sudden if due to depressed fracture 
or hemorrhage. In rare cases there may be complete paralysis—+.e., the 
muscles are entirely removed from voluntary control—but in the great 
majority of cases there is merely impairment of this control, or the 
paralysis is monoplegic in type. Complete paralysis is usually due to a 
lesion in the internal capsule or crura. The parts least paralysed are 
those which do not act independently from their fellows of the opposite 
side, such as the muscles of the trunk, chest, and abdomen; whilst those 
most completely paralysed are the muscles which commonly act inde- 
pendently. The facial muscles may be involved to a slight extent, but 
never to the degree in which they are affected in paralysis of the facial 
nerve or its nucleus. 

The condition may be preceded by muscular spasm or even an attack 
of Jacksonian epilepsy. A careful examination may reveal weakness of 
the muscles on the same side of the body as the lesion. 

Analgesia very often accompanies paralysis, and it occurs on the 
same side of the body, but these symptoms disappear altogether, or are 
diminished during the course of a few days. The condition is sometimes 
accompanied by abnormal movements, ataxic locomotion, or forcible 
rotation of the head and eyes to the side of the body on which the lesion 
is situated. The duration of the disease is variable; sometimes recovery 
takes place in a few weeks, eventually reaching a stage of partial paralysis, 
after which no improvement takes place. The muscles undergo atrophy 
from disuse, but the reaction to electrical stimulus remains unimpaired. 
Hemiplegia may be followed at a later date by choreic movements of the 
limbs. 

Proenosis.—Unless the cause can be determined and its removal 
effected, prognosis is unfavourable. 

TREATMENT.—As the condition is due to many and vastly different 
factors, special treatment is required in each case. 


ACUTE MENINGITIS. 


Synonyms.—Acute inflammation of the Meninges; Leptomeningitis; 
Meningo-encephalitis; Acute hydrocephalus. 

Acute meningitis may be regarded as probably the most common 
acute inflammatory affection of the nervous system met with in equine 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE = 1135 


practice; but in spite of the fact that it is of comparatively frequent 
occurrence, we must admit that in many instances very little is definitely 
known with reference to its etiology and pathology, while its differential 
diagnosis from encephalitis (acute inflammation of the brain) is surrounded 
by marked difficulties. A consideration of the views expressed by various 
authors as to the relations between meningitis and encephalitis leads us 
to the conclusion that, although it is possible theoretically to lay down 
rules for the differentiation of the two conditions, yet in practice it is 
impossible to apply them with any degree of utility. Hutyra and Marek 
state that as small bloodvessels from the pia mater penetrate the super- 
ficial layers of the brain substance, the diseased process is almost certain 
to spread from the meninges to the encephalon, and practically every 
case 18 one of meningo-encephalitis. The affection starts in the mem- 
branes, and the brain is secondarily affected. 

According to Cadéac, the symptoms manifested do not depend on the 
lesions in the meninges, but on alterations produced in the cerebrum, the 
medulla oblongata, and the cranial nerves. He compares the morbid 
changes induced on the surface of the brain by meningitis to the lesions 
in the heart which result from an attack of pericarditis, and regards 
encephalitis per se as a rare affection. The usual lesions met with in 
encephalitis are in the form of abscess or foci of degeneration, either 
isolated or occurring at various points, and diffuse inflammatory changes 
are not observed. 

As, however, suppurative encephalitis (cerebral abscess) 1s not an 
uncommon condition, we deem it advisable to describe meningitis and 
encephalitis separately, but at the same time the former condition will 
be regarded as being associated with encephalitis to a varying extent. 
The term “ meningo-encephalitis ”’ is regarded by some authors as one 
which might very well be dispensed with, on the grounds that meningitis 
is always accompanied by lesions of the encephalon. 

Epizoétic cerebro-spinal meningitis is an infectious malady charac- 
terised by lesions of the meninges, encephalon, and of the spinal meninges, 
and will be found fully described in Vol. I. Some authors regard the 
affection just mentioned as an epizoétic type of meningitis, and term 
the ordinary form “ sporadic meningitis.” 

The dura mater is seldom the primarv seat of inflammation in the 
acute form of the disease, but may be involved in association with the 
other meninges. The term pachymeningitis is applied to inflammation 
of the dura mater when occurring as a disease per se, but in most instances 
the process is a chronic one. This membrane, owing to its fibrous nature, 
is believed to offer resistance to the action of micro-organisms. On the 


1136 SYSTEM OF VETERINARY MEDICINE 


other hand, the arachnoid and the pia mater readily become infected by 
micro-organisms in cases of suppurative processes in connection with the 
eye, ear, etc., or from septic wounds of the cranial region, the infection 
being carried by way of the lymphatics. When the pia mater is the 
primary seat of the lesions, the affection is termed “ leptomeningitis.”’ 

In some cases all the meninges are involved, and also the ependyma 
(the membrane lining the lateral ventricles). Not uncommonly the 
infection extends to the meninges of the spinal cord, and spinal menin- 
gitis is then associated with cerebral meningitis. 

Eriotocy.—The affection always depends on microbial causes, but 
the real nature of the infecting agent in the primary or so-called idio- 
pathic form has not been determined. According to Hutyra and Marek, 
some cases of the malady depend on a similar micro-organism to that 
causing Borna disease (see Vol. I.), and may be regarded as sporadic 
instances of that affection. Christiani found on examining the cerebro- 
spinal fluid from cases of ordinary meningitis, diplococci similar to those 
occurring in Borna disease, and also micro-organisms agreeing with the 
Diplococcus intracellularis, which is believed to be the cause of cerebro- 
spinal fever in man. Other infective agents may also be responsible, 
and it is suggested that normal saprophitic micro-organisms in the body 
may, under exceptional circumstances, assume a .pathogenic réle, and 
produce the disease. Certain predisposing causes are recognised, such 
as exposure to chills, severe fatigue, exposure to the sun, etc., and prob- 
ably act by lowering the vital resistance. But in a large number of cases 
no cause can be discovered. 

The secondary forms of meningitis are said by some authors to be far 
more common, but this is not our experience. We must admit, however, 
that in many of the cases we observed, a frequent lesion discovered post 
mortem was acute gastritis, but we are unable to explain its connection 
with the meningitis. 

Secondary meningitis may depend on a large variety of etiological 
factors, all of which are associated with the entrance and development of 
micro-organisms in the meninges. Traumatic causes include infected 
wounds of the cranial region or poll; operations, such as excision of the 
eye, trephining the frontal sinus, or trephining for the evulsion of diseased 
molar teeth; wounds of the orbit or forehead, which become the seat of 
infection of malignant cedema or erysipelas. Diseases of the structures 
in the vicinity of the cranial cavity, such as necrosis of the bones, sup- 
purative disease of the middle ear (rare in the horse), poll-evil (in which 
the pus has burrowed so as to reach the spinal meninges in the occipital 
region). In such instances pachymeningitis occurs primarily, and is 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE = 1137 


succeeded by leptomeningitis. Pysmic diseases, especially strangles, 
are often complicated with a suppurative form of meningitis. Amongst 
other affections which may be associated with meningitis we may 
mention influenza, ulcerative endocarditis, tuberculosis, joint-ill, ete. 
When infection occurs from suppurative conditions of the eye, or of 
the region of the orbit, it may reach the meninges by extension along 
the nerves passing through the orbital hiatus, or by way of the 
ophthalmic vein. Cases of meningitis are recorded due to the presence 
of larval parasites in the tissues adjacent to the meninges. Rupture of 
an encephalic abscess outwards gives rise to suppurative meningitis. 

Tubercular meningitis is uncommon in the equine species as compared 
with bovines (see Tuberculosis in the Horse, Vol. I.). 

Morsip AnAtomMy.—There are probably few diseases in which the 
symptoms are so violent, and yet the post-mortem lesions so insignificant, 
as acute meningitis. In many instances no macroscopic lesions can be 
detected. The suppurative forms are those in which macroscopical 
changes are more likely to be observed. Generally speaking, the lesions 
vary from case to case, and according to the stage at which death has 
taken place. Some authors regard the presence of a large amount of 
fluid exudate between the dura mater and the arachnoid as an important 
lesion, but Cadéac points out that the quantity is very variable, and he 
quotes Hering, who has found 300 to 420 grammes in cases which during 
life did not present any symptoms of meningitis. He is of opinion that 
the amount of the exudate has no significance in connection with the 
disease, nor is 1t in proportion to the intensity of the affection. More- 
Over, in certain instances there may be an absence of effusion. He 
regards the solid exudate as one of the most characteristic lesions. The 
vessels of the pia mater are engorged, and the membrane itself is the seat 
of extensive cellular infiltration. It is appreciably thickened, due par- 
tially to the vascular engorgement, but also to the fact that the meshes 
in its structure contain a fluid exudate, This fluid may be serous in 
character (serous leptomeningitis), but more often it is purulent (purulent 
leptomeningitis). In other cases the inflammatory exudate lies in the 
arachnoid spaces, or may be collected at one point, so as to form a sub- 
dural abscess. The pia mater is sometimes adherent to the adjacent 
brain substance. Pus occasionally follows the course of the larger 
vessels, extending down with the pia mater into the sulci. The venous 
plexuses then appear as gelatinous yellow cords, and the ventricle in 
this case frequently contains a yellow turbid fluid with flocculi of fibrin 
or even pus floating in it. 

When the condition is confined to the membranes overlying the 

VOL, Il. 72 


1138 SYSTEM OF VETERINARY MEDICINE 
cerebral hemisphere, the term “ convexity meningitis ” is applied; when 
affecting the pons and medulla, it is designated “ basal meningitis.” If 
the inflammatory exudate is fibrinous in character, it takes the form of 
a thin yellow layer spread over the cerebral convolutions, often joining 
them securely to their adjacent covering. In such cases the superficial 
layer of brain tissues may appear infiltrated with exudate, and swollen, 
thus causing the convolutions to appear less prominent. Occasionally, 
however, it may present minute hemorrhagic points or even abscess 
formations. The cerebral arachnoid space is continuous with the arachnoid 
space in the spinal meninges, so that infection may spread until it finally 
engages the latter. This condition is specially likely to occur in those 
cases where sufficient time has not elapsed for the production of fibrous 
adhesions, which are frequently useful in preventing the spread of the 
infective exudate. The roots of the cranial nerves passing through the 
meninges occasionally become implicated, especially in those instances 
where infection is spread along the optic nerve in eye disease, or along 
the facial or auditory nerve in middle-ear disease. In chronic lepto- 
meningitis the membranes are thickened, denser than normal, and closely 
adherent to the cerebral cortex, but generally only over a localised area. 
Inflammatory exudate in cases of leptomeningitis may be straw-coloured, 
yellowish, greenish, reddish, or turbid in character, and it is most com- 
monly found in greatest quantity at that point where the inflammatory 
process commenced. In tubercular meningitis, greyish or yellow-white 
nodules, varying in size from a pin’s head to a pea, are seen scattered 
evenly throughout the pia mater, but more especially along the course 
of the larger vessels at the base of the brain. The exudate may be of a 
solid nature, and disposed in the form of plaques, or in bands surround- 
ing the vessels. Itis found chiefly on the convexity of the cerebral hemi- 
spheres or between the depressions of the convolutions, and sometimes 
in the vicinity of the optic chiasma and at the origin of the cranial nerves. 

The lateral ventricles may be involved, and contain a variable amount 
of fluid (internal hydrocephalus). According to Cadéac, when the in- 
flammatory process develops rapidly, the cerebrum shows but few lesions 
—namely, a certain degree of congestion—while the grey matter presents 
a slightly bluish tint, and the white substance shows a number of red 
spots. Later on the cerebral substance is cedematous on the surface, the 
convolutions are slightly flattened by the exudate, while in exceptional 
cases small purulent and hemorrhagic foci occur on the surface of the 
cerebrum. 

In traumatic cases the dura mater is thickened and inflamed, and its 
internal face may be covered by a fibrous purulent exudate. 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE = 1139 


The term “external hydrocephalus” is applied to the condition 
characterised by the presence of an exudate between the pia mater and 
the cerebral surface, or between the dura mater and the arachnoid. 

Symptoms.—The clinical picture of meningitis is very variable. The 
diversity of symptoms is believed to depend on the location, extent, and 
nature of the lesions. The symptoms probably depend on the action of 
bacterial toxins on the nervous tissue, and also on increased intracranial] 
pressure due to hyperemia and extravasation. The most severe symp- 
toms are observed when the cortical grey matter, the medulla oblongata, 
and the roots of the cranial nerves are involved. The leading phenomena 
consist of general symptoms of brain disturbance. Some authors describe 
a typical course characterised by a primary disturbance of consciousness, 
evidenced by dulness, a sleepy condition, disinclination for movement, a 
stumbling gait, etc., followed by symptoms of excitement and even 
mania, and succeeded by deep depression and coma. But these stages 
are by no means constant, and in our experience there 1s nothing typical 
in the development or course of the disease. 

In many instances the primary symptoms presented are a staggering 
gait, a sleepy appearance, and marked depression. In a variable period 
the animal assumes the recumbent position, and exhibits violent con- 
vulsive movements of the fore and hind limbs. These muscular move- 
ments occur in a spasmodic manner, and periods of ease are observed. The 
animal is unable to rise, and the head is constantly directed backwards. 
Nystagmus and sometimes strabismus are observed. The struggling 
becomes more violent, and death takes place from exhaustion; but the 
animal is generally destroyed before the final stage is reached, as previous 
experience teaches the practitioner that such cases are hopeless. 

In many instances, on the first visit of the practitioner the animal is 
found in the recumbent position and struggling. It 1s not uncommon 
for the owner to leave the horse apparently healthy in the evening, and 
to find him down and struggling violently on the following morning. 

Again, cases are met with in which, after a short period of depression 
accompanied by a staggering gait, violent symptoms develop. The 
animal rushes about the stall in a delirious manner, and strikes his head 
against the wall or the manger. He may even manifest maniacal symp- 
toms, and be dangerous to approach. The membrana nictitans may 
protrude over the eyes, and the pupils are dilated. Without any warning 
he may rear, throw himself down, and struggle violently. In some 
instances profuse sweating is observed. These cases correspond with the 
clinical description of “‘ mad staggers ” given by the older writers. The 
stage of excitement varies in duration. In some instances itis prolonged; 


1140 SYSTEM OF VETERINARY MEDICINE 


in others it is short; but in both instances the animal ultimately goes 
down, struggles violently, and finally coma sets in. 

Again, cases are observed in which the early stage of depression is 
prolonged. The animal presses his head against the wall or the manger, 
and appears indifferent to his surroundings. He may pick up food in a 
desultory manner, attempt to chew it, and then let it fall from his mouth. 
Difficulty in swallowing fluids may be observed, and the head is pushed 
into a bucket of water until the nostrils are covered by the fluid. — 

Hyperpyrexia is generally present, and some very high temperatures 
have been recorded, even up to 108° F. The pulse is full and frequent 
in the early stages, but later on becomes weak. The respirations are 
accelerated during the stage of excitement, but in the later stages become 
retarded and deep, and towards the termination of the case may be of 
the Cheyne-Stokes type. The visible mucose are injected, and in some 
instances hypereesthesia of the skin of the head is exhibited, the animal 
offering considerable resistance to manipulation of that region. The 
limbs may be held in unnatural positions, being either widely separated 
or even crossed. This is especially observed prior to the animal going 
down. Unequal dilatation of the pupils may be observed, also clonic 
spasms of the cervical muscles, retraction of the upper lip, and in some 
instances trismus is present, owing to spasm of the masseter muscles. 

When meningitis supervenes on a preceding disease, such as influenza, 
pneumonia, or strangles, its presence may not be detected until violent 
nervous phenomena are manifested. Some outbreaks of influenza are 
characterised by the frequent occurrence of meningeal complications. 
The most violent forms of meningitis are those resulting from wounds in 
_ the region of the orbit which have become infected by erysipelas or 
malignant oedema. In such cases we observed at first marked depression, 
swollen eyelids, and a hanging head. In a variable period the animal 
fell down, and manifested the most violent fits of clonic convulsions. 
The struggling was so constant that it was with the greatest difficulty 
destruction was carried out, and the sweating so profuse that the animal’s 
body was enveloped in a cloud of steam. 

CouRsE AND Duration.—This is very variable. In cases charac- 
terised by violent symptoms death may occur in two or three days, or 
even sooner. Instances are recorded in which the duration was from 
two to three weeks. Some authors met with partial recoveries succeeded 
by relapses. Chronic meningitis is also described, associated with chronic 
hydrocephalus (dropsy of the ventricles), amaurosis, and various nervous 
phenomena. 

Proenosis.—In our experience true meningitis always proves fatal. 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE 1141 


Some authors, however, claim to have met with recoveries, but it seems 
probable that such cases depended on reflex disturbance of the brain 
originating in gastric disorder. 

DIFFERENTIAL Diagnosis.—Attempts have been made to differentiate 
meningitis from encephalitis, but the rules laid down are not of any 
assistance to the clinician. From a practical point of view, the distinc- 
tion is not of importance, because both diseases are equally fatal, and, 
as already remarked, encephalitis to a varying extent is always associated 
with meningitis. ; 

Only occasionally can we differentiate between serous and purulent 
meningitis. The presence of suppurative foci in any part of the body, 
followed by the acute nervous symptoms already mentioned, is sugges- 
tive of the purulent type of the disease. It is said that the suppurative 
type runs a more rapid and violent course. | 

In tumours of the brain the symptoms develop more slowly than in 
meningitis. 

Rabies may be mistaken for meningitis associated with a tendency 
on the part of the animal to bite and destroy surrounding objects, but 
these symptoms are not of common occurrence in the latter affection. 
The history of the horse having been bitten recently by a rabid dog 
and the existence of rabies in the district will assist in the diagnosis (see 
Rabies, Vol. I.). 

In some cases of gastric disorder—e.g., gastritis and gastric impac- 
tion—very violent nervous phenomena may be manifested, and it is 
impossible to foretell the result. In some instances recovery occurs alter 
treatment directed to the stomach has been adopted; in others meningitis 
develops. These are probably the so-called “staggers” of the older 
writers (see p. 96). 

Inability to rise, associated with violent convulsive struggling, is 
common to meningitis, the secondary stages of azoturia, uremia, and the 
later stages of tetanus. A differential diagnosis is based on the history 
of the case. 

In tetanus, the presence of trismus and the protrusion of the mem- 
brana nictitans are important diagnostic features. But it must be 
remembered that in some cases of meningitis similar symptoms may 
occur at intervals. In tetanus, however, the spasms are tonic in 
character in the early stages, while in meningitis they are clonic through- 
out the disease. 

In the later stages of azoturia and uremia, in the absence of a correct 
history of the case, an erroneous diagnosis may be given by even the 
most experienced clinician. 


1142 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—This is notoriously unsatisfactory. If the animal is 
unable to rise, and presents violent convulsions, treatment is of no avail, 
and destruction should be ordered. 

When, however, the animal is able to stand, and the symptoms are 
violent, venesection may be tried, but should be carried outearly. Quick-- 
acting purgatives are indicated, and the most suitable are either eserine 
or arecoline. To combat the nervous excitement, chloral hydrate should 
be prescribed, either in the form cf bolus or by rectal injection, co as to 
avoid the risks of drenching. Opiates are contra-indicated, as they tend 
to increase the nervous excitement. In cases where the symptoms are 
so violent that neither a bolus nor a rectal injection can be given with 
safety, hypodermic injections of hyoscyamine may be administered. An 
ice-bag may be applied to the region of the head. Various other lines 
of treatment are recommended, but they prove of little or no value in 
practice. When the nervous symptoms quickly yield to therapeutical] 
measures, it is highly probable that the affection was not true menin- 
gitis. 


CHRONIC MENINGITIS. 


Very little is known with reference to this condition in the horse. 
Cases are recorded by Cadéac which followed an acute attack, and pre- 
sented evidences of chronic hydrocephalus (see p. 1150), partial loss of 
control over the limbs, amaurosis, deafness, local forms of paralysis, etc. 


ENCEPHALITIS (INFLAMMATION OF THE BRAIN). 


As already remarked, encephalitis to a varying extent is practically 
always associated with meningitis. Two forms of the affection are usually 
described—viz., (1) Simple Acute. Encephalitis, also termed Acute Non- 
Purulent Encephalitis ; and (2) Purulent Encephalitis, also known as 
Cerebral Abscess. 

Simple Acute Encephalitis possesses little interest for the clinician, 
as it is not possible to distinguish the condition from meningitis, the 
clinical picture presented being practically common to both affections. 
Various writers have described the disease, but Dexler (1899, 1903, 1904) 
devoted special attention to it. 

ErioLocy.—The affection is regarded as ,being usually secondary to 
systemic infections, especially influenza and contagious pneumonia. 
In some instances micro-organisms cannot be detected in the brain tissue. 
The disease generally sets in during the course of the affections men- 
tioned, but occasionally it occurs as a sequel after the disappearance of 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE = 11438 


the symptoms of the primary malady. In many instances no etiological 
factors can be discovered. It is suggested that intoxication by bacterial 
toxins, derived from some primary focus of disease in the lungs, intes- 
tines, etc., may be the cause of the brain lesions in some cases. Localised 
encephalitis has been observed in the vicinity of parasitic cysts, neo- 
plasms, and embolic lesions. Some authors record cases said to be due 
to feeding on damaged rye-grass. Over-exertion and fatigue are regarded 
as predisposing causes. 

Morsip Anatomy.—According to Cadéac, the lesions are never of a 
diffuse character, but other authors describe a diffuse hemorrhagic form. 
The morbid changes may occur in any part of the encephalon—thus, the 
cere bral hemispheres, the basal ganglia, the crura cerebri, the pons varolii, 
the medulla oblongata, the cerebellum, etc., may be the seat of the | 
lesions. 

Sometimes cases showing evidences of profound cerebral disturbance 
before death exhibit comparatively insignificant lesions, which may even 
escape notice except a careful post-mortem examination is made. Itis 
rare, however, to find a single centre of disease. Sometimes the con- 
dition is extensive or diffuse in character, and occasionally associated 
with hemorrhage. When the inflammatory process engages the tissues 
surrounding the third and fourth ventricles, it may be accompanied by 
dropsy of these cavities, in which case they contain a turbid, blood- 
stained fluid. The lesions vary in size from a hen’s egg to a pin’s head, 
but are never sharply defined from the surrounding tissue. They may 
be greyish-red, violet, or brownish-red; and if they occupy the grey 
matter they are pink, reddish, or greyish-red. When occurring in the 
white matter, the brain substance in the neighbourhood is infiltrated 
with a serous exudate, and is moist, shining, and swollen on section. 
It occasionally exhibits a somewhat gelatinous appearance. Not in- 
frequently fine hemorrhagic points are distributed throughout portions 
of the brain tissue. The hemorrhagic form is not uncommon, and 
then areas of extravasated blood of considerable size may be found. 
This form, according to Hutyra and Marek, occurs more frequently in the 
horse than in other species. The brain tissue in the immediate locality of 
the lesion sometimes presents a variegated appearance on account of the 
rupture of small vessels. In long-standing cases these areas change 
to a yellowish-brown colour owing to disintegration of blood-pigment. 
Hemorrhage may be due to degenerative changes, often fatty in char- 
acter, engaging the vessel wall during the inflammatory process. In 
encephalitis involving the cortex, leptomeningitis is likely to be 
present, especially in connection with the diffuse hemorrhagic form. 


1144 SYSTEM OF VETERINARY MEDICINE 


Histotocicat CHancEs.—Small hemorrhages can be detected in the 
immediate vicinity of the bloodvessels, and extensive migration of round 
cells can be demonstrated. The nerve cells become swollen and granular, 
later undergoing atrophy and fatty or other degenerative changes. The 
nerve fibres are swollen and disintegrated. The causal organisms of the 
primary condition may be found in the hemorrhagic deposits. The 
leucocytic infiltration is insignificant when compared with the extrava- 
sation of red cells in the perivascular spaces and other situations. The 
inflammatory lesions of the pia mater can be made out without any diffi- 
culty in the diffuse hemorrhagic type. In the rare cases where recovery 
takes place the lesion breaks down into a granular detritus, becomes 
absorbed, and a cyst-like structure forms in its place. When the lesions 
are of small size cicatrices may result, so that if several small lesions in 
close proximity one to the other are present, a condition which may be 
described as cerebral sclerosis is produced. 

Symptoms.—These are notoriously uncertain. Generally speaking, 
they resemble those described as occurring in acute meningitis—viz., pre- 
liminary excitement, followed by marked depression and coma. Death 
may occur within forty-eight hours, but in some cases the animal may 
live for a week. 

PRoGNOSIS.—This 1s very unfavourable. Very rarely recovery may 
take place, but even then some permanent defect remains, such as blind- 
ness, muscular weakness, monoplegia or hemiplegia, or a tendency to 
vertigo. These sequele render the horse useless for all practical purposes. 
Many cases tend to become subacute or even chronic, showing symptoms 
of so-called “sleepy staggers,” reeling, inco-ordination of body move- 
ments, the animal being eventually slaughtered or dying from inanition 
due to refusal of food. 

DIFFERENTIAL Diacnosis.—In spite of the attempts made to formu- 
late rules for the differentiation of encephalitis from meningitis, in practice 
it is not possible to apply them with any degree of accuracy. 

If primary suppurative foci are present in any part of the body such 
a condition is of assistance in distinguishing the simple form of the disease 
from the suppurative type. 

TREATMENT.—Therapeutical measures similar to those advised for 
meningitis are indicated in encephalitis, but in the large majority of cases 
a fatal termination results in spite of treatment. 

Purulent Encephalitis (Cerebral Abscess).— This is a condition in 
which one or more localised areas of suppuration develop in the cerebral 
tissue. Cerebral abscess in the equine species is not uncommon, and 
foals are said to be especially susceptible. 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE 1145 


EtroLocy.—The great majority of cases of cerebral abscess are due 
to direct or indirect infection by pyogenic organisms. It occurs as a 
result of the spread of infection in pyemic diseases, notably strangles, 
but also occasionally in pneumonia, empyema, puerperal septicemia, 
pleurisy, osteomyelitis, and osteoporosis, or, in fact, from any localised 
focus of suppuration. According to Dexler, 60 per cent. of the cases 
depend on strangles. Cerebral abscess is sometimes associated with 
suppurating disease of the ear—rare in the horse, but more common in 
the dog—infection spreading either directly or via the veins. It may 
also follow acute purulent inflammation of the facial sinuses, spreading 
directly through the cribriform plate of the ethmoid or via the veins. 
Sometimes it is due to a needle or other foreign bodies penetrating from 
the pharynx, or punctured wounds or sharp-pointed bodies penetrating 
into the cranial cavity at any point. Infected compound fracture of the 
bones forming the cranium may lead to the formation of a cortical abscess. 
Suppurative meningitis sometimes extends so as to engage the outer 
layers of the brain substance itself. Cerebral abscess is often due to the 
spread of infection from septic thrombi of the venous sinuses in the 
immediate neighbourhood, or directly from suppurative meningitis. 
Parasitic cysts in the cerebrum sometimes undergo necrosis, with subse- 
quent disintegration, and form a suitable nidus for the growth of pyogenic 
organisms which may be accidentally present in the circulating blood. 

Morzip Anatomy.—The position of a cerebral abscess depends to 
some extent on the cause of infection. Abscesses due to the spread 
of infection from meningitis are usually found in the cortical region, those 
due to purulent inflammation of the facial sinuses are found in the frontal 
lobes, or if due to disease of the ear they occupy a position in the temporal 
lobe. These abscesses differ greatly in size, and may be single or multiple. 
The amount of pus present varies from a few drops to a few ounces. . In 
acute cases the abscess wall is fragmented in appearance, and the sur- 
rounding brain tissue is infiltrated with pus and softened by the inflam- 
matory process. In chronic cases it is encapsulated by a wall of newly 
formed fibrous tissue. The contents of the abscess cavity may be white, 
gteyish-yellow, or dark brown due to degeneration of blood-pigment. 

Symptoms.—During the development of large abscesses symptoms of 
increased intracranial pressure may be observed, in addition to those due 
to absorption of toxins or destruction of some important part of the brain. 
The evidences of cerebral abscess are by no means pathognomonic, and an 
acute case differs markedly from a chronic one. Generally three stages 
may be recognised in the disease. In the initial stage there may be fre- 
quent rigors, followed by a rise of temperature, the pulse is frequent, the 


1146 SYSTEM OF VETERINARY MEDICINE 


respirations are accelerated, and the animal may show signs of intense 
pain in the head, evidenced by depression, and resisting when attempts 
are made to manipulate that region. 

During the secondary stage, when the abscess is fully formed, the 
animal sinks into a state of rapidly progressive dulness, which at times 
is interrupted by marked nervous excitement, even amounting to 
delirium. In some cases pronounced dulness without excitement occurs. 
The initial rise of temperature may pass unnoticed, owing to the fact that 
the animal is already in a febrile condition from some antecedent 
condition. 

General paresis of the muscles of the body may make its appearance, 
and, depending on the site of the abscess, local forms of paralysis are set 
up, such as ophthalmoplegia, sudden blindness, ptosis, or squint, and 
other types of cranial nerve paralysis. Unilateral paralysis of vision, 
paralysis of some group of body muscles, monoplegia, or even hemiplegia 
may occur. In other cases the head is carried on one side, or the head 
and neck may be retracted. 

In the terminal stage the abscess ruptures into the arachnoid spaces 
or into one of the lateral ventricles, and death may take place from 
diffuse purulent leptomeningitis. The rupture of a cerebral abscess is 
indicated by a sudden rise in temperature to 105° or 106° F., and the 
pulse becomes very frequent. There is muscle twitching, tetanic spasms, 
and coma, and death speedily takes place. When the abscess does not 
rupture, death may occur from toxemia and general weakness. If the 
condition is due to disease of the ear, the abscess in the temporal region 
may discharge spontaneously through the auditory meatus. If the 
lesion exists in the frontal lobe, no symptoms may be observed until 
evacuation through the cribriform plate of the ethmoid occurs. In 
abscess of the parietal lobe, paralysis of the face and limbs of the 
opposite side sometimes develops. Small abscesses may cause no 
symptoms of paralysis, except the lesions occur in connection with the 
internal capsule or on the course of the pyramidal tract. In the more 
or less chronic cases no symptoms may be observed for a considerable 
period, and careful observation is required to detect the small variations — 
in temperature which doubtless occur. When abscess formation is due 
to septic compound fractures of the cranial bones, it generally occurs in 
the cortical region, and may, within a few days, extend, eventually 
setting up fatal leptomeningitis. If an abscess occurs in connection with 
the cerebellum, it is usually small, but as it increases in size serious 
symptoms may develop, such as nystagmus and vertigo, with inco- 
ordination of body movement. Giddiness, reeling gait, retraction of 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE = 1147 


head and neck, and blindness are also observed. The pulse is infrequent 
and very weak, the temperature often subnormal. Sometimes paralysis 
of the limbs, due to pressure on the underlying medulla, is present. In 
purulent encephalitis forming part of a general pyzemia abscesses are 
usually multiple. In certain obscure, ill-defined, chronic cases of brain 
abscess the animal appears to enjoy almost perfect health except for the 
fact that he is attacked at intervals by vertigo and epileptic seizures. 

Proenosis.—In purulent encephalitis prognosis is most unfavourable, 
as the condition proves fatal in the great majority of cases. Death may 
occur within three days from the onset of the attack, or the animal may 
live for weeks, or even longer, in chronic cases. 

According to Le Calvé, the manifestation of symptoms depends not 
only on the rapidity with which abscess formation occurs, but also on the 
seat of the lesion. Latent zones occur in the brain, in which extensive 
morbid alterations may take place without producing symptoms. 

DiFFERENTIAL Diacnosis.—This is often difficult except the con- 
dition is anticipated, owing to the fact that there is local suppuration in 
some other part of the body. The onset of distinct brain symptoms 
under such circumstances leaves very little doubt that the case is one of 
cerebral abscess. 

In acute cases the condition may be confused with that of suppurative 
meningitis, but, according to some authors, in this condition there is a 
uniformly high temperature, a more rapid course, and a greater tendency 
to paralysis and epileptic seizures early in the course of the disease. 
Chronic cases can only be diagnosed by the occurrence of special symptoms, 
such as various forms of paralysis of the cranial nerves, especially when 
the animal exhibits intermittent elevations of temperature. 

TREATMENT.—The only treatment likely to prove successful consists 
in the localisation of the abscess, trephining the skull immediately over 
it, and evacuating the purulent contents. This procedure can only be 
carried out where the abscess is subdural, or encapsuled and super- 
ficially situated in one of the cerebral hemispheres. But a correct 
diagnosis or localisation of the abscess is rarely possible. According to 
Cadéac, operative measures have not given encouraging results. 


CHRONIC ENCEPHALITIS. 


Chronic Encephalitis rarely or never exists as a primary condition. 
It is nearly always secondary to a more or less acute attack. A certain 
amount of chronic inflammation of the brain exists in the neighbourhood 
of tubercular deposits, tumours, and parasitic cysts. Febrile symptoms 


11448 SYSTEM OF VETERINARY MEDICIN” 


and loss of consciousness may be observed, sometimes paralysis of some 
of the cranial nerves may develop, giving rise to such conditions as 
ptosis, strabismus, etc. 

TREATMENT.—Therapeutical measures of any kind are useless in this 
condition. 


CHRONIC HYDROCEPHALUS. ~ 


Synonyms.—Chronic dropsy of the ventricles; Internal hydrocephalus ; 
Kpendymitis; Immobilité. 

“Chronic internal hydrocephalus” is the term used to indicate a 
morbid process resulting in the accumulation of fluid in the ventricular 
spaces, with consequent dilatation of these spaces and increased intra- 
cranial pressure. The term “chronic external hydrocephalus” is used 
when the fluid collects in the meningeal spaces, and it may exist over a 
circumscribed area when the underlying brain tissue has undergone con- 
traction following inflammation. A space is thus formed which is later 
filled with fluid. Acute external hydrocephalus exists in all cases of 
meningitis. Congenital hydrocephalus, either internal or external, is 
not an uncommon condition, and may give rise to dystokia. 

The term “staggers”? is sometimes applied to hydrocephalus, but 
it is a very vague designation (see p. 97). French authors use the term 
“immobilité ’? in connection with chronic hydrocephalus (see p. 1158). 

Chronic dropsy of the ventricles is rarely met with in thoroughbred 
horses; it chiefly attacks common-bred horses of the heavy type and of 
phlegmatic temperament. It is held that the formation of the osseous 
cranium in these animals is more favourable to the development of 
hydrocephalus in that they have a broad skull and a wide tentorial 
opening, but it must be recognised that these animals generally perform 
hard work, and are consequently exposed to repeated variations in intra- 
cranial pressure, which, as will be seen later, is a predisposing cause of 
dropsy of the ventricles. Geldings and mares are said to be proportion- 
ally more liable to ventricular dropsy than entire horses, and it has been 
held by some that there is a connection between loss of internal secretion 
of the essential genital organs and the development of the brain, which 
may account for its occurrence. But Trasbot found the disease more 
commonly in stallions. 

ErioLocy.—The lateral ventricles communicate with the third 
ventricle via the foramen of Monro, and the third and fourth ventricles 
communicate through the aqueduct of Sylvius. Obviously cerebro-spinal 
fluid may collect in the ventricles under the following sets of circum- 
stances: (1) If the quantity of this fluid formed from the venous plexuses 


DISEASES OF THE BRAIN: HORSE 1149 


of the ventricles is so abundant that the overflow cannot escape through 
the aqueduct; or (2) if the calibre of the aqueduct has become so nar- 
rowed or occluded that it diminishes or prevents the normal escape of 
fluid through it. 

Dexler, from the result of his very thorough and interesting investiga- 
tions of this subject, holds that the primary factor in the causation of 
this disease is occlusion of the sylvian aqueduct determining passive 
engorgement of the lateral ventricles and the third ventricle, especially 
as he was on no occasion able to demonstrate any alteration in the venous 
plexuses, choroid, or ependyma lining the ventricle. This writer also 
states that the tentorium cerebelli encloses a space which under normal 
circumstances is occupied by a small portion of the vermiform process of 
the cerebellum and corpora quadrigemina, as well as the crura cerebri 
and the aqueduct of Sylvius. Pulsation of the brain at each contraction 
of the heart can only occur by expansion of its substance in the . 
subarachnoid space, ventricles, and tentorial cavity, because the organ 
is enclosed in a bony covering, and is itself incompressible. The ten- 
torium is more or less rigid and frequently ossified, so that the cerebral 
pulsation principally affects the portion of the occipital lobes adjacent 
to the tentorial opening, and as these lobes are continually being pressed 
into the opening they gradually tend to form a three-cornered protrusion 
at this point. When long-continued powerful pulsation or increased 
intracranial pressure exists, this protrusion increases 1n size, eventually 
exerting pressure on the corpora quadrigemina, which in turn press on 
the aqueduct of Sylvius, thus tending to diminish the escape of fluid 
through its lumen. The arrest of fluid in the lateral and third ventricles 
mechanically increases intracranial pressure, which in turn determines 
ereater protrusion of the occipital lobes into the tentorial spaces, with 
consequent greater pressure on the aqueduct, eventually leading to com- 
plete occlusion. It is thus clear from the foregoing statements that 
recovery from this condition is not likely to take place. Itis unnecessary 
to emphasise the fact that any set of circumstances which are capable of 
determining increased intracranial pressure, inter alia, induce chronic 
ventricular dropsy. Such diseases as meningitis, encephalitis, brain 
tumour, and depressed fracture may all act in this way. 

More rarely the foramen of Monro or aqueduct of Sylvius may be 
blocked by the pressure of new growths or parasitic cysts. Heredity 
undoubtedly plays an important part in determining predisposition to 
the disease. Congenital cases may be due to malformation or to injury 
to the mother during gestation. Certain circumstances are thought to 
render the animals more liable to attacks of hydrocephalus, especially 


1150 SYSTEM OF VETERINARY MEDICINE 


those conditions giving rise to repeated active or passive cerebral hyper- 
emia, and frequent exposure to great heat, over-exertion, and over- 
feeding on cereals or leguminous foods. Animals which are the subject 
of hepatic, gastric, cardiac, or pulmonary affections are said to be pre- 
disposed to ventricular dropsy. 

Morspip ANATomMy.—The lesions found in a case of chronic hydro- 
cephalus vary according to the duration and extent of the disease. The 
principal abnormalities are distension of the lateral ventricles with fluid, 
together with enlargement and deformity of the brain itself. The lateral 
ventricles are more or less symmetrically distended as well as the anterior 
portion of the third ventricle. The posterior portion of the third ven- 
tricle and the aqueduct of Sylvius appear very small, and are sometimes 
obliterated. A protuberance is found on that portion of the occipital lobe 
which lies in relation to the tentorial opening. The optic thalamus and 
optic chiasma may appear flattened. The anterior pair of the corpora 
quadrigemina are forced apart, and a saddle-shaped depression is seen on 
their surface. 

The pituitary body sometimes occupies a deep cleft. The anterior 
edge of the pons tends to curve upwards, and the superior vermiform 
process is pressed downwards, making the cerebellum appear closer to the 
foramen magnum than normal. The uncus is readily made out. The 
pressure in the distended ventricles may be so great as to cause oblitera- 
tion of the normal cerebral convolutions. The brain tissue surrounding 
the ventricles is pale, has a dried up appearance, and is increased in con- 
sistency. Occasionally the venous plexuses appear thickened and gela- 
tinous, owing to the dilatation of the vessels composing them. Rupture 
of the septum lucidum may take place, thus establishing free communi- 
cation between the lateral ventricles. ‘The amount of fluid present varies 
from 2 to 5 ounces. It sometimes has the character of normal cerebro- 
spinal fluid, and may contain a little urea or cholesterin, whilst in other 
cases 1t may be turbid, and contain fibrinous flocculi. In cases of con- 
genital chronic hydrocephalus there may be enormous quantities of fluid 
present, filling all the ventricles, the brain substance being greatly enlarged 
and distorted, the convolutions flattened, and the bones of the cranium 
soft and easily perforated. It may be difficult to distinguish between 
the white and grey matter. The ependyma is thickened and granular in 
appearance. The meninges may be adherent to each other or to the 
surface of the brain, and occasionally exhibit a finely granular appearance. 

Symproms.—In the newly born animal well-marked hydrocephalus 
may exist. Such animals die during the act of delivery, or if not are 
destroyed. In these cases the imprisoned fluid may escape through the 


DISEASES OF THE BRAIN: HORSE 1151 


nose or by rupture of the overlying integument. Convulsive seizures or 
localised muscle spasm may be seen in the adult suffering from external 
hydrocephalus. Symptoms of internal hydrocephalus are due to in- 
creased intracranial pressure acting on the brain substance anterior to the 
tentorium, and they vary greatly in severity and duration. 

During the course of an ordinary attack the animal exhibits profound 
disturbance of consciousness and sensation, together with unusual move- 
ment of the body. Complications frequently arise, causing interference 
_with the normal cardiac and respiratory movements, and the condition is 
often associated with serious digestive disorder. In the early stages the 
symptoms are obscure and by no means easy to detect, but the first sign 
generally observed by the owner is dulness or sluggishness on the part of 
the animal whilst at work. In horses that have been the subject of a 
previous attack, profound disturbance of consciousness may be the first: 
symptom exhibited. The horse becomes very restive, easily frightened, 
and may resist by force any effort to restrain him. This excitable stage 
often ushers in the usual phenomena of an ordinary attack. After a 
varying interval from the onset of the first symptom great dulness makes 
its appearance, the animal stands with eyes closed, the lower lip drooping, 
the facial expression being senseless, dull, and sleepy, whilst the head is 
rested on the manger, pressed against the wall, or hangs between the legs. 
The patient appears to have lost his knowledge with regard to familiar 
objects, or pays little attention to his surroundings; he gains false im- 
pressions from quite ordinary noises, and shows this by executing erratic 
movements of the ears, often moving them away from the sound, or 
pointing them in opposite directions. A gradually increased incapability 
of carrying out the usual orders soon becomes apparent, the animal 
appearing to have forgotten their meaning. The skin reflexes are gener- 
ally lost or greatly diminished (rarely exaggerated), and no resistance may 
be made when the ears are pulled, the skin pinched, or other external 
stimuli applied. The animal may be roused from his lethargic condition 
by loud shouting, but speedily relapses into his former state. The 
patellar reflex is said to be increased. 

The appetite remains, but feeding is carried out in an unnatural 
manner. Large quantities of food may be taken into the mouth at the 
one time and chewed for a brief period, the food mass being then allowed 
to remain in the mouth for a long time before chewing is recommenced 
and the food swallowed. The horse prefers to feed from the ground rather 
than from the rack or manger. He grinds his teeth constantly, and great | 
care must be taken to prevent injury to the hand of the attendant if an 
attempt is made to administer medicine in the solid form, and a balling- 


1152 SYSTEM OF VETERINARY MEDICINE 


iron should be employed. During the act of drinking the head is thrust 
so deeply into the bucket that the nostrils are covered with water. The 
water is taken by a champing movement of the jaws, and is swallowed 
spasmodically. The horse appears to have lost his sense of judging the 
distance between himself and familiar objects, and he will be observed - 
to stand quite close to the manger when feeding. The position adopted 
by the animal is very unnatural, the legs being held in a peculiar fashion, _ 
frequently without changing, for very long periods. They may be crossed, 

pushed forward in front of the body, or held with one foot resting on the 
coronet or hoof of the opposite limb. Although the animal can move the 
limbs at will, yetif they are placed in an awkward position by the clinician 
they are allowed to remain exactly as placed. Marked inco-ordination in 
the action of the muscles of locomotion due to paresis is observed during 
progress. During progression the animal staggers blindly either to the 
right or to the left, often in a plunging manner, and the groom who leads 
him is in danger of being crushed. Whilst in the stable the horse may 
inflict injuries on himself on account of falling against the walls. If left 
to himself in the open he may execute rotary movements. The feet may 
be lifted higher than normal, as if some obstacle wasin the way. Backing 
is performed with difficulty, the fore-limbs being dragged instead of raised. 
The peculiarity of gait may be in part due to the fact that there is in many 
cases considerable interlerence with vision, even amounting to temporary 
amaurosis, due to pressure on the optic papilla. Slight or moderate fever 
may be present, but in many cases the temperature is subnormal, the 
pulse is soft, slow, and infrequent,and the respiration is retarded and deep. 
Peristalsis is interfered with, and there is resulting constipation. Death 
may take place at the end of ten to twenty days, being frequently preceded 
by convulsions, the animal falling to the ground and “ galloping himself 
to death.” On the other hand, the symptoms may gradually subside, 
and the animal appears to make a more or less complete recovery; 
but in genuine cases of chronic hydrocephalus relapses will occur, 
especially if the animal is exposed to violent exertion or to dietetic 
errors, 

In congenital bd toaee the condition is more pronounced than 
in the acquired form of the disease. In severe cases the brain appears 
to be enclosed in a thin-walled sac, which is filled with a clear or slightly 
turbid serous fluid, the medullary substance forming a thin layer inside 
the wall. The cranium is greatly enlarged. The animal generally dies 
- goon after birth. Cases are recorded in which the animal lived and 
showed no symptom of disease, although the cortex of the brain was 
greatly diminished. 


DISEASES OF THE BRAIN: HORSE 1153 


CouRsE AND Proenosis.—The prognosis in chronic hydrocephalus 
is always grave, especially when the condition is associated with delirium 
and blindness, as it is then practically always fatal. Even if apparent 
recovery takes place, a relapse may be expected to occur at no far distant 
date. In severe attacks the animal lives for seven to twenty days, death 
occurring from starvation, hypostatic pneumonia, or interference with the 
vital centres in the medulla. In other cases ventricular dropsy may last 
for years, or the horse may die from some intercurrent disease. Never- 
theless, if chronic hydrocephalus becomes established, it pursues a gradual 
course with increasingly severe exacerbations. Horses used for slow 
haulage work are not so seriously interfered with as those used for quick 
work. Occasionally death results from a self-inflicted injury during an 
attack. 

DiFFERENTIAL D1acnosis.—It is often almost impossible to differ- 
entiate chronic hydrocephalus from meningitis, encephalitis, abscess 
formation, and other brain diseases. A careful examination of the animal 
must be carried out, and the history of a past attack of the disease will be 
of service in arriving at a diagnosis. In meningitis there is usually a 
certain amount of fever, fits of excitement alternate with those of de- 
pression, there is absolute loss of appetite, and a rapidly fatal termination. 
Paralysis of the cranial nerves, congestion of the optic papilla, and focal 
symptoms occurring at the opposite side of the body, indicate the forma- 
tion of tumours or invasion of the brain by parasitic cysts. Animals 
suffering from intense sexual excitement may show symptoms simulating 
chronic hydrocephalus, but the periodical occurrence in connection with 
the sexual life readily distinguishes this abnormality. Such conditions 
as opium-poisoning, gastro-intestinal affections, and metastatic cerebral 
abscess formation occurring in connection with strangles, present special 
symptoms which will be of assistance in diagnosis. The symptoms 
which specially indicate chronic hydrocephalus are dulness, unnatural 
position of the limbs and head, and the apparent blindness and aimless 
method of feeding, the absence of pronounced fever, and the history of 
previous attacks. 

Mepico-LrcaLt Asprct.—According to Cadéac, “immobilité”’ is an 
affection which in most Continental countries is of importance from a 
medico-legal point of view, as horses suffering from the disease can be 
returned to the seller. He refers to the latent type of the affection, and 
shows the necessity for very careful examination in such cases. The 
horse should be observed in the stable, also when at rest outside, then 
during movement, being trotted by hand, also in saddle and in harness, 
and after a period of rest. Several examinations may be necessary before 

VOL. II, 73 


1154 SYSTEM OF VETERINARY MEDICINE 


any symptoms are detected, and some restive horses cannot execute 
certain movements. There may be a difficulty in “ backing,” which is 
more apparent some days than others. We must, however, point out that 
this symptom is common to certain affections of the spinal cord (see 
Shivering, p. 1219). ; 

TREATMENT.—AIl authors agree that, once the disease is established, 
treatment of any kind is useless. The milder cases may be capable of 
performing slow work by paying attention to careful dieting. Operative 
treatment is not only useless, but dangerous. 


CEREBRAL HYPERZEMIA. 


Synonym.—Congestion of the brain. 

The amount of blood present in the cerebral bloodvessels is physically 
incapable of any great variation in volume. The venous trunks are 
surrounded by the tough tissues of the dura mater, and are often in close 
relation to the cranial bones, so that they are incapable of distension by 
any force which the arteries could exert on them through the brain sub- 
stance. They do not even admit of distension when the venous outflow 
from the brain is obstructed. Itis clear, then, that the quantity of blood 
in the cerebral vessels cannot alter except the volume of the other contents 
of the cranium are diminished, since the brain is enclosed in a bony cover- 
ing. The amount of cerebro-spinal fluid which could be displaced would 
allow very little blood to be added to the normal contents. Itisin reality 
the velocity of the blood-flow in the cerebral vessels which alters when 
changes take place in the general circulation, and not alteration in the 
amount of blood present. As pointed out by Dexler, increased flow of 
blood to the brain is likely to be manifested by subjective rather than 
objective symptoms. The older authors were in the habit of blaming 
cerebral hyperemia for the production of many conditions, exhibiting 
symptoms of excitement. Ona post-mortem examination the brain may 
appear to contain more blood than is normal, but very often this state of 
thingsis due to the position in which the head was held at the time of 
death. If serious disturbance of the cerebral circulation existed for any 
length of time, it would be reasonable to expect cedema of the brain tissue, 
with minute hemorrhagic extravasations into its substance. 

We therefore regard hyperemia as a passive temporary condition, and 
not as a disease capable of producing symptoms per se. Simple hyper- 
emia, or rather increased flow of blood through the brain, normally occurs 
in healthy animals. It is sometimes seen as the result of profound 
psychical disturbances, such as might occur during railway journeys, in 


DISEASES OF THE BRAIN: HORSE 1155 


sexual intercourse, at the onset of acute disease, after poisoning, or owing 
to fear. Permanent alteration in the normal vascular conditions occurs 
during the course of many brain affections, but the lesion responsible for 
their causation can be detected at the post-mortem examination as well 
as the hyperemia. The cerebral circulation may be affected by pressure 
on the jugular vein owing to badly fitting harness, or as the result of 
tumours in the cervical region. It also occurs in many constitutional 
disorders and in heart disease. The condition is indicated by an ex- 
hibition of hypersensitiveness and excitement followed by depression on 
the part of the animal. The action of the heart is accelerated, and the 
respirations are increased in number. Sometimes the animal appears 
easily alarmed and restive. The condition usually passes off within a few 
hours. Animals presenting symptoms of cerebral hyperemia should be 
subjected to careful examination in order to determine its cause, always 
bearing in mind that it may be the premonitory symptom of some grave 
disorder. The cases should be kept under observation for a few days in 
order that fresh symptoms may be noted in the event of their occurrence. 


CEREBRAL ANAEMIA. 


Decreased flow of blood through the cerebral vessels follows sudden 
dilatation of the vessels of the splanchnic area. This condition is ob- 
served in connection with such operations as paracentesis abdominis, 
when large accumulations of fluid are allowed to escape too rapidly. It 
is also a symptom in certain forms of cardiac diseases. It may occur after 
rapid parturition, accidents or severe injuries, and also in great fright. 
Local aneemia of some portion of the brain follows the introduction of a 
foreign body into the cranium, such as an embolus, a blood clot, or a 
depressed bone. No doubt the brain takes part in the general anemia 
of constitutional diseases. At the post-mortem examination of these 
cases the meninges are paler than normal, the bloodvessels are in a state 
of collapse, and the brain substance itself has an anemic appearance. 
The symptoms exhibited are those of loss of consciousness, pallidity of 
the visible mucous membranes, dilated pupils, rapid small pulse, and 
shallow, irregular respirations. 

These symptoms are displayed for a varying length of time, when 
gradual return to consciousness takes place with complete recovery, or the 
animal may be dull and show a staggering gait for a few days. In cases 
going on to a fatal termination there are frequent attacks of convulsions 
before death. Prognosis in this condition depends entirely on, the cause 
of the condition. 


1156 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—In performing such operations as paracentesis abdominis 
care should be taken to prevent sudden dilatation of the vessels of the 
abdomen. If the animal is unconscious, the head should be raised above 
the level of the ground. Massage may be applied to the surface of the 
body, and in order to increase the circulation, stimulants, such as ether, or — 
caffeine, or normal saline solution, may be administered subcutaneously. 
Resort may be had to artificial respiration. 


CEREBRAL HAZMORRHAGE. 


Synonyms.—Cerebral apoplexy ; Hemorrhage of the brain. 

The lower animals are much less frequently the subject of cerebral 
hemorrhage than man, owing to the fact that inflammatory and degenera- 
tive changes of the arteries are not of common occurrence. 

EtroLtogy.—Cerebral hemorrhage may be due to some antecedent con- 
dition causing malnutrition, or to such changes as fatty degeneration of 
the arterial wall. It occurs in acute infectious diseases, such as purpura 
hemorrhagica, septicemia, and anthrax. It may also be seen in animals 
suffering from heart disease, kidney disease, hemiplegia, and chronic 
hepatitis. 

Kitt has recorded cases occurring in the horse due to rupture of an 
aneurism of a cerebral vessel caused by the larve of sclerostomes. Brain 
tumours, especially those of a sarcomatous nature, are frequently the seat, 
of extensive hemorrhage. Thrombosis and embolism of the cerebral 
bloodvessels produce practically similar symptoms, although seldom so 
well marked. The onset of symptoms in thrombosis is slow, whilst in 
embolism it is sudden. 

Excitement, violent muscular exertion, or excessive coughing, may act 
as predisposing causes to apoplexy in cases in which disease of the vessel 
wall exists. According to Dexler, atheromatous arteritis of the vessels 
of the brain has not been demonstrated in cases of cerebral hemorrhage 
in animals. 

Morspip AnatoMy.—The hemorrhages vary in size, but are usually 
small. Ii the blood is large in quantity, it damages the brain tissue, and 
may even destroy the basal ganglia, or extend to the cavities of the 
ventricle; such cases terminate fatally within a very short time, and on 
post-mortem examination a large clot is found to occupy the ventricle 
and the greater part of the hemisphere. In these cases the clot is su- 
rounded by ragged, discoloured brain tissue. If the animal lives for a few 
days, the brain tissue is stained yellow on account of the absorption of 
hemoglobin, orit may even become brown in colour and consist of disinte- 


DISEASES OF THE BRAIN: HORSE 1157 


grated blood and nerve tissue, the surrounding brain substance being 
softer than normal. If recovery takes place, the blood becomes absorbed, 
and leaves a large coloured spot in which crystals of hemoglobin can be 
demonstrated. No part of the brain is exempt from the danger of 
hemorrhage, but itis found most commonly in the cortical region or in the 
neighbourhood of the basal ganglia. 

It the pyramidal tract of the cortex be the seat of a permanent lesion, 
it undergoes secondary descending degeneration. Sometimes vessels 
rupture on the surface of the brain or between the meninges (meningeal 
hemorrhage), and these cases are by no means uncommon in the lower 
animals, being usually due to traumatism. 

Symptoms.—Minute hemorrhages occurring during the course of 
acute specific disease cause no symptoms. Slight bleeding into the 
internal capsule or crura cerebri may cause symptoms of unsteady pro- 
gression, nervousness, and sweating, with or without temporary loss of 
consciousness. Sometimes the apoplectic attack is preceded by occasional 
fits of vertigo, but very often no warning is given, and the animal may 
stumble, make involuntary movements, and fall to the ground in a semi- 
comatose condition, or he may even fall suddenly as if shot. Convulsions 
may or may not be exhibited before the onset of complete coma. In 
cases of extensive hemorrhage, death speedily supervenes. Whilst in a 
state of coma, the animal appears more or less paralysed, the pulse is full 
and tense, and the breathing loud and stertorous. 

There may be deviation of the head and eyes to the side on which the 
lesion is situated. Hyperpyrexia occurs if the bleeding has taken place in 
the neighbourhood of the heat-controlling centre, and is always regarded 
as an unfavourable sign. If coma persists for any length of time, death 
usually occurs from pulmonary cedema, or the condition is followed by 
hemiplegia. Complete recovery is uncommon in the lower animals. 

Dollar* recorded a case of cerebral hemorrhage associated with the 
presence of a tumour the size of a hen’s egg in the cerebellum. The 
tumour had existed for a long time without causing symptoms, and the 
latter were partly due to the occurrence of hemorrhage. The anima] 
was a gelding aged eleven years. The head was carried to one side, 
and weakness in the hind-quarters was manifested; if urged beyond 
a slow walk, he staggered and threatened to fall. The neck was turned 
to the right side, and the chin was directed towards the middle line. 
There was slight paralysis of the muscles of the right side, the upper lip 
and nose were turned towards the right, the right nostril was more 
dilated than the left, especially if the horse was excited. The right eye 


* Veterinarian, 1896, 


1158 SYSTEM OF VETERINARY MEDICINE 


was turned downwards, forwards, and inwards; it was sensitive to light, 
and the fundus was normal. The left eye was turned upwards and out- 
wards, the pupil was widely dilated, the retina was insensitive to light, 
the eye was also insensitive, and the membrana nictitans projected some 
distance over it; ptosis was present. There was difficulty in progres- 
sion of the hind limbs; the toes were dragged along the ground, and when 
the animal was turned round, he almost fell down. Any noises, especially 
on the left side, aggravated the symptoms; the neck was then jerked 
towards the right and the head twisted on the neck; strabismus was in- 
creased. While walking, the animal staggered, and the feet were lifted 
and put down in a spasmodic manner. Post-mortem the tumour 
was found to be a glioma. Hemorrhage was found at the base above 
the fourth ventricle, also on the right side about half an inch from the 
median commissure. 

DirFERENTIAL D1acnosis.—Cerebral apoplexy is suspected when a 
sudden attack of loss of consciousness followed by paralysis occurs, 
especially when no history of traumatism can be obtained. Embolism 
must be thought of when the animal is the subject of parasitic aneurism 
or heart disease. In these cases the resulting paralysis is more localised 
than in cerebral hemorrhage, and loss of consciousness is not often 
present. If the condition 1s slow in its onset, thrombosis should be sus- 
pected. It is not possible to differentiate cerebral hemorrhage from 
meningeal hemorrhage. 

TREATMENT.—This is very unsatisfactory. In the early stages vene- 
section is advised. Perfect quietnessisimportant. Purgatives are indi- 
cated, such as aloes and calomel. Stimulants are contra-indicated. 
Potassium iodide is advised in order to assist in the absorption of extrava- 
sated blood. 


MENINGEAL H/EMORRHAGE. 


Hemorrhage in connection with the meninges may occur between the 
bones of the skull and dura mater (extradural), or on the surface of the 
brain internal to the dura mater (intradural). 

Et1oLogy.—Meningeal hemorrhage may be the result of directinjury, 
of blows or falls, fractured skull, or gunshot wounds. Sometimes the 
meningeal vessels become so weakened by being involved in inflammatory 
processes of the dura mater that they may actually rupture spontaneously. 
The condition is occasionally observed in the newly born animal on 
account of undue violence used during delivery. The size of the hemor- 
thage depends on the nature, extent, and severity of the injury, and on 
the vessel affected. 


DISEASES OF THE BRAIN: HORSE 1159 


Symproms.—At first the animal is restless and excited, but the 
gradual onset of profound drowsiness is soon apparent, the pulse is full 
and slow, and respiration quickened, difficult, or even stertorous. Later 
coma is likely to supervene. The period of unconsciousness varies, and 
is often due to concussion. After a time it passes off, only to be followed 
by a second period of unconsciousness due to increased intracranial 
pressure on account of extravasated blood. 

Protrusion and congestion of the eyeballs, with dilatation of the 
pupils, may be noticed where the oculo-motor nerve nucleus is involved. 
If the brain tissue is lacerated or the hemorrhage extensive, death occurs 
in from twenty-four to forty-eight hours. 

TREATMENT.—In cases due to traumatism, the radical line of treat- 
ment advised by some writers consists in trephining the skull, exposing 
the clot, removing it, and checking the hemorrhage by ligature or other 
means. Needless to remark, such an operation is hardly likely to be 
undertaken by the general practitioner. Moreover, the risks of menin- 
gitis supervening must be considered, and the difficulties in diagnosis 
cannot be overlooked. 

Absolute rest, cold applications to the head, and the internal adminis- 
tration of agents likely to lower blood-pressure, are indicated. 


H/MORRHAGE INTO THE PONS VAROLII, MEDULLA OBLONGATA, 
AND CEREBELLUM. 


Hemorrhage occurring in the central region of the pons is followed 
by deep coma and paraplegia, and a fatal termination results after a 
short interval. Cadéac records cases in which unilateral facial paralysis 
and hemiplegia were observed, also instances in which paralysis of the 
hypoglossal and of the facial nerve was present, associated with paralysis 
of the lips and ocular symptoms. 

Hemorrhage into the medulla may occasion sudden death, owing to 
the destruction of the vital centres. A slight hemorrhage from the 
medullary vessels is usually followed by irregular asymmetrical paralysis 
of groups of muscles. 

Cerebellar hemorrhage is not common, and the symptoms are obscure. 
In the Prussian Military Report, 1888, a case of cerebellar hemorrhage 
and softening is recorded by Brissot. The horse at times exhibited such 
vicious tendencies that it was impossible to approach him. The head 
was carried to one side, and there was complete inco-ordination of muscular 
movements. 


1160 SYSTEM OF VETERINARY MEDICINE 


EMBOLISM AND THROMBOSIS OF CEREBRAL BLOODVESSELS. 


Cases of embolism and thrombosis affecting the cerebral circulation 
have been only sparsely recorded by veterinary writers, but no doubt 
the condition occurs in the lower animals, although not so frequently as — 
in man. 

Plugging of the cerebral vessels may occur as the result of mitral or 
aorta valve disease, or aneurism of the anterior aorta or carotids, owing 
to portions of the valvular vegetation or particles of fibrin becoming 
detached and carried into the cerebral circulation. Such conditions as 
embolism and thrombosis cause obstruction to the blood circulation, and 
set up softening of the portions of the brain tissue supplied by the 
affected vessels, unless the blood-supply is kept up by collateral anasto- 
mosis. The term “ encephalo-malacia ” is used to indicate a condition 
in which there is softening of the cerebral tissues. Brain tissue so affected 
becomes greyish or speckled in colour, softer than normal in consistence, 
and, if cut with a knife, appears to have lost its smooth glistening appear- 
ance. It readily breaks up under the pressure of a stream of water, or 
may even be fluid in consistence and milky in appearance. Sometimes 
the tissue presents a yellowish-brown colour, due to the decomposition of 
blood-pigment. It is not infrequent to find in cases of embolism recog- 
nisable extravasations of blood scattered throughout the diseased area, 
and then a form of so-called red softening may occur in their neighbour- 
hood. Embolism may lead to acute hemorrhage, but even apart from 
this, death may occur rapidly if the blood-supply to the vital centres is 
cut off—so rapidly, in fact, that sufficient time may not have elapsed 
for the production of any visible microscopical change in the brain tissue. 
Embolic lesions confined to the motor tracts will determine secondary 
degenerative changes in these tracts if the animal is allowed to live long 
enough. Sometimes the softened area is absorbed, leaving a cyst-like 
formation in its place. This usually occurs in cases where comparatively 
unimportant brain matter is involved, and where recovery takes place. 

Symproms.—The symptoms resemble those of cerebral hemorrhage 
already mentioned, but are more likely to be localised than general, 
owing to the fact that the only portion of the brain tissue involved is that: 
supplied by the affected vessel. Sudden complete loss of consciousness 
occurs less commonly than in apoplectic conditions. Death supervenes 
very quickly in some cases. Embolism and thrombosis are occasionally 
followed by hemiplegia and coma, or hemiplegia occurs alone without 
coma. As has been already noted, recovery takes place when unim- 
portant brain matter is involved. 


DISEASES OF THE BRAIN: HORSE 1161 


Thrombosis is not nearly so common as embolism, but, when it occurs 
the symptoms are much slower in their onset. It eventually, however, 
gives rise to the same effect as embolism—7.e., ataxia, coma, and various 
forms of paralysis. Cases of thrombosis and embolism may exhibit 
symptoms similar to those occurring in so-called “sleepy ” or “ head 
staggers.” 

TREATMENT.—If the condition is diagnosed, treatment should be 
instituted on the same lines as for cerebral hemorrhage (see p. 1158). 


TUMOURS OF THE BRAIN. 


The formation of tumours within the cranial cavity is not a common 
occurrence, but, nevertheless, they are more frequently seen in this 
situation than within the spinal canal. Many varieties cf neoplasms have 
been described, but by far the commonest tumour occurring in the horse 
is one which is termed a “‘ psammoma.” These tumours, however, differ 
very materially from the neoplasms described under this title in human 
pathology, and are characterised by the presence of a varying amount of 
cholesterin. They usually originate in connection with the choroid plexus, 
and may be uni- or bilateral, and vary in size from a pea to a hen’s egg. 
They will often be found to occupy the greater part of the lateral ven- 
tricles on post-mortem examination. Sarcomata and melanotic sarco- 
mata are usually metastatic when they occur, and, under these circum- — 
stances, are multiple. Simple sarcomatous growths have been described 
stowing from the membranes or cranial bones, and later on invading the 
brain substance. Gliomata are another variety of brain tumours, and 
they may be described as a hyperplasia of the neuroglia. In appearance 
these growths bear a strong resemblance to normal brain tissue, and it 
is very difficult to ascertain where the tumour ends, and the brain tissue 
begins at the periphery of the growth. Neoplasms of the nature of glio- 
sarcomata are occasionally identified, and appear to invade and destroy 
the bloodvessels in their immediate neighbourhood, giving rise to hemor- 
rhage. The following tumours have also been recorded as occurring In 
connection with the brain or its membranes: Myxomata, osteomata, 
fibromata, lipomata, angiomata, and secondary carcinomata. The 
peculiar brain tumour known as a “ cholesteatoma ” occurs very rarely, 
and is really of the nature of a teratoma or cyst which develops in the 
cerebral hemispheres. 

Parasitic cysts involving the brain are not common in horses. Occa- 
sionally cystic formation follows on the disintegration of other tumours. 


1162 SYSTEM OF VETERINARY MEDICINE 


When tubercular deposits take place in the brain, they occasion pre- 
cisely similar symptoms to those of brain tumour. 

Morpip ANAtoMy.—The appearance of a brain affected with tumour 
formation depends greatly on the nature of the growth and its position. 
The neoplasm may have its origin in the brain, meninges, or cranial bones, . 
frequently spreading inwards from these situations. A zone of subacute 
inflammation surrounds the periphery of the tumour, and the neighbour- 
ing brain tissue is infiltrated by round cells and serous exudate. In 
other cases it may be the seat of yellow or white softening, the entire 
brain contents becoming cedematous and increased in size owing to cir- | 
culatory disturbance. The convolutions may become more or less 
obliterated if the brain undergoes any considerable enlargement. Some- 
times the cranial bones overlying the growth are thinned by pressure, and 
become so soft that they may be indented by digital pressure. The term 
“ craniotabes ” is applied to this condition. When the tumour lies in the 
lateral ventricle, or occurs at the base of the brain, itis usually well defined 
in outline, whereas it may be somewhat difficult to recognise in other 
situations. Great distension of the ventricles is said to accompany 
tumour formation in the middle lobe of the cerebellum. 

Fletcher recorded a case* in which a tumour composed almost entirely 
of cholesterin, in the form of an irregular grey body the size of half a 
walnut, was found post-mortem, between the cerebellum and the medulla 
on the leit side. It was partly blended with the choroid plexus. 

Rutherford reported a case in which an elongated, firm tumour was 
found lying behind the cerebellum, between the latter and the medulla. 
It was studded with numerous glistening particles of cholesterin. 

Cadiot met with a tumour of the right cerebral hemisphere in a five- 
-year-old stallion. It occurred in the form of a large soft mass of a reddish- 
grey tint, and occupied the upper part of the lateral ventricle, and pene- 
trated in various directions into the grey matter. Examination showed 
that it was a glioma. 

Symptoms.—The period which exists between the commencement of 
tumour development and the onset of symptoms varies greatly with the 
nature of the growth. In many cases no serious symptoms are set up 
for years. Brain tumours determine general symptoms by causing in- 
creased intracranial pressure, and special or focal symptoms by destroy- 
ing the tissue in which they grow, and by exerting pressure on neigh- 
bouring structures. General symptoms may take the form of greatly 
increased excitability, which in certain cases may amount to acute mania. 
There is sometimes profound disturbance of temperature (hyperpyrexia) 


* Journal of Comparative Pathology and Therapeutics, 1891. 


DISEASES OF THE BRAIN: HORSE 1163 


if the tumour occurs in the pons, medulla, or corpus striatum. A very 
constant and pronounced symptom due to increased intracranial pressure 
is venous congestion of the optic papilla. This symptom is made evident 
by the use of the ophthalmoscope, and is said to be much more constantly 
present in this condition than in any other. The congestion is often 
bilateral when the base of the brain is affected, and is followed by atrophy 
of the papilla and chronic dilatation of the pupils. During the growth of 
some tumours, attacks of vertigo, followed by pronounced dulness, slow- 
ing of the pulse-rate and respiratory movements, constipation, and in- 
activity of the general body functions, are seen. These cases terminate 
by the animal sinking into general coma. The development of focal 
symptoms depends altogether on the position of the tumour, and is of 
great assistance in determining its localisation. In tumours occurring in 
the sensorio-motor areas, spasms of groups of muscles or even Jacksonian 
epilepsy occurs primarily, to be followed by some form of paralysis, 
monoplegia, or hemiplegia, sometimes associated with hemianesthesia. 

If a tumour is situated in the internal capsule or basal ganglia, a wide- 
spread paralysis occurs without previous muscle spasms or convulsions, 
and the paralysis occurs on the opposite side of the body to that of the 
tumour. Tumours of the pituitary gland are very rare. Disturbance 
of vision occurs owing to the proximity of the gland to the optic 
chiasma. | 

In tumours of the cerebellum there may be well-marked choking of 
the optic papilla, cerebellar ataxia, vertigo, nystagmus, and sometimes 
hemiplegia from pressure on the underlying pons. When the occipital 
lobe, optic thalamus, or other portion of the optic tracts are involved in 
the growth of tumours, there is hemianopia, amaurosis, or other disturb- 
ances of vision, and occasionally symptoms of ataxia. 

Tumours of the corpora quadrigemina will give rise to inco-ordination 
of the muscles of the opposite side of the body, and very often double 
ophthalmoplegia. Deafness results from tumours occurring in the tem- 
poral lobe. Tumours growing at the base of the brain are liable to im- 
plicate the cranial nerves, and then special symptoms are recognisable, 
such as paralysis of the optic, trigeminal, facial, glosso-pharyngeal, or 
hypoglossal nerves. Superficial tumour formations, or those involving 
the bones, may cause local tenderness over the site of their development, 
and even lead to destruction of the bone, with consequent protrusion of 
the brain tissue. 

In Fletcher’s case (see p. 1162) the animal always seemed nervous, 
and for six months previous to death the head was inclined towards the 
left, and the poll towards the right side. The animal was unable to walk 


1164 SYSTEM OF VETERINARY MEDICINE 


steadily in a straight line, and in the later stages there was difficulty in 
backing and in controlling the hind-limbs. 

In Rutherford’s case (see p. 1162) the horse staggered as if intoxicated, 
and crossed his legs; the eyes had a vacant stare, there was twitching of 
the eyelids and hyperesthesia of the limbs. The animal was very 
nervous, and started at the slightest sound. Ifforced to move, he would 
stagger, and while standing, the limbs were drawn wide apart, appearing 
like props to the body. | 

In Cadiot’s case (see p. 1162) the horse would stumble over obstacles 
on the road, and no longer obeyed the reins. The head and neck were 
held in a stiff manner, the neck was slightly concave on the right side, 
and the head was inclined downwards and towards the left. While at 
rest he seemed unsteady in the limbs of the near side, the legs were 
brought closely together, and the fetlocks were semiflexed, as if the animal 
wished to lie down. He turned towards the right in an ever-decreasing 
circle, and finally swayed from side to side and fell down. There was 
difficulty in rising, and assistance had to be given. If the fore-limbs 
were crossed, the horse remained in this position. He was unable to 
walk in a straight line, and continually turned towards the right. Trot- 
ting was impossible, but he could back with ease. Pressure over the 
lumbar region was painful, and caused the animal to fall. In the right 
eye vision was abolished, the pupil was dilated, and the eyelids were 
mobile. On ophthalmoscopic examination the papilla was found 
markedly hyperemic, and the vascular strie very prominent, especially 
towards the margin. The sense of hearing was less acute than normal. 
General sensation was diminished, except in the region of the head and 
limbs. There were no evidences of vertigo. The appetite was good. 

CoursE AND Prognosis.—The severity of the symptoms and the 
rapid progress of the case depends on the nature of the tumour present 
and its position. Death speedily follows the development of malignant 
neoplasms or those in which hemorrhages are likely to occur. In other 
cases death results from exhaustion, emaciation, pneumonia, or inter- 
ference with the vital centres in the medulla. The prognosis in the case 
of cerebral tumour formation is very grave, recovery being rare, and 
treatment practically hopeless. 

DIFFERENTIAL D1aGnosis.—Diagnosis is very difficult, and the con- 
dition is likely to be confused with cerebral abscess, chronic encephalitis, 
chronic meningitis, acute encephalitis, embolism, cerebral apoplexy, and 
thrombosis. The slow onset of symptoms in tumour formation is of 
assistance in differentiating the condition from that of hemorrhage, 
embolism, or thrombosis. In abscess formation diagnosis is assisted 


DISEASES OF THE BRAIN: HORSE 1165 


when a history of septic processes having occurred in the neighbourhood 
of the head is obtained, together with a fluctuating temperature. Cases 
of acute meningitis and encephalitis run a much more rapid course, and 
are accompanied by fever. The use of the ophthalmoscope and the 
presence of localised symptoms assist in diagnosis. 
TREATMENT.—Theoretically, in cases of superficial tumours, operative 
interference is suggested, but practically any treatment is hopeless, and 
destruction of the animal is the most advisable course to adopt. 


COMPRESSION AND CONCUSSION OF THE BRAIN. 


The brain is not commonly injured when external violence is applied 
to the skull or when the animal takes part in a serious accident, on account 
of various physical and architectural arrangements present in the cranial 
anatomy which tend to absorb vibration and disperse violence, thus 
preventing such influences from reaching the brain. In the horse it may 
be said that traumatic injury involving the skull is the almost universal 
cause of injury to the brain. Such injuries inc ude fracture, with or 
without depression of the cranial bones, followed by more or less simul- 
taneous hemorrhage and extensive bruising of the brain tissue. Con- 
tusion of the brain and its membranes without apparent injury to the 
bone may result from a fall, and only slight bruising of the skin is then 
apparent. In this case, however, the damage to the brain and meninges 
overshadows the osseous lesions, which must be regarded as compara- 
tively unimportant. At the instant an injury occurs the brain receives 
shock, or is bruised or even destroyed, by the concussion or forcing 
inwards of portions of the organ, with consequent, almost immediate, rise 
in intracranial pressure. This brain shock usually occasions the exhibi- 
tion of general symptoms, but sometimes only local symptoms are shown. 

The clinical manifestation of the foregoing condition are termed “ con- 
cussion ’’ and “ compression ”’ of the brain. If the skin is broken by 
direct violence, the fracture which follows will be found at the seat of the 
impact, and its extent varies with the nature of the impinging object and 
the degree of violence exerted. Fractures caused by indirect violence— 
that is, when the bone breaks at a point other than the seat of injury— 
are almost always due to violence inflicted with a blunt instrument 
acting over a wide area. A compound fracture involving the dura mater 
must always be regarded as a serious injury. Simple or fissured fractures 
often prove difficult of diagnosis. Compound fractures are easy to diag- 
nose, as the lesion in the bone is generally visible. The cerebral vessels 
may be punctured by a spicule of bone driven into them in cases of de- 


1166 SYSTEM OF VETERINARY MEDICINE 


pressed fractures. Fractures at the base of the skull may be due to a 
fall or to a heavy object striking the head. Sometimes in these cases 
the condyle of the lower jaw may be driven through the base of the skull, 
especially when the animal falls on the chin. These basal fractures are 
frequently associated with contusion and laceration of the brain tissue, — 
with consequent injury to the cranial nerves. Punctured wounds of the 
brain are not common, but when they occur are generally compound. 
These wounds may be occasioned by a bullet, and septic matter may be 
introduced with the foreign body. 

A slow form of compression of the brain occurs in connection with 
chronic lesions of the meninges, hydrocephalus, exostoses on the cranial 
bones, neoplasms of the brain, etc. 

Hr1oLocy.—Difficulty has been experienced in explaining the causa- 
tion of the serious symptoms occurring after concussion. It was at one 
time held that the brain was thrown into a state of vibration, thus 
causing temporary suspension of its functions, but this theory is un- 
tenable on anatomical and physical grounds. The incidence of slight 
capillary hemorrhage has also been put forward as an explanation of 
these symptoms, but as these hemorrhages persist for a long time after 
the symptoms have passed off, and are never so extensive as to account 
for the profound unconsciousness which occurs in these cases, it is diffi- 
cult to hold them entirely responsible as etiological factors. Duret’s 
theory 1s now generally accepted. He states that the symptoms are due 
to stimulation of the restiform bodies by a wave of cerebro-spinal fluid, 
which is driven against the base of the brain by a blow on the skull, thus 
producing profound anemia of the cerebral tissues, to which the symp- 
toms can be directly attributed. The momentary increase in intra- 
cranial pressure which occurs at the instant the blow is given would 
account for the capillary hemorrhages. 

The symptoms of compression are explained as follows: If any addi- 
tion is made to the bulk of the matter inside the cranial cavity, room is 
gained at first by displacement into the vertebral canal of a certain 
amount of cerebro-spinal fluid. If the pressure increases still more, the 
cerebral capillaries become compressed, thus disturbing circulation and 
interfering with nutrition of the brain tissue. Later the pressure bears 
on the brain substance itself, producing the characteristic symptoms of 
compression. The vagus and vasomotor centres are irritated, causing 
slowing of the pulse-rate, contraction of the small arterioles, and increased 
arterial tension. This maintains an adequate circulation in the vital 
centres in the medulla. The Cheyne-Stokes respiration, which is fre- 
quently observed under these circumstances, is due to rhythmical varia- 


DISEASES OF THE BRAIN AND MEMBRANES: HORSE = 1167 


tion in arterial tension. During the period of the fall in blood-pressure 
the centres kecome anemic and respiration fails, while during the rise in 
pressure the medulla is again supplied and breathing is resumed. The 
compressed parts of the brain become anemic, while the other parts 
become congested, so that the nutrition of the entire organ is interfered 
with. | 

Morspip ANATomy.—At a post-mortem examination of a case ex- 
hibiting symptoms of concussion before death there is likely to be some 
damage to the brain tissue, such as minute hemorrhages scattered widely. 
In other cases we may be able to discover colloid bodies, patches of 
sclerosis, and pigmentary degeneration of nerve cells. When the symp- 
toms of compression have been exhibited ante-mortem, the lesions vary 
greatly according to the extent of the injury. In some instances minute 
petechial hemorrhages are found, but in more severe cases visible areas 
of extravasation, varying in size from a split pea to a hazel-nut; may be 
identified. These appear as a dark zone of extravasated blood sur- 
rounded by an area of red softening, occurring in any situation. Distinct 
laceration of the brain may be present, and these cases are always fatal 
and due to fracture. In compound fracture the brain may protrude 
through the external opening. If extensive hemorrhage is present, 
blood may be found in the ventricles. When recovery takes place after 
a serious brain injury the disintegrated brain substance is replaced by 
cicatricial tissue. The nerve cells and fibres are never regenerated. 
Extravasations of blood may become encapsulated, and constitute the 
so-called “hemorrhagic cysts.”” Notrarely adhesions occur between the 
brain and its membranes, or between the meninges, brain, and cranium. 
Meningitis and cerebral abscess frequently follow on severe brain 
injuries. 

Symproms—1l. Concussion.—The symptoms of concussion are in 
reality those of shock. Immediately after the injury is inflicted signs 
of profound general disturbance are exhibited, but in some instances 
several minutes may elapse before these symptoms appear, especially 
when they are due to hemorrhage. In slight cases the affected animal 
stumbles and falls, and becomes unconscious for a short period, rising 
again after an interval. He may appear dazed for a few minutes after 
he regains consciousness. In severe cases the animal falls, and dies in 
a short time, disp]~ying convulsive attacks without having regained. 
consciousness. 

In an ordinary case the pulse is infrequent, small, and feeble, and very 
often irregular, and the respirations are short, shallow, and often sighing 
in character. If the animal lives long enough, the temperature hecomes 


1168 SYSTEM OF VETERINARY MEDICINE 


subnormal, the skin is cold and covered with a clammy sweat, the pupils 
are widely dilated, and react sluggishly to light. It is possible to rouse 
the animal by shouting, but he soon becomes lethargic again; voluntary 
movements and deep reflexes are abolished, but no true muscular paralysis 
exists. After a varying interval—from a few minutes to a few hours— — 
the horse regains consciousness, and occasionally at this stage mild 
epileptiform seizures occur, and the symptoms gradually pass off, the 
pulse becomes more frequent and bounding, until complete consciousness 
is regained. 

Even after recovery the animal may hold the head to one side or 
move in circles, whilst in other cases so-called ‘‘ waltzing movements ” 
are displayed. More rarely hemianesthesia, or paralysis of cranial nerves 
resulting in amaurosis, etc., may occur. Occasionally, when the symp- 
toms of unconsciousness have passed off, the horse becomes very restive, 
tosses about, the eyelids are closed, the pupils contracted, the pulse slow, 
feeble, and small, and grinding of the teeth is observed. In these cases 
recovery proceeds very gradually. 

2. Compression.—This term is used to express a condition in which 
there is marked increase of intracranial pressure due to hemorrhage or 
other causes. The symptoms frequently supervene on those of concus- 
sion, but there may be an interval during which apparent recovery takes 
place, and then the graver symptoms of compression are exhibited. The 
rapidity of onset of symptoms and their course and duration vary widely 
according to the nature and extent of the brain lesion. The first symp- 
toms are those of irritation, hypersensitiveness to external stimuli, rest- 
lessness, contraction of the pupils, and falling temperature. As pressure 
increases paralysis ensues, and there is gradual loss of consciousness 
passing on to coma. During the period of coma there is cyanosis of the 
nasal mucose, the pulse is full, slow, and bounding, the respiration slow 
and deep, later becoming stertorous and snoring, on account of paralysis 
of the soft palate. Retention of urine and feces due to paralysis of the 
bladder and rectum is frequently present. .Sometimes focal symptoms 
are seen, due to pressure on definite cortical centres which control certain 
groups of muscles on the opposite side of the body to that of the lesion. 
These muscles first show spasm, and later paralysis. Hemiplegia or 
ophthalmoplegia may supervene later, the pupils are dilated or con- 
tracted, and the pupillary reflex to light is lost. Choking of the optic 
papilla is observed on ophthalmoscopic examination, the vessels being 
distended and tortuous. The incidence of hyperpyrexia usually indi- 
cates a fatal termination. Towards the end coma becomes more pro- 
found, and muscular and sensory paralysis is general and complete. The 


DISEASES OF THE BRAIN: HORSE | 1169 
vital centres in the medulla may become involved, and death results from 
cessation of respiration and cardiac action. In this connection it is well 
to note that different parts of the brain show varying power of resistance 
to circulatory disturbance, the cortex is least resistant, whereas the 
medulla is most resistant, therefore the respiratory and cardiac centres 
hold out longest. Death is often hastened by hypostatic pneumonia, 
and may be preceded by the occurrence of Cheyne-Stokes respiration. 
When the condition is septic there is a considerable elevation of tem- 
perature during the whole course of the disease. Death may occur 
within a few hours after an injury, when there is extensive hemorrhage, 
or the patient may lie for days in an unconscious condition. Depressed 
fractures or the presence of foreign bodies, such as bullets per se, would 
appear to be incapable of causing severe symptoms of compression, and 
when such phenomena occur under these circumstances they are generally 
due to hemorrhage or to interference with circulation, with resulting 
cedema. -In many cases depressed fractures or foreign bodies cause no 
disturbance of health. 

The symptoms of basal fracture are often indefinite. Heemorrhage 
from the nose or mouth, followed by the escape of cerebro-spinal fluid or 
even brain matter appearing in the oral cavity, may be seen in fractures 

involving the pharynx. Slow discharge of dark blood from the ears, 
followed by the escape of cerebro-spinal fluid, with profound uncon- 
- sciousness, may occur in other cases. The special points of assistance in 
. diagnosis of basal fracture are the incidences of unconsciousness and the 
- diffuse character of the cerebral symptoms, evidence of injury to indi- 
vidual cranial nerves, persistent hemorrhage from the nose, mouth, or 
ears, extravasation of blood under the conjunctiva or behind the mastoid 
process. Notwithstanding all these signs, diagnosis is often difficult. 

Proenosis.—In coneussion, if unconsciousness is speedily got over, 
and due only to this cause, the prognosis is good, and recovery usually 
complete. The prognosis in a case of compression is usually unfavour- 
ablein the horse. High temperature, persistent contraction of the pupils, 
and the occurrence of such conditions as nystagmus, are regarded as 
unfavourable. If serious destruction of the brain tissue, a compound 
fracture, or an extensive hemorrhage, be present, the case is almost 
bound to terminate fatally. In many cases the patient recovers partially, 
but exhibits symptoms of permanent injury which render him useless. 
Compound septic fractures are always fatal. 

DIFFERENTIAL D1aGNosis.—When an animal receives a shock and is 
found unconscious, it 1s extremely difficult to decide whether the uncon- 


sciousness is due to concussion, compression, or, in many cases, whether 
VOL, II. 74 


1170 SYSTEM OF VETERINARY MEDICINE 


serious injury is present or not. The condition must be carefully dis- 
tinguished from trauma, apoplexy, embolism, etc. The animal should 
be carefully examined for the presence of fracture or other injury to the 
skull. The sudden appearance of unconsciousness unaccompanied by 
fever suggests an injury. The localisation of the position of injury is 
based on the focal symptoms shown. If no injury can be detected, 
diagnosis is difficult. 

TREATMENT.—In the treatment of this condition rest must be con- 
sidered of primary importance, so as to prevent congestion and to diminish 
the risk of bleeding from damaged bloodvessels. The animal should be 
removed to a comfortable, well-bedded loose-box. Cold applications, 
such as water, ice, etc., may be applied to the region of the head, with 
the object of diminishing hemorrhage. 

Where hemorrhage is suspected, venesection can be resorted to. In 
any case, brisk purgation is indicated. Some authorities recommend the 
administration of a dose of atropine and ergotin combined. After an 
interval, when it has been supposed that a clot has formed, the adminis- 
tration of stimulants is indicated. If unconsciousness persists, directions 
should be given to turn the animal, so as to prevent the formation of bed- 
sores. The diet should be laxative and easy of digestion. Even if the 
animal recovers consciousness within a few minutes, he should be rested 
for at least a fortnight. Injuries to the skull of the nature of fracture or 
extensive laceration should be treated surgically. In severe injury 
immediate slaughter is the wisest course to adopt. 


PARASITES OF THE BRAIN. 


Invasion of the cerebral tissues by parasitic cysts is not common in 
the horse. However, Cenurus cerebralis and other parasites have been 
identified, generally occurring singly in one of the hemispheres or in the 
lateral ventricle. For further information, see section on Parasites. 


DISEASES OF THE CEREBELLUM. 


Heemorrhage of the Cerebellum.—This lesion has been observed by 
Girard, Ollivier and Martin, Thomassen, and Kopp. Degenerative 
changes usually follow in a variable period of time. The symptoms 
recorded were very variable. In some cases paralysis of the right side 
of the body was observed in connection with an area of softening in the 
right hemisphere of the cerebellum. Brissot recorded an instance in 
which the animal exhibited such violent symptoms that the attendant 


DISEASES OF THE BRAIN: HORSE 1171 


could not approach him, the head was turned either to the right or the 
left side, and there was complete inco-ordination of muscular movements. 
Kopp met with a case in which the horse practised self-mutilation by 
biting the muscles of the left elbow. The animal also displayed clonic 
contractions of the muscles all over the body. On the fifth day slight 
paralysis of the lower lip was observed, delirium appeared, the animal 
neighed frequently, and later on became violent. On the thirty-first day 
evidences of apoplexy and general paralysis supervened. In Ollivier and 
Martin’s case the animal, without showing any previous symptoms, held 
his head depressed, showed disinclination for movement, and died 
suddenly. Lesions of the vermiform process were found to produce 
ataxia, muscular inco-ordination, and a stumbling gait. 

Cases have been met with in which lesions of the cerebellum were not 
accompanied by any symptoms, but in such the vermiform process was 
not involved. 

Abscess of the Cerebellum.—This lesion is rarely met with. A case 
was recorded by Corby* in which the abscess was consecutive to an 
attack of strangles. Instances have also been observed by Trasbot, 
Gotze, Baret, and Jacoulet. 

The symptoms manifested were inco-ordination of muscular move- 
ments, loss of equilibrium, and inability to maintain the standing pos- 
ture. In some cases the loss of power in the hind-limbs was well marked, 
and the animal fell to the ground, but after a short time was able to rise. 
More often the animal did not fall quickly, but first took some steps in a 
backward direction. In Corby’s case there was preliminary excitement, 
followed by coma and loss of sight. 

Tumours of the Cerebellum.—sSee pp. 1162-1164 for description of 
tumours of this region. 

Melanomata have been met with by Blanc and Roll, and a cystic 
tumour by Lorge, which invaded the left cerebral hemisphere as well as 
the cerebellum. 


DISEASES OF THE PONS VAROLII. 


Heemorrhage of the Pons Varolii.—Cases of this lesion have been 
observed by Girard, Briickmuller, Dieckerhoff, and Thomassen. The 
condition is associated with softening of the organ. 

The etiological factors recognised were atheromatous alterations in 
the vessels, and, in rare instances, external injuries. Degenerative changes 
(softening) may result from lesions of the basilar artery, such as throm- 


* Veterinarian, 1859. 


1172 SYSTEM OF VETERINARY MEDICINE 


bosis. Briickmuller and Dieckerhoff have observed a few instances in 
which the presence of parasites was the cause of the morbid alterations. 
The nervous lesions occurring in the pons consist of a loss of consistence 
in the nervous tissue, which is altered to a yellowish colour. They may 

be central or unilateral. | 

Symproms.—In cases of hemorrhage of the pons, death may occur 
suddenly, or the symptoms resemble those met with in cerebral apoplexv 
(see p. 1157). When the lesions consist of degenerative changes, marked 
nervous depression is observed as a premonitory symptom. In both 
instances, and in cases where the lesion is unilateral, alternate hemiplegia 
occurs, facial paralysis being observed on the side corresponding to the 
lesion, associated with paralysis of the limbs on the opposite side of the 
body. Girard observed a difficulty in mastication, the food accumulating 
between the teeth and the cheeks, owing to paralysis of the hypoglossal 
nerve and of the facial nerve of the same side; also drooping of the ear 
and paralysis of the upper eyelid. Thomassen met with instances in 
which ocular lesions were present, such as keratitis, ulceration of the 
cornea, and even complete disorganisation of the eyeball. The lips 
deviate towards the opposite side of the body. 

Cadéac observed hemianesthesia (anesthesia of one side) of the face, 
and loss of the corneal reflex. The limbs of the opposite side were dragged 
along the ground, and unable to support weight. In many instances the 
limbs are primarily involved, and the facial region is subsequently 
paralysed. Paralysis of all the limbs occurs when the lesion is central. 
It is not possible to differentiate hemorrhage of the pons from softening 
of this structure. . 

Tumours of the Pons.—These include melanomata, sarcomata, fibro- 
sarcomata, fibromata, and endotheliomata. 

Symproms.—These resemble to a certain extent the phenomena 
occurring in hemorrhage and degenerative changes in the pons. Ac- 
cording to the recorded cases, facial paralysis of the side corresponding 
to the lesion is usually present. Compression exerted by the tumour on 
the roots of certain of the cranial nerves and on the structures in the 
vicinity of the pons produces important symptoms. Thus, when the 
motor oculi (third cranial nerve) is involved, the muscles of the eye 
become paralysed. When the roots of the fifth nerve become compressed, 
paralysis of the jaws occurs. Other phenomena are observed according 
to the structures involved. Thus can be explained the occurrence of 
loss of equilibrium, turning in a circle, hemianesthesia of the face, 
and paralysis of the buccinator muscle. Cadéac has observed defective 
hearing, polyuria, glycosuria, albuminuria, ptosis, alternate hemiplegia 


DISEASES OF THE BRAIN: HORSE 1173 


and conjugate deviation of the eyes, sensory disturbances, and some- 
times hyperesthesia. The course of the disease is slow, and death 
finally results. 


DISEASES OF THE CRURA CEREBRI. 


Heemorrhage and Softening.—Hemorrhage may occur as the result 
of vascular changes in infectious diseases, such as strangles and pneu- 
monia, or from senile degeneration. 

Softening has been observed in cases of thrombosis, embolism, and 
hemorrhage. 

Symproms.—In the recorded cases the following symptoms were 
observed: Alternate hemiplegia, in which the motor oculi nerve is involved 
on one side, and paralysis of the facial nerve and of the limbs is observed 
on the opposite side. Storck observed paralysis of the upper eyelid 
(ptosis) to a varying extent, the eye was deviated outwards, and the 
pupil did not react to light. Prehension of food was deficient, the hypo- 
clossal nerve was paralysed, leading to loss of power in the muscles of 
the tongue, and the facial nerve was also involved. A staggering gait 
was observed, and the fore and hind limbs of the side corresponding to 
the affected facial nerve were paralysed. One side of the body was 
anesthetic. Not infrequently there was a tendency to walk in a circle. 
Difficulty in respiration, and excitement followed by depression, were also 
observed. 


DISEASES OF THE MEDULLA OBLONGATA. 


Heemorrhage.—This as a lesion per se is not so frequently met with 
as cerebral apoplexy, but is often associated with the latter. Cases are 
recorded by Dieckerhoff, Perrey and Deysine, Lassartesse, Leblanc, and 
others. 

The etiological factors are similar to those mentioned in the case of 
cerebral apoplexy. According to Duret, violent falls or injuries to the 
anterior frontal region of the head may cause the condition. Leblanc 
regarded violent contusions of the occipital region as a common etio- 
logical factor. 

Symproms.—These depend on the seat and on the extent of the 
hemorrhage. When extensive, it may involve the pons, the crura 
cerebri, the cerebral hemisplieres, and blood gains entrance to the fourth 
ventricle. In such cases death may occur rapidly. As the lesions may 
involve various cranial nerves, a variety of symptoms may be mani- 
fested, such as difficulty in mastication and deglutition, circulatory and 


1174 SYSTEM OF VETERINARY MEDICINE 


respiratory troubles, paralysis of the tongue, salivation, amaurosis, 
nystagmus, muscular inco-ordination, vertigo, moving in a circle, ete. 

Progressive Bulbar Paralysis — Synonyms. — Labio-glosso-laryngeal 
paralysis; Chronic inferior polioencephalitis. 

This condition, characterised by paralysis of the muscles of the lips, | 
tongue, soft palate, pharynx, and larynx, is described by various Con- 
tinental authors. It has been known in several localities in Belgium 
since 1851, also in Holland, and cases have been recorded by Cadéac in 
France, and by Froéhner and Rosenfeld in Germany. Horses aged from 
eight years old and upwards are those commonly attacked. 

The etiological factors have not been definitely determined. Thomas- 
sen suggested that the affection might depend on an intoxication arising 
from the ingestion of white beetroots. 

The paralysis of the affected nerves is generally symmetrical, and 
there is no deviation of the lips or of the tongue, but occasionally it is 
unilateral. The motor nerves involved are those having their origin in 
the floor of the fourth ventricle—viz., the facial, the vagus, and the 
hypoglossal. According to Degive, the lesions observed are discolora- 
tion and marked atrophy of the muscles of the tongue and of the lips, 
a slight diminution in volume of the roots of the cranial nerves men- 
tioned above, fatty degeneration of a large number of muscular fibres of 
the intrinsic muscles of the tongue. The substance of the medulla was 
apparently normal. According to Cadéac, cases are observed in which 
the lesions affect the entire extent of the medulla, and also involve 
the spinal cord, and may result from extension of cerebro - spinal 
meningitis. 

Symproms.—The affection is chronic and progressive. The early 
symptoms are not well marked, and consist of slight difficulty in pre- 
hension, mastication, and deglutition. Portions of the food escape from 
the mouth during mastication. As the disease progresses, food, fluid, and 
saliva escape from the mouth owing to paralysis of the lips, and there is 
difficulty in drinking. Later on the lower lip hangs and the tongue pro- 
trudes from the mouth, salivation is well marked, the masseter muscles 
become paralysed, and the lower jaw “drops” to a variable extent. 
Sometimes food and water return through the nostrils. When paralysis 
of the pharynx occurs, food may enter the trachea and bronchi, and set 
up septic broncho-pneumonia. Owing to paralysis of the larynx, an 
intense roaring sound accompanies respiration. In some instances the 
- muscles of the head and the masseter muscles become atrophied. The 
disease may continue for five or six months, but is always fatal. Death 
may occur from inanition or as the result of pulmonary gangrene. 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1175 


TREATMENT.—This is unsatisfactory. In the early stages nerve 
tonics, such as nux vomica and hypophosphites, are advised, and the 
food should be limited to oatmeal and linseed gruel, milk, etc. 

In well-marked cases treatment is useless. 

Tumours.—These are rarely met with. Cases of sarcomata and 
papillomata have been recorded. 

Symproms.—These depend on compression of the origin of certain 
cranial nerves (facial, vagus, hypoglossal, etc.). Paralysis of the tongue, 
irregular and accelerated respirations, constipation, and abdominal pain, 
have been observed. Cadéac records a case in which a tumour was 
situated at the upper extremity of the cervical spinal cord, and caused 
compression of the inferior part of the medulla. The symptoms observed 
were coma, followed in a few hours by death. 


DISEASES OF THE SPINAL CORD AND) ITS MEMBRANES. 


GENERAL REMARKS. 


As already remarked, diseases of the spinal cord are of more frequent 
occurrence in equine practice than affections of the brain, but at the 
same time we must admit that our knowledge of the former maladies is 
not in any way more advanced than is the case with the latter diseases. 
Similar difficulties in diagnosis occur in both, and the remarks made in 
connection with the post-mortem examination of the brain will equally 
apply to the spinal cord. A proper examination of the spinal cord can 
only be carried out by a skilled pathologist who is perfectly familiar with 
the normal histological characters of this structure, as well as with 
the morbid alterations. Theoretically, it is possible to fill pages with 
descriptions of the various lesions of the cord discovered by specialists, 
and also to lay down rules for the differential diagnosis of the diseases 
of this structure; but from a clinical point of view the subject can only 
be discussed within rather narrow limits. It must be remembered that, 
once we are satisfied an incurable disease of the cord exists, which in- 
capacitates a horse from work, destruction of the animal is the only 
tational course to adopt. But we cannot ignore the fact that even the 
broad differential diagnosis between a case presenting symptoms sug- 
gestive of a serious lesion which may possibly recover and one which is 
hopeless is in many instances by no means an easy matter. — 


1176 SYSTEM OF VETERINARY MEDICINE 


While the etiology of certain spinal affections is still wrapped in 
obscurity, we meet with many instances due to accidents, falls, injuries, 
etc. Such causes are far more likely to induce spinal than brain lesions, 
a fact which can be explained by the brain being so well protected by 
the cranial bones, while the spinal cord is more exposed to injuries of | 
various kinds, including fractures of the vertebrae in the dorso-lumbar 
region, resulting from excessive muscular action of powerful muscles 1 in 
this vicinity. 

Another point worthy of mention is that latent or obscure spinal 
affections may exist for a variable period without interfering materially 
with the working capacity of a horse, and in such instances a severe fall, 
or the occurrence of violent struggling while the animal is cast for an 
operation, may produce a serious and incurable lesion. On the other 
hand, although certain chronic lesions of the brain may occasionally exist 
without producing symptoms, yet in most instances the affected animals 
are unfit for work. 

Paralysis of the hind-limbs (paraplegia), inducing inability to rise, is 
one of the commonest nervous conditions met with in practice. As we 
shall see later on, it may depend on various lesions of the spinal cord, 
or on a combination of cerebral and spinal lesions. We may also remark 
that diseases of the dorso-lumbar portion of the cord are of far more 
common occurrence than those of the cervical region. Of late years 
Continental authorities have shown that lesions of the terminal portion 
of the cord are responsible for certain important nervous phenomena, 
which previously were not recognised. 

Probably the most common chronic nervous affections met with in 
the horse are those termed “ shivering” and “ stringhalt,’”’ but, as we 
shall point out when discussing these diseases, Continental authors do 
not describe the former as a special malady. There is no definite evidence 
to show that either of these affections depend on spinal lesions, although 
they are regarded by many as being due to disease of the cord. 

As regards the incidence of diseases of the spinal cord, the following 
figures taken from the Reports of the ary Veterinary Service, 1911-12, 
and 1912-13, are interesting: 





1911-12. 1912-18, 1911-12.* 1912-13,* 
y Paraplegia es ss 32 29 23 20 
General paralysis ate 5 7 6 6 
Stringhalt sig is 4 10 2 1 


* Army Veterinary Service, India. 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1177 


No mention is made of shivering in the above reports. Probably 
this is explained by the fact that the disease is usually met with in heavy 
horses (see p. 1219). 


ACUTE SPINAL MENINGITIS. 


Synonym.—Inflammation of the spinal meninges. 

Although the inflammatory process may commence in any of the 
spinal membranes, it generally spreads from one to the other of these 
structures. 

When the dura mater is alone involved, the condition is known as 
Pachymeningitis. This as a disease per se is rare in the horse, but as a 
chronic affection itis common inthe dog. In pachymeningitis the lesions 
are generally found on the internal face of the membrane, but in rare 
instances they occur on its external aspect, and the condition is termed 
‘external pachymeningitis,” or “ sclero-meningitis.”’ 

Leptomeningitis is the term applied to inflammation of the pia mater. 

There is a consensus of opinion with reference to the rarity of un- 
complicated spinal meningitis, and in practice we find that the condition 
is generally associated with inflammation of the cerebral meninges in the 
form of cerebro-spinal meningitis. We have observed cases in which the 
early symptoms pointed to inflammation of the spinal meninges, but 
later on evidences of cerebral meningitis were apparent. 

A chronic form of spinal meningitis is described by some authors, but 
it cannot be differentiated from chronic myelitis (see p. 1184). 

ETIoLoGy.—Spinal meningitis may occur as a complication of infec- 
tious diseases, such as strangles and contagious pneumonia. In strangles, 
when an abscess is formed in the region of the poll or upper part of the 
neck, the pus may burrow through the muscles, cause necrosis of the 
atlanto-axoid ligament, and reach the dura mater, or it may enter through 
the intervertebral foramina, or the infection may reach the meninges via 
the lymph channels and blood-stream. 

In surgical conditions, such as poll-evil, fistulous withers, caries of the 
vertebree, etc., purulent infection reaches the external aspect of the dura 
mater, and sets up inflammation, which then extends to the internal aspect 
of the membrane, and spreads to the pia mater. In tubercular ostitis of 
one or more of the cervical vertebre a tuberculous meningitis may result. 

As regards the influence of exposure to chills, excessive fatigue, long 
journeys by rail or boat, etc., these probably act as predisposing factors. 
We met with a case of spinal meningitis in a hunter that had been freshly 
docked, and sent a long journey by rail in very cold weather. Injuries to 
the vertebral column are believed to be a cause of the disease. 


1178 SYSTEM OF VETERINARY MEDICINE 


Morpip Anatomy.—The lesions are very slight in the dura mater, or 
may be absent, except in cases arising from surgical conditions. The pia 
mater and the arachnoid are the usual seats of the morbid alterations. 
In the early stages the meninges are congested, reddish in colour, and 
may show small punctiform hemorrhages. An inflammatory exudate is _ 
found in the intermeningeal space. At first this is fluid in consistency, 
and may be either of a light yellow colour or sero-sanguinolent. Later 
on it becomes turbid, and may contain fibrinous flocculi. In some cases 
the exudate is purulent. Some authors describe an increase in the serous 
fluid between the membranes as one of the morbid alterations, but, 
according to Hutyra and Marek, this does not indicate the presence of 
spinal meningitis, as it is also observed in cases of extreme emaciation. 
Dexler has found more or less resistant adhesions between the meninges. 
Gohier recorded a case in which large abscesses developed between the 
spinal cord and the membranes in the lumbar region. The fibrinous or 
purulent exudate may involve the roots of the spinal nerves. 

The spinal cord may be involved as a secondary condition, and areas 
of congestion and softening, or hemorrhagic foci may be observed. 
Cadéac states that the cellular tissue between the spinal canal and the 
dura mater is more or less infiltrated, and in some instances shows 
suppurative foci. 

Symproms.—When the affection is associated with cerebral menin- 
gitis, the symptoms of the latter predominate, and it is not possible to 
recognise the phenomena attributable to the spinal lesions. When, how- 
ever, the lesions are confined to the spinal meninges, certain symptoms 
are presented which are fairly characteristic; but, as already remarked, 
such cases are of comparatively rare occurrence. The nervous pheno- 
mena depend more on the implication of the spinal nerve roots and the 
nerve terminals in the membranes than on the lesions in the meninges. 
According to Hutyra and Marek, the hyperemic dilatation of the vessels 
and the inflammatory changes cause irritation of the nerve structures 
mentioned, leading to increased sensibility of the skin and areas supplied 
by the affected nerve trunks. In the later stages the conductivity of the 
nerve roots is lessened or destroyed, and the superficial layers of the 
spinal cord itself are involved. These changes will explain some of the 
prominent symptoms observed in the disease—viz., hyperesthesia of 
the skin, and spasmodic contraction of certain muscles, followed by 
paralysis. 

The preliminary symptoms are very variable. In some cases we may 
observe a stiffness in progression, especially in the hind-limbs, and an 
arching of the back. These are associated with hyperesthesia of the 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1179 


skin. The animal shows extreme nervousness, and resents being handled. 
Rigors may precede the nervous phenomena in some instances. The 
temperature is usually very high, and the respirations are accelerated. 
Not uncommonly, when the lesions involve the lumbar region of the cord, 
the horse presents similar symptoms to those observed in cases of lamin- 
itis affecting the hind-feet. Hach hind-foot is rapidly snatched up alter- 
nately, and the general attitude of the animal suggests constant pain and 
discomfort. Spasmodic contraction of various groups of muscles (de- 
pending on the seat of the lesions) are induced when the parts are even 
lightly handled. If the animal be forced to walk, he does so with diffi- 
culty, and in a cramped manner, the vertebral column being held as 
motionless as possible. In some cases the act of walking causes cramp- 
like contractions of the muscles. Retention of urine and inability to 
defecate occur, owing to contraction of the sphincters of the bladder and 
anus respectively. Priapism is occasionally observed in male animals. 
When the cervical region of the cord is the seat of the lesions, the muscles 
of the neck are spasmodically contracted. The duration of this period 
of increased reflex excitability is very variable. It is succeeded by 
evidences of compression, or of extension of inflammation to the cord. 
The most common symptom is paraplegia (paralysis of both hind-limbs), 
and the previously hyperesthetic areas become anesthetic. The animal 
assumes the recumbent position, and is unable to rise. If forcibly raised 
by. slings, the hind-limbs are unable to bear any weight, and he sinks 
backwards in spite of the mechanical support. The inflammatory 
process may extend to the anterior region of the cord, and general paralysis 
then results. Or it may spread to the meninges of the brain, and symp- 
toms of cerebral meningitis then mask those of the spinal affection. 
Paralysis of the bladder and of the sphincter ani may be present. 

CoursE AND Duration.—In some cases death may occur within a 
few days, especially when the cervical region of the cord is involved. 
In other instances the animal may live for a week, or, exceptionally, when 
the lesions are circumscribed, the duration may be a month or more. 
Generally, however, complications set in, such as pneumonia, bed-sores, 
etc., and prove fatal, or the animal is destroyed as incurable. 

Occasionally, cases are observed in which the course of the disease 
differs from that described. The hyperesthetic stage may be absent, 
and paralysis occurs early: Not uncommonly the practitioner may 
not be called in until paraplegia has set in. Chronic cases are rarely 
observed. 

Proenosis.—This is distinctly grave. In almost every instance the 
disease terminates fatally, or the case has to be destroyed. 


1180 SYSTEM OF VETERINARY MEDICINE 


DIFFERENTIAL DiaGnosis.—Spinal meningitis may be confounded with 
tetanus, cerebral meningitis, acute muscular rheumatism, myelitis, 
laminitis, and azoturia. Considerable difficulty may be experienced in 
the differential diagnosis when any of these affections present atypical 
symptoms. , 

In tetanus the tonic muscular spasms are persistent and generalised, 
and on quickly raising the head the protrusion of the membrana nictitans 
over the eyeball is observed. When trismus is present as well, the 
differentiation is easy. 

Cerebral meningitis is characterised by marked preliminary excite- 
ment (see p. 1139), and when the horse goes down, violent struggling 
occurs. As already remarked, the combination of cerebral with spinal 
meningitis is comparatively common. 

In acute muscular rheumatism, although the muscles are painful to 
palpation, hypereesthesia of the skin is absent, and the peculiar “ snatch- 
ing’ action in the hind-limbs is not observed. 

In myelitis there may be considerable difficulty in the differential 
diagnosis, especially when paraplegia has set in. In the earlier stages 
the presence of severe pain and muscular spasms point to spinal menin- 
gitis. From a practical aspect, the differentiation is not of great im- 
portance, more especially when we consider that in the majority of 
instances spinal lesions to a more or less extent are present in menin- 
gitis. Fever is said to be absent in myelitis, and paralysis sets in 
early. 

In laminitis, as the disease is seldom confined to the hind-feet, the 
peculiar attitude of the animal, and the presence of heat and tenderness 
of the feet, are suggestive. In rare instances the hind-feet are chiefly 
affected. Then we must depend on the presence of heat and tenderness 
in the feet, and the absence of muscular spasms and of hyperesthesia of 
the skin. 

In azoturia the history of the case must be considered, also the hard, 
prominent condition of the gluteal muscles and the coloration of the 
urine. In the later stages, however, without a correct history of the 
case, the nervous phenomena may resemble those of spinal meningitis, 
as In some instances of azoturia convulsions are absent, the coloration 
of the urine disappears and the leading feature is paraplegia. 

TREATMENT.—In the early stages excitement should be allayed by 
the administration of chloral hydrate and bromide of potassium. A 
strong purgative is indicated, such as aloes with calomel. Local applica- 
tions are of doubtful value. When paralysis sets in, the case is hopeless. 
Some authors advise that the animal be placed in slings before complete 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1181 


paraplegia occurs. According to Cadéac, all forms of treatment generally 
prove useless. 

Chronic Spinal Meningitis.—This is rarely met with; it may occur 
as a sequel to an acute attack, or may tend to run a chronic course 
from the outset. 

It cannot be differentiated from chronic myelitis. 


MYELITIS. 


SynonyM.—Inflammation of the spinal cord. 

Under this heading are included inflammatory lesions of the spinal 
cord, and also conditions of a chronic nature, which some authors con- 
sider do not depend on inflammatory changes. Myelitis is not so com- 
monly met with in the horse as in the dog. Continental authors have 
devoted special attention to the subject both clinically and pathologically, 
but we must admit that in ordinary practice the disease is not studied to 
any extent. The differential diagnosis presents considerable difficulties, 
while, as we have already remarked, the post-mortem examination is a 
tedious process, and the lesions can only be discovered by an expert 
pathologist. Moreover, as, according to Hutyra and Marek, “ recovery 
in the clinical sense of the term is exceptional,” it is not surprising to 
find that the affection is of more interest to the pathologist than to the 
clinician. 

Various forms of the disease are described, such as transverse myelitis, 
in which the lesions are localised; deffuse, in which a circumscribed por- 
tion of the cord is involved, with extension of the disease either in an 
ascending or a descending direction. In desseminated myelitis, lesions in 
the form of inflammatory foci occur in the white and grey matter of the 
cord, and the extent and distribution are variable. Again, the lesions 
may be confined to the inferior cornua of grey matter, and to this con- 
dition the term poliomyelitis is applied. 

Myelitis is frequently followed by degenerative changes, such as 
softening of the cord (myelo-malacia). 

Kir1oLocy.—The ‘majority of authors regard infectious diseases, such 
as influenza, strangles, and pneumonia, as the most common etiological 
factors. According to Cadéac, strangles is the most important of these, 
and myelitis occurring in young foals is due to this cause. The bacterial 
toxins are believed to induce sclerosis of the vessels of the cord, and thus 
to produce the lesions. Hutyra and Marek point out that there is scarcely 
any tendency to purulent myelitis in the case of strangles. The same 
authors also state that diseases of the vertebre and surrounding tissues 


1182 SYSTEM OF VETERINARY MEDICINE 


rarely extend to the cord, and only in very exceptional instances does 
simple tuberculous myelitis develop. External injuries and all causes 
inducing compression of the cord (see p. 1187) may also produce myelitis. 
In spinal meningitis the inflammatory process may extend to the cord. 
Myelitis also occurs in connection with epizootic cerebro-spinal menin- — 
gitis and dourine. Cold, excessive fatigue, etc., may be regarded as pre- 
disposing causes. Thrombosis of the spinal artery following a severe 
injury leads to degenerative changes in the cord. In many instances no 
cause can be discovered. 

Morprip ANATOMy.—Continental authors, including Weber and 
Barrier, and Dexler, have devoted special attention to the histological 
changes in myelitis. Obviously, the examination can only be carried out 
by an expert pathologist, and, as macroscopical lesions are not always 
present, and, moveover, special skill is necessary in order to detect them, 
we do not consider it desirable to devote much space to a consideration 
of the subject. Those who desire to study specially the morbid anatomy 
of the affection are referred to ‘‘ Pathologie Interne,” par C. Cadéac, 
tome vill.: “ Maladies du Systéme Nerveux.” 

According to Hutyra and Marek, in acute myelitis the substance of 
the cord is softened, moist, and glistening, reddish in colour, and studded 
with hemorrhagic points, and it may be impossible to distinguish the 
grey and the white substance. In some instances the affected cord is 
altered to a greyish-red, pulp-like mass. The meninges may or may not 
be involved. 

In chronic cases a new growth of connective tissue takes place in the 
substance of the cord, and gives to it a firm, fibrous appearance. This 
sclerotic change eventually leads to pressure degeneration of some of the 
tracts of the cord. 

SyMpToms.—These are very variable, and depend on the extent and 
seat of the lesions. In ordinary practice very little attention is devoted 
to distinguishing the various forms of myelitis, and a diagnosis of spinal 
disease usually suffices. It is possible, however, by careful observation 
to increase our knowledge in this direction. 

_In transverse myelitis the nerve tracts are interrupted on both sides 
of the cord, so that sensory and motor disturbances result. The symp- 
toms vary according to the seat of the lesion. Paraplegia may occur 
suddenly in cases due to an injury of the spine, or to embolism of the 
spinal vessels. In some instances the paraplegia is slowly developed, 
being preceded by a gradual disinclination for movement and disturb- 
ance of sensation, but finally complete paralysis sets in. 

When the lesion occurs in the middle dorsal region, the animal lies 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1183 


down and is unable to rise, and cannot even change the position of the 
posterior half of his body. Complete anesthesia extends as far forward 
as the seat of the lesion. 

When the sacral portion of the cord is involved, incontinence of urine 
occurs. Involuntary defecation is also observed. When the lesions 
affect the more anterior portions of the cord, retention of urine takes 
place, also the feces accumulate in the rectum. Bed-sores usually 
develop, being due to loss of trophic influences, as well as to pressure 
from decubitus. In the later stages the muscles of the affected regions 
become atrophied and degenerated. 

In myelitis of the cervical region, in addition to the symptoms men- 
tioned, paralysis of the intercostal muscles occurs, leading to respiratory 
disturbances and pulmonary cedema. 

Disseminated myelitis is uncommon in the- horse. It may be asso- 
ciated with inflammatory foci in the brain. In a case of the disease 
recorded by Weber and Barrier a gradually progressive paresis of the 
extremities was observed, which continued for three months. During 
progression the animal lifted both the fore and hind feet in a jerky 
manner. The limbs were abducted and advanced with excessive flexion, 
then adducted and set down clumsily. Extreme flexion of all the joints 
occurred under the weight of the body, and stumbling was observed. 
The motor disturbances were accentuated by blindfolding the animal, 
and well-marked ataxia was present. The animal was kept under 
observation for nine months, and then destroyed. The autopsy revealed 
an inflamed area in the right half of the cord immediately in front of the 
origin of the seventh nerve, involving the outer third of the superior 
column, the lateral column, and the greater part of the grey matter. In 
the left half of the cord in the lumbar region three inflammatory foci were 
found close together, involving the greater part of the lateral column and 
the superior cornu. When cerebral and spinal lesions are associated, a 
complicated clinical picture is the result. 

Diffuse myelitis generally commences in the posterior regions of the 
cord, and tends to spread to the anterior parts of this structure. Sensory 
and motor paralysis of the tail, croup, and hind-limbs, incontinence of 
urine, involuntary defecation, and paralysis of the sphincter ani, are 
observed. As the anterior region of the cord becomes involved, paralysis 
of the respiratory muscles«and the muscles of the fore-limbs occurs, 
associated with difficult respiration and general paralysis. In some cases 
the animal walks in a clumsy manner, shows a disinclination to trot, and, 
when forced to do so, the anterior region of the body sways, and he is 
unable to move in a straight line. If while trotting he is suddenly 


1184 SYSTEM OF VETERINARY MEDICINE 


turned, he will fall. The hind-limbs are flexed in a spasmodic manner, 
and set down very cautiously. These symptoms are generally followed 
by a gradually progressive paralysis. 

Robertson* described cases of chronic myelitis and meningitis which 
at first exhibited a certain amount of pain and difficulty in executing — 
particular movements, associated with general rigidity of muscles, but 
showed little disposition to lie down, or, when down, they showed great 
difficulty in rising. These phenomena gradually but steadily passed 
into more or less well marked deficiency of muscular power and paralysis, 
especially paraplegia. In the early stages of some cases the following 
symptoms were observed: Difficulty in turning rapidly or in a limited 
space, a disposition to stagger against doorways in passing through them, 
inability to move backwards in or out of harness, trailing of the limbs, 
and knuckling over on the fetlocks, or bruising of one fetlock from blows 
with the opposite foot. These symptoms were followed by inability to 
use the limbs either for support or locomotion. This author met with 
instances of chronic myelitis in which decided failure of muscular power 
and paralysis were the first phenomena observed. 

DiFrFERENTIAL Diacnosis.—Although attempts have been made to 
differentiate myelitis from spinal meningitis, we find that in practice it 
is a very difficult matter. Moreover, the conditions are often combined. 
Robertson described both affections under one heading. In myelitis 
there is an absence of fever, muscular spasms, and hyperesthesia. If, 
however, myelitis be associated with meningitis, it is impossible to deter- 
mine the presence of the former; nor is the question of much practical 
importance, as both conditions are equally hopeless. 

Paraplegia occurs in such a diversity of affections that a very careful 
examination 1s necessary in order to determine its source. The differ- 
ential diagnosis is of importance, more especially to ascertain if the 
inability to rise depends on a permanent lesion or on a temporary con- 
dition. The subject will be discussed under the heading of Compression 
of the Cord (see p. 1187). 

In instances due to spinal injuries the history of the case will assist. 

TREATMENT.—The indications for treatment are similar to those men- 
tioned for spinal meningitis (see p. 1180). Itis of importance to avoid 
hasty conclusions as to the hopeless nature of a case; hence, if in doubt, 
treatment should be attempted until there are evidences that further 
therapeutical measures are useless. 

Chronic Myelitis——This term is applied not only to the lesions result- 
ing from an acute attack of myelitis, but also to sclerosis of various tracts 


* “ Practice of Equine Medicine.”’ 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1185 


in the cord commencing primarily as a degeneration of nerve fibres. 
The latter condition was described by Robertson, the sclerosis affecting 
the cerebellum in some cases and the spinal cord in others. The symp- 
toms varied according to the seat of the sclerotic changes. When the 
cerebellum was involved, the animal showed a disposition particularly to 
gyration in movement, with spasmodic action of the muscles of the eye- 
ball. 

In the spinal form disturbance of motor rather than of sensory 
power was observed, although both were ultimately affected. Sudden 
paralysis was rarely seen. The aberration usually consisted of a loss of 
co-ordination in the movement of the muscles of the limbs. The want of 
power over voluntary movement was slow in development, and spas- 
modice action of certain sets of muscles was often noticeable. 

Lack of space prevents us from describing the various lesions in the 
chronic degenerative diseases of the spinal cord, and as such affections 
are not amenable to treatment, they possess little interest for the clin- 
iclan. Readers who desire full information on the subject are referred 
to “ Pathologie Interne,” par C. Cadéac, tome viii., in which work, under 
the heading of Myelitis and Secondary Degenerations of the Spinal Cord, 
the various lesions are described at length. 


ENZOOTIC SPINAL PARALYSIS. 
See Vol. I., p. 900, for a full account of this disease. 


SPINAL HAAMORRHAGE. 


This includes hemorrhage within or upon the cord (Ha@matomyelia), 


and hemorrhage between the meninges or external to them (Haema- 
torachis). 


Kr1oLocy.—The most common cause is a severe injury resulting from 
falls, fractures of the vertebre, etc. According to Jacoulet and Joly, 
strangles has an important influence in the production of the condition. 
Spinal hemorrhage may be observed in cases of acute myelitis. Accord- 
ing to Cadéac, in azoturia a large number of hemorrhages in the substance 
of the cord may be detected. Some authors record cases of spinal menin- 
geal hemorrhage in the newly born animal as the result of powerful 
traction applied during difficult parturition. The lesion has also been 
met with in purpura hemorrhagica. 

Morgip ANaTtomy.—Champetier has observed dilatation of the vessels 


of the pia mater, with subarachnoid effusion and hemorrhage into the 
VOL. II. | 75 


1186 SYSTEM OF VETERINARY MEDICINE 


grey substance of the cord. The hemorrhage may occur in any part of 
the cord, but most frequently in the lumbar enlargement. In some 
instances capillary hemorrhages and cedema of the pia mater have been 
observed. Occasionally purulent infiltrations of the cord have been met 
with. Cadéac states that in rapidly fatal cases of azoturia he has often — 
found hemorrhages posterior to the lumbar enlargement, and the nerve 
fibres constituting the cauda equina were surrounded by a mass of blood 
of a dark colour. | 

Girard met with cases of strangles which were associated with paralysis, 
and on post-mortem found numerous hemorrhages in the spinal meninges 
and a large increase of fluid in the subarachnoid space, this fluid being 
blood-stained. 

Symproms.—These depend on the pressure exerted by the blood on 
the cord. They appear suddenly, and resemble those described as 
occurring in compression of the cord (see p. 1189), and vary according to 
the location of the hemorrhage. Paraplegia is a common symptom, and 
groups of muscles may also become paralysed. 

TREATMENT.—See Compression of the Cord (p. 1192). Shght hemor- 
rhages may recover spontaneously by absorption of the clot, but severe 
cases prove fatal. 


CONCUSSION OF THE SPINAL CORD. 


Some authors describe this condition along with injuries of the spinal 
cord; others regard it as a temporary condition due to falls, ete., and 
believe that no lesions are present; others, again, are of opinion that the 
symptoms depend on minute hemorrhages either into the substance of 
the cord or the meninges, or temporary injury of nerve roots. However 
this may be, we are of opinion that the condition merits a special con- 
sideration, as it is familiar to clinicians, and must be carefully differ- 
entiated from permanent affections of the spinal cord. 

Robertson drew attention to the subject, and stated that in all the 
cases which came under his notice the animals were hunters, and the 
affection resulted from leaping, where the drop was considerable and 
unexpected. The symptoms were manifested at the time by a deficiency 
of power to move onwards as usual, this being more marked on pulling 
the horse up and again getting him to proceed. The loss of power in the 
limbs was never completely lost, but on the following morning, on lead- 
ing the horse from the stable, a marked stifiness of the loins was noticed, 
and a want of control over the movements of the hind-limbs was present 
to such an extent that the projections of the haunch were apt to be 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1187 


brought in contact with the sides of the doorway; also there was a ten- 
dency for the hind fetlocks to be knocked against each other. In some 
cases the animal might be able to move at a walking pace in a straight 
line, but if made to trot, or to turn round, or to move in a backward 
direction, the want of control was very obvious. In a few instances pain 
was exhibited on manipulation along the dorsal and lumbar spines, but 
more frequently anesthesia of these regions was present, and when the 
animal lay down there was difficulty in rising. 

The above clinical picture we have observed on many occasions. In 
some instances the horse was at pasture, and it was presumed that a fall 
was the cause of the symptoms. In others, no definite cause could be 
assioned. Recovery was sometimes rapid, but cases occurred in which 
the animals were not fit for work until after a lapse of several 
weeks. 

The prognosis must be guarded, as it is difficult to judge with refer- 
ence to the results in such cases. 

Treatment consists of rest, and the application of a cataplasm of 
kaolin and glycerine to the region of the loins. Nux vomica and iodide 
of potassium may be given in the food. 


INJURIES TO THE SPINAL CORD—COMPRESSION OF THE 
SPINAL CORD. 


Under this heading we include various lesions of the spinal cord 
depending on several causes, such as fractures and dislocations of the 
vertebra, external violence without fracture, compression of the cord by 
extravasated blood, or by tumours, abscesses, etc. 

Et1ioLocy.—Fracture of one or more of the dorsal or lumbar vertebre 
is not an uncommon cause of injury to the spinal cord. Fracture of one 
of the cervical vertebre is more rarely met with. The actual lesion is 
generally due to displacement of the fractured bones, which brings about 
compression or crushing of the cord. In some instances splinters of bone 
may cause injury to the cord. Again, the fracture may produce hemor- 
rhage and the formation of a large blood-clot, which causes compression 
of the cord. Such fractures may occur under various conditions as 
follows: Severe falls when jumping, especially when the horse fails to 
negotiate a bank or falls in an awkward manner on the opposite side. 
Severe muscular contraction may produce fracture of a vertebra. Thus, 
if a horse falls into a dyke, and is unable to extricate himself, the violent 
struggling is likely to cause the lesion. A similar result may follow if the 
animal gets ‘“‘ cast’ in his stall. 


1188 SYSTEM OF VETERINARY MEDICINE 


One of the most important causes of fracture of one of the dorsal or 
lumbar vertebre is the struggling which ensues when a horse is cast for 
an operation. Here the injury does not result from the actual casting, 
but occurs while the animal is struggling to get free from the restraint 
of the hobbles. This struggling is greatly accentuated, owing to the 
pain of the operative measures when no anesthetic is employed. There 
is no doubt but that firmly securing the animal with a view to overcome 
struggling is a fertile cause of fracture, more especially when no measures 
are taken to prevent him from arching the back and bending the neck 
towards the sternum. The adoption of anesthetics in equine surgery 
has succeeded in greatly reducing the number of cases of fractures of the 
vertebra. 

It is generally admitted that previous disease of the vertebra, such 
as osteomalacia and intervertebral ossification, play an important part 
in the production of fractures of these bones during surgical operations. 
Here we may remark that fracture may occur without immediate dis- 
placement, so that the horse may rise after the operation, return to his 
stall, and manifest no symptoms of spinal injury until shortly afterwards. 
and in some instances not until he lies down. Some observers state that 
when a simple splitting of the bone takes place evidences of complete 
fracture may not be shown for some weeks. 

Dislocation of the vertebree is more likely to occur in the cervical 
region. It may or may not be associated with fracture, and the usual 
cause 1s an awkward fall in jumping, or an injury sustained by the animal 
when he runs away and his head comes into violent contact with a wall 
or a lamp-post. It may also occur in cases where a horse rushes back- 
wards when secured by a halter and chain. The lesions produced may 
be intermeningeal hemorrhage, or hemorrhage into the tissue of the cord 
itself, compression being produced in both instances, or direct injury to 
the cord may result. 

Tuberculosis of the vertebree is exceptionally a cause of compression 
of the cord leading to paraplegia. Mégnin recorded a case of the kind. 
According to Hutyra and Marek, the usual seat of the lesion is the dorsal 
portion of the spine. Cadéac states that the three last dorsal and the 
two first lumbar vertebre are usually involved, and the compression of 
the cord is due to the softened condition of the affected bones. But 
tuberculous growths, with considerable enlargement of the vertebra 
bodies may also be a cause of compression of the cord. 

Strains of the dorso-lumbar region are due to excessive muscular 
movements, such as may occur in horses cast and secured for operations. 
Displacement of the intervertebral discs may result, associated with 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1189 


stretching of the superior and inferior common vertebral ligaments, and 
compression is exerted on the cord. 

Tumours.—According to Hutyra and Marek, neoplasms are rarely 
the cause of compression of the cord (see p. 1192). 

Parasites.—The larve of certain parasites may become encysted in 
the spinal cord, and occasionally cause compression of this structure 
(see p. 1193). ? 

Abscesses.—According to Hutyra and Marek, these are observed very 
rarely in the spinal canal. Reul recorded a case in which an abscess 
due to strangles was situated on the inferior aspect of the spinal cord in 
the region of the lumbar enlargement. More commonly pus from 
abscesses in the vicinity of the vertebre gains entrance to the spinal 
canal through the intervertebral spaces, such as in cases of strangles, 
fistulous withers, or poll-evil. Hither compression of the cord or sup- 
purative meningitis may result. A rare cause of injury to the cord is 
the entrance of sharp-pointed bodies through the intervertebral spaces in 
the cervical region. In exceptional cases aneurism of the aorta causes 
erosion of the bodies of the vertebree and compression of the cord. 

Kxostoses in the form of osteophytes situated in the region of the 
intervertebral discs, especially in the dorsal and lumbar vertebre, are 
recognised as causes of compression of the cord. 

Morpip ANaTtomMy.—The lesions depend on the nature of the etio- 
logical factor. In dislocation and fracture of vertebre, intermeningeal 
hemorrhage, and hemorrhage into the substance of the cord will be 
observed, or in severe cases the cord is crushed and the nerve roots 
destroyed. | 

In cases of compression due to tumours, etc., the thickness of the 
cord is diminished and its consistence may be modified. Morbid changes 
in the appearance of the surface or cross-section, such as alterations in 
the shape of the grey matter and of the inferior fissure, may be observed. 

Cases are met with in which no lesions can be detected in the spinal 
cord, although well-marked symptoms were present during life. It is 
hardly necessary to point out that before arriving at the conclusion that 
no lesions are present, the cord should be examined by an expert path- 
ologist, who is familiar with the normal histological appearance of the 
spinal cord in the horse. 

For a full description of the various lesions found by Dexler, the 
reader is referred to “‘ Pathologie Interne,” par Cadéac, tome viii. 

SyMPTOMS.—These vary according to the nature, extent, and location 
of the lesions. In the case of injuries to the cord, and compression of 
this structure in the cervical region, such as result from fracture or dis- 


1190 SYSTEM OF VETERINARY MEDICINE 


location of the cervical vertebre, the following phenomena are observed : 
If the injury to the cord is severe and complete, and involves the region 
between the medulla oblongata and the origin of the fifth and sixth pairs 
of cervical nerves, death occurs suddenly owing to paralysis of the respira- 
tory muscles. In cases of dislocation with fracture there is a decided 
painful enlargement over the seat of the injury, and the head may be 
deviated more or less to the opposite side. If an attempt be made to 
straighten the head in cases that are not immediately fatal, compression 
of the cord may be produced, followed by sudden death. When the 
injury to the cord is not extensive, the animal may live for a few hours. 
Cases are recorded in which life was prolonged for several weeks, the 
symptoms being similar to those observed in compression or injury of 
the posterior portion of the cervical region of the cord. In the latter 
instance the nerves of the brachial plexus are first affected, resulting in 
paralysis of the fore-limbs, followed after a time by paresis of the hind- 
limbs. According to Cadéac, the paralysis of the fore-limbs commences 
in the form of monoplegia, and paraplegia is not a constant phenomenon 
in compression of the cervical region of the cord. Hutyra and Marek 
state that in the fore-limbs the reflexes are destroyed, but persist and 
are even exaggerated in the posterior parts of the body. These authors 
also describe a peculiar type of respiration in which, during inspiration, 
expansion of the thorax does not occur, the ribs remain motionless, and 
the respiratory movements are limited to the diaphragm and abdominal 
muscles. Other observers record instances in which spasmodic contrac- 
tions of the subcutaneous muscles occurred, also rigidity of the neck, with 
inability to lower the head, or the head may be drawn towards the 
sternum. 

In cases where the dorso-lumbar region of the cord suffers from injury 
or compression, the symptoms vary according to the extent of the lesions. 
In severe injuries paraplegia occurs, with paralysis of the bladder and 
rectum. When compression is less marked, a staggering gait is observed, 
also a difficulty in rising from the recumbent position. In some instances 
the animal may “ knuckle over” on both hind-fetlocks while standing, 
and during progression there is a difficulty in bringing the hind-limbs 
forward. Dragging of the toes or crossing of the legs may also be 
observed. 

W. Willams drew attention to the fact that fracture of a dorsal or 
lumbar vertebra might occur without displacement, and hence without — 
compression of the cord, so that recovery resulted, and the existence of 
the fracture could not be detected during life. It is also of importance to 
remember that a horse may fracture one of the dorsal or lumbar vertebre 


DISEASES OF SPINAL CORD AND MEMBRANES: HORSE 1191 


while cast and undergoing an operation, and may be able to rise and 
walk to his stable without showing any symptoms, but later on paraplegia 
results. Instances of injury to the cord in the absence of fracture may 
occur under similar conditions. 

Injury or compression of the sacral portion of the cord induces, accord- 
ing to Hutyra and Marek, sensory and motor paralysis of the area sup- 
plied by the sciatic nerve, the nerves of the croup and tail, and those 
supplying the sphincters of the anus and bladder. 

Cadéac describes compression of the terminal extremity of the spinal 
cord associated with paralysis of the tail and sphincters, but this is in 
reality a chronic interstitial neuritis of the cauda equina, and will be 
described under the heading of Diseases of the Peripheral Nerves (see 
p. 1205). | 

CoursE.—This depends on the seat and the extent of the injury, and 
the degree of compression present. When the cervical part of the cord 
is involved, death may occur rapidly. In other instances paraplegia sets 
in, and although the animal may live for some days, complications occur, 
and destruction is generally carried out. 

Proenosis.—This is usually unfavourable. In some instances where 
the compression depends on hemorrhage, recovery may result. 

DIFFERENTIAL D1agnosts.—lIn all cases of spinal injury great care 
should be exercised in arriving at a definite diagnosis. Instances are 
met with in which the symptoms are apparently very serious, yet recovery 
may result. On the other hand, the early symptoms may appear trivial, 
but later on assume a grave character. 

The history of the case must be carefully studied, and the possibility 
of a fractured vertebra without displacement should not be overlooked. 

The variety of conditions with which paraplegia is associated renders 
a differential diagnosis very difficult. It is not uncommon to find the 
animal in the recumbent position, and suffering from paraplegia on our 
first attendance, and yet we may not be able to trace any history of an 
accident or injury. Hasty conclusions should be avoided, and the prac- 
titioner must satisfy himself by a careful examination that a serious 
lesion of the cord is present before ordering the destruction of the animal. 
In many instances it is wiser to defer giving a definite opinion until 
expectant treatment has been first tried. 

Lack of space will not permit us to enter into the differential diagnosis 
of injuries and compression of the cord, and the large number of condi- 
tions simulating such lesions. The latter include cases of azoturia in the 
later stages of subacute types, myelitis, strain of the psoew muscles, frac- 
tures of the pelvis, advanced cases of nephritis, etc. 


1192 SYSTEM OF VETERINARY MEDICINE 


TREATMENT.—When evidences are present of complete paralysis of 
the hind-limbs, or when symptoms suggestive of injury of the cervical 
portion of the cord are manifested, the animal should be destroyed. In 
doubtful cases the animal should be allowed a good bed of straw, and — 
his position must be changed at intervals, so as to prevent the occurrence 
of bed-sores. The condition of the bladder should receive attention, and 
the catheter must be employed when necessary. Slings are useless, and, 
as pointed out by W. Williams, they render a case depending on fracture 
of a vertebra which is not displaced, hopeless, by causing displacement of 
the fracture, and thus inducing pressure on the cord. 


TUMOURS OF THE SPINAL CORD. 


Neoplasms may occasionally develop in the spinal cord, but more 
commonly they are found in connection with the meninges. Various 
observers have recorded cases in which neoplasms developed in the 
vicinity of the vertebre, and gained access to the neural canal either 
through the osseous tissue or via the intervertebral foramina. Instances 
have been met with in which the tumour started as a primary growth in 
the vertebre. 

Melanomata.—These occur as part of a general melanosis, especially 
in grey horses. According to Hutyra and Marek, they develop in con- 
nection with the vertebre, and in very occasional cases exclusively in 
the meninges. Their common seat is in the dorso-lumbar region, but 
they have also been observed in the cervical region. Cadéac states that 
their common location is in the connective tissue occupying the space 
between the dura mater and the walls of the neural canal; but in some 
instances they develop external to the canal, and gain entrance by the 
intervertebral foramina, or by destroying the vertebra with which they 
are in contact. 

Sarcomata.—According to the recorded cases, these tumours are found 
adherent to the external face of the dura mater, and induce local degenera- 
tive changes in the spinal cord, and also in the nerve roots. In some 
instances the neoplasms are of considerable size. 

Osteomata.—According to Cadéac, these are of frequent occurrence, 
especially in the lumbar region, and generally result from periostitis 
developing in the vicinity of the intervertebral discs, or of fractures of 
the body of the vertebrae which have united. 

Papillomata have been occasionally observed, and develop in connec- 

tion with the pia mater. They are said not to produce any appreciable 
Symptoms. 


DISEASES OF THE PERIPHERAL NERVES: HORSE 1193 


Amongst rare tumours we may mention lipomata, cholesteatomata, 
and chondromata. 

Symproms.—The symptoms observed in cases of tumours of the spinal 
cord resemble those described as occurring in compression of the cord 
(see p. 1189), but the development and course are very slow. The 
symptoms will vary according to the seat of the lesion. 

Diagnosis is attended with marked difficulties, and nothing can be 
done in the way of treatment. 


PARASITES OF THE SPINAL CORD. 


Dieckerhoft has observed the presence of larve of Mstrv. In rare 
instances the Cenurus cerebralis has been found between the meninges 
in the lumbar region of the cord. 


DISEASES OF THE PERIPHERAL NERVES. 


Eir1oLogy.—The general etiology can be conveniently considered 
under the following headings: (1) Traumatic Injuries ; (2) Compression ; 
(3) Neurates. 

Traumatic Injuries—These include injuries arising from blows, 
kicks, or penetrating wounds. A superficial nerve in the vicinity of a 
bone may be crushed between the latter and some hard object. The 
internal plantar nerve may be bruised by a severe ‘“‘ speedycut”’ or by 
‘‘ brushing.” In rare instances a nerve situated between a muscle and 
a bone may be injured by the powerful contraction of the former, or it 
may be severed by wounds of the soft tissues, or by fractures. Again, a 
nerve may be accidentally severed during operative measures, such as 
the opening of a strangles abscess in the region of the face or head. 

Compression.—This may result from various causes. Familiar 
examples are found in a neuroma developing on the proximal end of the 
plantar nerve aiter the operation of neurectomy, and giving rise to pain 
and lameness; also in fracture of the first rib, causing pressure on the 
roots of the radial nerve and inducing paralysis of the latter (radial par- 
alysis). Radial paralysis is occasionally observed as a sequel to long 
operations, and is believed by some authors to depend on pressure exerted 
on the cubital region owing to the animal being kept in the recumbent 


1194 SYSTEM OF VETERINARY MEDICINE 


position for a prolonged period. Pressure on the seventh nerve at the 
point where it reaches the facial region may be caused by a badly fitting 
harness bridle, and facial paralysis is induced (see p. 1197). Compression 
of a nerve may also occur from tumours or enlarged lymphatic glands in 
the vicinity, or from a callus forming on a bone as the result of a fracture. 

Neurttis —This term signifies inflammation of a nerve or nerves. 
According to Hutyra and Marek, it is not an uncommon affection in 
animals, and in the vast majority of cases it is due to the influence of 
toxins derived from micro-organisms, as exemplified in strangles, influ- 
enza, and dourine. Neuritis in certain nerves may also result from 
chronic lead-poisoning. Other causes include injuries, blows, stretching, 
compression, etc., especially if affecting a single nerve. Extension of 
inflammatory action from structures in the vicinity of a nerve is also 
regarded as an etiological factor. Thus, the recurrent nerve may be 
involved in cases of pleurisy, the glosso-pharyngeal nerve in pharyngitis, 
etc. Occasionally severe inflammation of lymphatic glands may involve 
a nerve in the vicinity. 

Morgrp ANAToMy.—When the inflammation is mainly confined to the 
connective tissue surrounding the nerve, the condition is termed ‘“ peri- 
neuritis.” “‘ Interstitial neuritis” signifies an accumulation of lymphoid 
elements between the nerve bundles, associated with an increase in the 
nuclei of the sheath of Schwann, and ultimately the nerve fibres may be 
completely destroyed and replaced by fibrous connective tissue. When 
degeneration of the nerve fibres is the primary lesion, the condition is 
termed “ parenchymatous neuritis.” 

In some instances the affected nerve is swollen, infiltrated, and con- 
gested. According to some authors, macroscopical lesions are found in 
only a small proportion of cases, and in these the inflammation has led 
to the production of a large amount of connective tissue, marked degenera- 
tion, and atrophy. Microscopical examination reveals in acute cases 
dilatation of the vessels, cellular infiltrations, and in many instances 
small hemorrhages; while in chronic forms an increase in the amount of 
connective tissue is observed. In both the acute and chronic type the 
nerve fibres extending in the peripheral direction from the seat of the 
disease become degenerated and disappear. 

It must be remembered that diseases of the encephalon often cause 
interference with the functions of the peripheral nerves. 

We shall now proceed to discuss briefly the diseases of the peripheral 
nervous system, commencing with the cranial nerves. 


DISEASES OF THE PERIPHERAL NERVES: HORSE 1195 


AFFECTIONS OF THE CRANIAL NERVES. 


Increased irritability or paralysis of one or more of the cranial nerves 
may result from a lesion involving their origin or occurring at any part 
of their intracranial or extracranial course. Intracranial lesions may 
arise as the result of hemorrhages, meningitis, tubercular deposits, etc. 
Contusion, laceration, or section of a nerve, may arise from a fracture of 
the cranial bones involving the foramen, through which it makes its exit. 
Extracranial lesions may be due to pressure exerted on the nerve by 
tumours, abscesses, etc.; also to injuries depending on direct violence, etc. 

1. Affections of the Optic Nerve—Opirc Neuritis—This condition is 
also known as papillitis, neuro-retinitis, papillo-retinitis, and “ choked 
disc.” The inflammation causes a swollen condition of the nerve-endings 
and papilla, resulting in congestion of the veins of the retina. 

Kr1oLogy.—Optic neuritis may be due to brain or orbital tumours, 
cerebral abscess, chronic hydrocephalus, infectious diseases, such as 
influenza, purpura hemorrhagica; also lead-poisoning, etc. 

Symproms.—An examination of the eye with the ophthalmoscope is 
necessary, in order to recognise the condition. As retinitis is often 
associated with papillitis, one description will suffice for both lesions. 
Examination of the fundus of the eye shows a reddish appearance of the 
retina for some distance around the optic disc, also dilatation of the blood- 
vessels. The optic disc is enlarged, its surface is of a purplish-red or 
mottled appearance, and it displays a radial striation. At first the veins 
of the disc may be difficult to distinguish, whilst those of the retina are 
dilated and tortuous. Later on the vessels of the disc are increased in 
size, while those of the retina are obscured by effusions of lymph. The 
condition usually terminates in amaurosis (paralysis of the optic nerve). 
In cases depending on a slight hemorrhage into the sheath of the nerve, 
recovery may ensue, butin the majority of instances treatmentis of no avail. 

Paralysis of the Optic Nerve-—Also known as amaurosis or atrophy of 
the optic nerve. In this condition blindness of one or both eyes results, 
according as the lesion is unilateral or bilateral. Various causes are 
recognised, which include injuries to the cranium, infectious diseases, 
such as influenza, profuse hemorrhage, specific ophthalmia, lesions of the 
brain, lead-poisoning, etc. In many instances no cause can be discovered. 
The prominent symptom is permanent dilatation of the pupil, which is 
unaffected by exposure to a strong light. Blindness is also present. 

For a full description of the diseases of the optic nerve, the reader 
is referred to “ Veterinary and Comparative Ophthalmology,” by Nicolas, 
translated and edited by H. Gray. 


1196 SYSTEM OF VETERINARY MEDICINE 


2. Affections of the Third, Fourth, and Sixth Cranial Nerves (the Motor 
Nerves of the Eyeball)—Paralysis—This may depend on intracranial 
diseases, such as meningitis, encephalitis, tumours of the brain, etc. 
According to Hutyra and Marek, there are no recorded cases of extra- 
cranial diseases of these nerves, but these authors suggest that fractures 
of bone in the immediate vicinity might cause injuries, while exostoses 
and tumours in the orbit might induce paralysis by pressure. _ 

Symproms.—The thord nerve (oculo-motor) is more frequently affected. 
Ptosis is the most prominent symptom. The upper eyelid droops, and 
there is inability to open the eye; but by powerful contraction of the 
corrugator supercilii, the animal is able to lift the upper eyelid to a slight 
extent. Other phenomena observed are dilatation of the pupil due to 
paralysis of the iris, also external strabismus. 

The fourth nerve (pathetic or trochlear) supplies the superior oblique 
muscle, and paralysis of this nerve causes defective downward and inward 
movement of the eyeball. The condition is rarely met with. 

Paralysis of the sixth nerve (abducens) causes paralysis of the external 
rectus muscle, so that the eyeball is turned inwards (internal strabismus). 

TREATMENT.—The cause should be sought for, and treatment adopted 
accordingly. Needless to remark that, as the paralysis depends in most 
cases on central lesions, therapeutical measures are of little avail. 

Spasm of the muscles supplied by the third nerve, especially the 
internal rectus and the levator palpebree, occurs in meningitis and other 
affections of the brain, and causes chronic rhythmical spasm of these 
muscles, so that involuntary rolling movements of the eyeballs are pro- 
duced. This condition is known as nystagmus. 

3. Affections of the Fifth Nerve (Trigeminus)—Paralysis.—This is only 
occasionally met with in the horse, but occurs with more frequency in 
the dog; hence it will be more fully considered in connection with the 
latter animal (see p. 1268). Hutyra and Marek cite the following cases: 
One recorded by Lydtin, in which a fibro-sarcoma in the immediate 
vicinity of the Gasserian ganglion was the cause of the paralysis. In 
another case a tumour of the same nature was found close to the temporo- 
maxillary articulation. Amongst other causes recorded we may mention 
the presence of an angioma, neuritis, and concussion of the brain. 

SymMproms.—These will depend on the branches of the nerve which 
are involved. Ifthe three main branches are affected, the chief phenomena 
presented will be paralysis of the muscles of mastication, and loss of sensa- 
tion in the parts supplied by these nerves. When the ophthalmic branch 
is alone involved, anesthesia of the skin of the forehead, the eyelids, the 
nasal mucosa, the cornea, and the surface of the eyeball occurs. Ocular 


DISEASES OF THE PERIPHERAL NERVES: HORSE 1197 


phenomena are observed—viz., a cloudy condition of the cornea, followed 
by ulceration, *owing to particles of dust, etc., entering the eye and 
settling on its surface, and later on the deeper structures of the organ 
become inflamed. Paralysis of the superior and inferior maxillary 
branches causes anesthesia of the skin of the face, nose, cheeks, and lips, 
and the mucosa of the tongue on the affected side. The muscles of 
mastication become paralysed on the affected side, and particles of food 
accumulate between the cheek and the teeth. Mastication is carried out 
on the sound side only. In cases of long duration the paralysed muscles 
become atrophied. Dexler, Tempel, and Marek have observed cases in 
which paralysis of the fifth nerve has been associated with facial paralysis 
(paralysis of the seventh nerve). 

TREATMENT.—If the affection depends on temporary causes, sloppy 
food should be allowed, and nux vomica may be given internally; but if 
due to lesions of the brain, treatment of any kind is useless. 

Spasm of the Muscles supplied by the Trigeminus.—This condition 
occurs in tetanus. The muscles are in a state of tonic spasm (trismus), 
and the jaws are more or less locked. We met with a case of trismus in 
a brood mare. The only other symptoms present were a swollen condition 
of the pharyngeal glands and nervous twitching of the masseter muscles. 
The case made a rapid recovery after a counter-irritant was applied to 
the pharyngeal region. No evidences of tetanus were present. Hutyra 
and Marek observed tonic or clonic contractions of the muscles supphed 
by the trigeminus in cases of acute cerebral meningitis; also in cases of 
so-called “ sleepy staggers.” 

Neuralyia of the Trigeminus.—W. L. Williams observed this condition 
in very nervous horses. The symptoms presented were frequent tossing 
of the head and rubbing of the lips against surrounding objects. Resec- 
tion of the infra-orbital nerve caused the symptoms to disappear in three 
cases (see “ Surgical Operations,” by W. L. Williams). 

4. Paralysis of the Seventh Nerve (Facial).—This occurs with com- 
parative frequency in the horse, and is usually unilateral. It is some- 
times termed “ dropped lip.” 

ErtroLogy.—The most common cause is an injury to the nerve at the 
point where it turns round the posterior border of the jaw and becomes 
superficially placed. The injury may arise from pressure exerted by a 
heavy or badly fitting harness bridle, or halter, or from a buckle in these 
pressing on the nerve. We observed two cases on the same farm, the 
cause being the use of a harness bridle which had been repaired by means — 
of a nail, and the latter pressed directly on the nerve. Blows, injuries 
from rolling, etc., may also induce the condition. Exposure to cold is 


1198 SYSTEM OF VETERINARY MEDICINE 


regarded by some authors as an etiological factor, but its influence is 
very doubtful. Various diseased conditions in distant organs are said 
to cause this paralysis, but the connection is “not proven.” In many 
cases it is impossible to discover the cause. 

Amongst other causes recorded are inflammatory infiltration of the 
pharyngeal and parotid regions, a neoplasm involving the ligaments of 
the temporo-maxillary articulation, a subarticular melanoma, neuritis 
depending on influenza or dourine, inflammation of the middle ear, caries 
of the petrous temporal] bone, neoplasms at the base of the brain. Injury 
to the nerve or its branches during the surgical opening of a strangles 
abscess is a rare cause of the condition. 

Symptoms.—As already mentioned, the affection is usually unilateral. 
The most prominent symptoms are hanging of the lower lip, the upper 
lip is turned towards the unaflected side, the animal has some trouble 
in feeding, as prehension of food is difficult. The nerve along its course 
may be swollen and painful to pressure. When all the branches of the 
nerve are involved, the ear on the affected side droops, there is inability 
to close the eyelids owing to paralysis of the orbicularis palpebrarum, or 
the upper eyelid may hang down more or less, due to paralysis of the 
corrugator supercilii, which assists in the elevation of this structure. 
On touching the cornea or conjunctiva with the finger, protrusion of the 
membrana nictitans and movements of the eyeball are produced, and, 
owing to these functions being unimpaired, ocular lesions, such as occur 
in cases of trigeminal paralysis, are not observed. But it occasionally 
happens that both lesions are associated, in which case ocular lesions 
will be present. The nostril on the affected side appears elongated, 
narrow, and lower in position than on the sound side; while, during 
inspiration, the ala is drawn inwards, and thus increases the narrowing 
of the nasal opening. Particles of food accumulate between the cheeks 
and the molar teeth, and during drinking the head is sometimes held. in 
an oblique manner. When the paralysis is bilateral, the lateral dis- 
placement of the upper lip does not occur, difficulty in respiration is 
observed owing to narrowing of both nostrils, and the prehension of food 
and the drinking of fluids may be seriously interfered with. Severe cases 
have been observed, in which the soft palate was paralysed, and during 
the process of drinking portions of the fluid were returned by the nostrils. 
When the condition depends on lesions of the brain, phenomena due to 
paralysis of other cranial nerves will be present, associated in some 
instances with hemiplegia of the opposite side of the body. 

CouRSE AND Prognosis.—In unilateral cases depending on injury to 
the nerve the course is variable. Recovery may take place in a few days; 


DISEASES OF THE PERIPHERAL NERVES: HORSE 1199 


more frequently several weeks will elapse before all the symptoms dis- 
appear. When the lesions occur in the nerve during its course through 
the petrous temporal bone, or in the cranial cavity, prognosis is un- 
favourable, and in bilateral cases similar remarks apply. When central 
nervous lesions are present, the case is hopeless. 

DIFFERENTIAL DrAGnosis.—In unilateral cases the clinical picture is 
so characteristic that diagnosis presents no difficulty. 

Paralysis of the muscles of the ear does not occur when the lesion in 
the nerve is situated beyond the stylo-mastoid foramen, as the nerves 
supplying these muscles are given off trom the main trunk immediately 
outside this foramen. In lesions of the intracranial portion of the nerve 
the abducens and the auditory nerve may be involved, and deafness, 
with strabismus of the eye on the affected side, may be observed. 

It is important to remember that in old horses, or those in poor con- 
dition, the lower lip may droop in the absence of facial paralysis. In 
such cases, if the lip be pricked with a needle, contraction takes place; 
but in cases of facial paralysis this procedure causes no movement in the 
lip, as reflex irritability is absent. 

TREATMENT.—The animal should remain at rest, and be left. without 
a halter. Soft food should be allowed, and a deep feeding-trough must 
be provided, so that prehension of food may be assisted. Mild counter- 
irritation along the course of the nerve is indicated, the most suitable 
being the application of a weak ointment of biniodide of mercury. The 
internal administration of iodide of potassium, with nux vomica, is 
advised by some authors. 

When the paralysis depends on intracranial lesions, treatment of any 
kind is of no avail. 

5. Paralysis of the Tenth Nerve (Vagus).—If we exclude paralysis of 
the recurrent nerve, lesions of the vagus are of very rare occurrence. 
Cases are recorded in which neuritis affecting the vagus has resulted 
from the action of bacterial toxins. The root of the nerve may be in- 
volved in diseases of the medulla. Chronic lead-poisoning and the toxic 
effects of Lathyrus sativus lead to paralysis of all the branches of the 
vagus. 

Symptoms.—The prominent symptoms are dysphagia, regurgitation 
of food, or an accumulation of ingesta in the cesophagus, stertorous 
breathing, and a tendency to gangrenous pneumonia, owing to the dif_i- 
culty in swallowing and the anesthesia of the laryngeal mucosa permitting 
the entrance of ingesta into the trachea. 

Treatment is useless. 

6. Paralysis of the Recurrent Nerve.—See Roaring (p. 825). 


1200 SYSTEM OF VETERINARY MEDICINE 


OTHER AFFECTIONS OF PERIPHERAL NERVES. 


As the majority of the above properly belong to the subject of lame- 
ness, only a short description of them can be given here. For full in- 
formation the reader is referred to Dollar’s work on veterinary surgery, — 
also to Share-Jones’s “ Surgical Anatomy of the Horse.” 

1. Paralysis of the Suprascapular Nerve.—This is a condition of com- 
paratively common occurrence, especially in young horses. In former 
times it was attributed to atrophy of the supraspinatus and infraspinatus | 
muscles, but in the present day the alterations in the muscles are regarded 
as due to paralysis of the suprascapular nerve. The condition is popu- 
larly known as “ shoulder-slip.” 

Etrotogy.—The majority of cases are met with in young horses which 
are put to plough for the first time. The horse that walks in the furrow 
is the one affected, the explanation being that one shoulder is exposed 
to more strain than the other. 

Mechanical injuries in the vicinity of the shoulder, such as result from 
collisions with a wall or with another horse, also cause paralysis of the 
suprascapular nerve, also severe falls from slipping, etc. The nerve is 
injured at the point where it turns round the outer surface of the scapula. 

Symproms.—These depend on the severity of the injury. In many 
instances, such as result from uneven draught during ploughing, the 
lameness may be slight, and the first symptom noticed is the atrophy of 
the muscles. In other cases a peculiar form of lameness is first observed. 
The supra- and infra-spinatus muscles are paralysed. According to some 
authors, the deltoid and teres minor muscles are also involved. When 
weight is placed on the limb, the latter moves backwards and outwards, 
and a well-defined space is observed between the scapula and the thoracic 
wall. The horse is unable to move over towards the affected’ side. 
Occasionally the affection is bilateral. In about two weeks well-marked 
atrophy of the affected muscles occurs, and not uncommonly they are so 
attenuated that the spine of the scapula becomes very prominent, and 
the supra- and infra-spinati fossee are well defined. 

Cours“ AND. Proenosis.—It is difficult to arrive at a definite prog- 
nosis. Recoveries are possible even when well-marked atrophy is 
present, but a considerable time is required. In cases where the atrophy 
is extensive and permanent the animal is only fit for slow work, but in 
slighter instances harness work can be accomplished. 

It must be remembered that in chronic foot lameness atrophy of the 
muscles of the shoulder is not an uncommon condition, but in such 
instances all the muscles of this region and of the forearm are affected. 


DISEASES OF THE PERIPHERAL NERVES: HORSE 1201 


TREATMENT.—In the early stages, rest, fomentations, massage, and 
the application of stimulating liniments, are indicated. When atrophy 
has occurred, the repeated application of counter-irritants to the affected 
muscles often produces good effects. Walking exercise should be ordered. 
Some authors recommend hypodermic injections of oil of turpentine in 
the region of the atrophied muscles. 

2. Paralysis of the Radial Nerve.—This is also known as musculo- 
spiral paralysis, or ‘‘ dropped elbow.” It is not uncommon in the horse, 
and has been specially studied by Hunting, Willis, and others. In 
former times the symptoms in all cases were ascribed to strain of the 
triceps extensor cubiti. | 

Errotocy.—Injuries to the radial nerve resulting in paralysis may 
occur from falls, severe strains, kicks, or contusions over the region where 
the nerve is superficial. Hunting and Willis showed that fracture of the 
first rib was not an uncommon cause of radial paralysis. The fibres of 
the radial nerve are derived chiefly from the dorsal roots of the brachial 
_plexus, and only receive slender contributions from the seventh and 
eighth cervical roots. The dorsal roots of the brachial plexus are directed 
round the anterior border of the first rib between the upper and middle 
third of the bone, coming into direct contact with the latter. In fracture 
of the rib at this point the nerve roots become injured, and hence radial 
paralysis results. 

_Cases have been observed to follow surgical operations when the 
animals were secured in the recumbent position for a long period. When 
in such instances a rapid recovery results, the symptoms are probably 
due to circulatory disturbance in the muscles. According to Frohner, 
excessive strain of the triceps extensor cubiti, producing myositis, and 
leading to atrophy and paralysis, may cause the symptoms ascribed to 
radial paralysis. 

Amongst rare causes of the condition may be mentioned neuritis 
resulting from inflammation of the axillary lymphatic glands, compres- 
sion from an enlarged axillary gland, arthritis of the elbow-joint, bac- 
terial toxins in cases of influenza, etc. Cases are recorded in which a 
spinal lesion was the cause of radial paralysis. We have observed an 
instance which resulted from an attack of azoturia. Kutzner recorded a 
case in which paralysis of the radial nerve was associated with paralysis 
of the crural nerves. 

Symproms.—These are very characteristic. The animal stands with 
the affected limb in the form of a bow. The elbow-joint is flexed, the 
shoulder-joint is extended, the toe of the foot touches the ground. Weight 


cannot be borne on the limb unless the knee is forcibly pressed back. 


VOL. II. 76 
: W 


1202 SYSTEM OF VETERINARY MEDICINE 


If the animal be forced to walk, the toe of the foot is dragged along the 
sround. In severe cases there is difficulty in rising. The ulna gives the 
appearance of being lower than its fellow on the sound side. Atrophy 
of the triceps sets in after a time in severe cases. 

Various degrees of motor disturbance are met with, according as the ~ 
paralysis is complete or otherwise. In some instances all the phenomena 
of radial paralysis are presented, but recovery takes place rather rapidly. 
Miller recorded a case in which the paralysis was bilateral. | 

TREATMENT.—In severe cases the animal should be placed in slings 
for a few days, and afterwards put into a large loose-box. The details 
of treatment are similar to those advised for cases of suprascapular 
paralysis (see p. 1201). 

3. Paralysis of the Brachial Plexus.—This is a very rare condition in 
the horse. Cases are recorded by Fréhner and others, and the causes 
assigned are injuries or contusions of the shoulder or axilla, fractures of 
bones in the vicinity, the presence of neoplasms, etc. 

Symproms.—In cases of complete paralysis of the brachial plexus . 
the limb on the affected side hangs from the body, and all power of 
movement in it is lost. If the animal is forced to move, the toe of the 
foot is dragged along the ground. When the paralysis is incomplete, 
the muscles involved vary according to the nerves that are affected. 
Anesthesia of the skin of the entire limb or of localised areas may be 
present in some cases. As a rule the animal maintains the recumbent 
position, and complications arise which render the case hopeless, in spite 
of treatment. 

4, Paralysis of the Sciatic Nerve.—Cases of this affection have been 
recorded by several authors. Various causes are described, such as 
injuries from kicks, punctured wounds, falls, pressure on the nerve by 
a sarcoma, abscesses in the lymphatic glands of the pelvis, etc. Paralysis 
of the sciatic nerve is frequently observed in dourine. Bilateral cases 
may depend on lesions of the brain or spinal cord. 

Symproms.—In complete unilateral paralysis of the sciatic nerve there 
is inability to flex the stifle-joint. In the standing posture the affected 
limb hangs in a powerless manner, and is incapable of free movement: 
If the limb be placed and held in the normal position, the extensors of 
the stifle are capable of fixing that jomt, and as a result the hock and 
joints below it are also fixed, so that the animal is able to bear weight 
on the leg. During progression the foot is dragged along the ground. 
Anesthesia of the limb below the stifle may be present, but in some 
instances hypersthesia is observed. In bilateral paralysis the symp- 
toms resemble those occurring in paraplegia due to a lesion in the lumbar 


DISEASES OF THE PERIPHERAL NERVES: HORSE 1203 


region of the cord, but differ therefrom in that the functions of the 
bladder and rectum remain unimpaired, and anesthesia of the inner 
surface of the thigh is absent. The paralysed muscles soon undergo 
atrophy. The prognosis is generally unfavourable. 

TREATMENT.—The indications for treatment are similar to those 
mentioned for suprascapular paralysis. 

5. Paralysis of the External Popliteal Nerve.—This condition 1s of very 
rare occurrence. Ina case observed by Darrow the cause was found to 
be pressure on the nerve by a larval hypoderma. Other causes recorded 
are pressure due to the loop of a hobble-shank, also a false step while at 
work. 

Symproms.—In complete paralysis of the nerve there is inability to 
flex the hock, or to extend the other joints of the limb. During pro- 
gression the toe is dragged along the ground. In cases of incomplete 
paralysis, when weight is placed on the limb, all the joints are flexed, 
and the animal moves in an awkward, stumbling manner. In many 
instances, anesthesia of the antero-lateral surface of the lower region of 
the thigh and of the metatarsus is present. 

6. Paralysis of the Internal Popliteal Nerve.—This is also a very rare 
condition. 

Symproms.—Inability to extend the hock or to flex the joints below 
. it. During progression the limb is advanced with all the joints in a con- 
dition of extreme flexion. The foot is lifted very high, and set down 
with a hesitating (“ tapping’) movement, the action as a whole bearing 
some resemblance to string-halt. Trotting is impossible.* 

7. Cramp of the Muscles of the Tibia.—According to Hutyra and 
Marek, this condition has been frequently observed in the horse. The 
affected limb is extended, directed somewhat backwards, and quite 
immobile, and the animal can only take a few steps with the other limbs. 
The condition lasts from a few hours to a day, but in exceptional cases 
may continue for longer periods. It can easily be mistaken for luxation 
of the patella. 

We have observed a few cases of this affection, one being in a thorough- 
bred two-year-old colt, and the others in cart-horses. No etiological 
factors could be determined. 

8. Paralysis of the Crural Nerve.—This condition is also known as 
‘* dropped stifle,” and is of comparatively rare occurrence. 

Errotogy.—The following causes are recognised: Slipping or falling 
with the hind-legs spread apart, violent kicking, which may produce 
stretching of the nerve, abscess or tumours in the psoz muscles. We 


* Moller and Dollar, “‘ Veterinary Surgery.”’ 


1204 SYSTEM OF VETERINARY MEDICINE 


have met with two cases of the affection. In one, the horse, while under 
a heavy load, started to kick, and succeeded in getting one hind-leg over 
the shaft of the cart; in the other, the horse, when starting a load, slipped 
and fell, and in his struggles to rise one of the hind-limbs was caught 
beneath one of the shafts of the cart. Paralysis of the crural nerve may 
occur in dourine, and may be due to neuritis. The paralysis of the 
quadriceps femoris, which sometimes results from an attack of azoturia, 
is due, according to Hutyra and Marek, to a primary diffuse degenera- 
tion of the muscles. . Moller, however, states that paralysis of the crural 
nerve occurs in connection with this condition, as the nerve passes 
through the psoas muscle, which seems specially involved in azoturia. 

Share-Jones* recorded a case of crural paralysis due to dilatation 
and thrombosis of the external ihac artery. The lumen of the vessel 
was much dilated for about 2 inches, and contained a parietal thrombus. 
The distended portion of the vessel caused continuous pressure on the 
crural nerve, and interfered with the functional activity of the latter. 

Symproms.—While the animal is standing, nothing special may be 
observed, but when forced to walk, there is inability to bear weight on 
the limb. Owing to paralysis of the quadriceps femoris muscle, the 
animal is unable to fix the stifle-joint, flexion of all the joints of the limb 
occurs, and he “drops”’ or “sinks” on the affected side, and there is 
difficulty in advancing the leg. Anesthesia of the skin of the inner 
surface of the thigh may be present. Later on atrophy of the affected 
muscles occurs. 

In some cases of azoturia the paralysis may be bilateral. 

Proenosis.—When atrophy is not present, recovery may take place 
in two or three weeks; but cases occur in which a long interval elapses 
before all the symptoms disappear. Bilateral cases are generally hope- 
less. 

TREATMENT.—The indications for treatment are similar to those 
mentioned for other forms of paralysis of peripheral nerves. 

9. Paralysis of the Obturator Nerve.—The etiological factors recorded 
are injury to the nerve resulting from a fracture of the pelvic bones, also 
a callus on the pubis causing pressureonthenerve. Insome instances no 
cause could be determined. The condition has been observed in dourine. 

Symproms.—The position of the limb may be normal while the horse 
is in the standing posture, or more or less abduction may be observed. 
During progression abduction is more marked, and if the horse be forced 
to trot, the limb is held off the ground in a state of abduction. In some 
cases the hip-joint is markedly flexed, and the stifle is moved in an 


* Veterinary Record, July, 1907. 


DISEASES OF THE PERIPHERAL NERVES: HORSE = 1205 


upward and outward direction. The act of backing is performed with 
difficulty. Atrophy of the abductors of the thigh results at a later stage. 
Recovery generally occurs, except in cases where the paralysis depends 
on pressure due to a callus. 

TREATMENT.—This is conducted on similar lines to those advised for 
other forms of paralysis of the peripheral nerves. 

10. Paralysis of the Gluteal Nerves.—This condition is of rare occur- 
rence. Cuny has observed a case in a mare subsequent to a difficult 
parturition, and probably depending on crushing of the superior gluteal 
nerve. The symptoms recorded in gluteal paralysis are atrophy of the 
gluteal muscles, weakness of the hind-quarters during progression, diffi- 
culty in turning round, and ata later stage the limb is kept permanently 
flexed during rest; but when the horse is forced to move, the foot is 
dragged along the ground. 

11. Paralysis of the Sacral Plexus.—Cases of this condition are recorded 
by Thomassen, Cadéac, and Giinther. The etiological factors mentioned 
were overstretching, also a sarcomatous growth involving the plexus. 
Gradual atrophy of the muscles of a hind-limb and of the croup of the 
same side was observed, and the affected limb during progression was 
lifted quickly upwards and inwards, and put down in a clumsy manner. 
Inability to rise after lying on the affected side was observed by Cadéac. 
_ Thomassen found on post-mortem marked thickening of all the nerves of 
the sacral plexus, an increase in the amount of the epineural and peri- 
neural connective tissue, with atrophy of the nerve fibres. 

12. Paralysis of the Pudic Nerve.—This gives rise to paralysis of the 
penis. Owing to paralysis of the retractor penis, the organ protrudes, 
hangs, and becomes cedematous. The following causes are recognised: 
Injuries to the perineum, diseases of the spinal cord, extreme debility, 
infectious diseases, such as influenza, etc. Occasionally the affection 
has been met with as a sequel to castration. 

The course of the disease varies. In some cases recovery may take 
place in a few weeks, or may be delayed for months; but in most instances 
amputation of the penis has to be carried out. For further details see 
works on Veterinary Surgery. 

13. Chronic Interstitial Neuritis of the Cauda Equina.—This condition 
brings about paralysis of the sphincters of the anus and bladder, and 
also paralysis of the tail. It has been investigated by Dexler, and also 
by other authors, According to some observers, the affection occurs 
more frequently in mares than in stallions or geldings, but Marek does 
not confirm this conclusion. It generally occurs in animals over eight 
. years old, and especially in old age. 


1206 SYSTEM OF VETERINARY MEDICINE 


ErioLogy.—The following causes have been recorded: Fractures of 
the caudal vertebre, fracture of the sacrum, injury to the croup, falls on 
the buttocks, injury to the tail due to the attendants assisting an aimal 
to rise by lifting him by this organ. 

Morsip Anatomy.—The nerve roots posterior to the termination of 
the spinal cord become surrounded by fibrous tissue, and the combined 
structures fill the sacral canal and extend into the intervertebral spaces. 
The lesions do not generally extend anteriorly beyond the second or first 
sacral nerve roots. In recent cases the connective tissue has a gelatinous, 
red appearance, or may be studded with hemorrhages. The caudal 
muscles show degeneration, and in advanced cases the muscles of the 
croup undergo similar alterations. Degeneration may occur in the nerves 
of the tail, the pudic nerves, and the gluteal nerves. 

Symproms.—Hyperesthesia of the skin of the tail and perineum 
occurs in the early stages, owing to irritation of the sensory nerves pro- 
duced by contraction of the connective tissue which surrounds them. 
Restlessness and a tendency to rub the tail against surrounding objects 
is observed. Later on the tail is paralysed, and hangs in a powerless 
manner. Anesthesia of the skin and other structures in the tail, also of 
the perineum, posterior gluteal region, and mucosa of the rectum (and 
of the vagina in the female), usually occurs. According to Hutyra and 
Marek, in the later stages there is usually a narrow hyperesthetic zone 
bounding anteriorly the anesthetic area, or there may be circumscribed 
hyperesthetic areas. Retention of feeces occurs, the sphincter ani is 
relaxed, and the posterior portion of the rectum is dilated and impacted 
with feces. In the later stages the urine is passed in small jets or in 
continuous drops, and paralysis of the sphincter and of the detrusor 
urine is present. Dysuria may occur, owing to paralysis of the detrusor 
urine, and cystitis may be observed as a complication. 

In rare instances, owing to the involvement of the anterior sacral and 
posterior lumbar nerves, paralysis of the lumbar region occurs; but in 
the majority of cases motor disturbances are absent. The affection runs 
a chronic course, and, according to Marek, in some instances the symp- 
toms may be fully developed in a month. Occasionally, with care and 
attention, the horse may be capable of work for about a year, but com- 
plications often set in and prove fatal. 

TREATMENT.—Little can be done in the way of treatment beyond 
attention to the condition of the rectum and bladder. The value of 
nerve tonics, such as nux vomica or strychnine, is doubtful. 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1207 


FUNCTIONAL DISEASES OF THE NERVOUS SYSTEM. 
(Neuroses without definite Anatomical Basis.) 


Under this heading are included a number of diseases of the nervous 
system, some of which are of comparatively common occurrence. 
Although we are familiar with their clinical manifestations, nothing is 
known with reference to their pathology, and post-mortem examinations 
do not reveal any definite lesions. It is probable that if more attention 
were devoted to the investigation of these affections by skilled patholo- 
gists, lesions would be discovered which would account for the morbid 
alterations of function displayed during life. But owing to the fact 
that up to the present time therapeutical measures have failed to achieve 
satisfactory results in the majority of instances, and also because horses 
suffering from these maladies are either greatly depreciated in value or 
even useless to their owners, very little interest is taken in the subject. 


MEGRIMS. 
Synonym.—Vertigo. 


This affection is characterised by periodical attacks of loss of con- 
sclousness and disturbance of equilibrium, which develop suddenly 
while the horse is at work, and the symptoms disappear in a short space 
of time. In the intervals between the attacks the animal appears to be 
in perfect health. These intervals vary in duration. In some instances 
the attacks occur in spring or summer time, and the horse is free from 
them during the winter. In others they may appear at any time, and 
with short intervals between them. Much confusion exists in veterinary 
literature with reference to the term “‘ megrims,”’ some authors regarding 
it aS synonymous with the so-called “staggers.” We have already 
remarked that the latter term is applied to a variety of conditions, and 
should be expunged from veterinary nosology. It cannot be asserted 
that the designation “ megrims ”’ or “ vertigo ”’ 1s by any means an ideal 
one, but owing to the absence of a better term it must be retained to 
signify a condition which is familiar to all practitioners. While admitting 
that disturbances of digestion exert an important effect on the occurrence 
of many cases of megrims, we must also point out that similar symp- 
toms may be observed in cases of certain brain diseases and affections 
of the heart, while in many instances no cause can be determined. The 
disease does not appear to be so commonly met with in the present day 
as formerly; probably an improved system of hygiene and dietetics, and 


1208 SYSTEM OF VETERINARY MEDICINE 


more attention to the rational working of horses, has exerted an influence 
on the incidence of the affection. The disease was very prevalent amongst 
horses kept for posting and stage-coach work in the days when travelling 
_ was carried out by this means. Some authors state that the malady is 
more commonly met with in draught-horses, but this is not our experi- 
ence, aS we have found more cases in well-kept harness horses, doing 
little work. Although harness horses are more frequently affected, yet 
in some well-marked cases the disease also occurs when the animals are 
ridden. 

Percivall* gave an excellent description of the affection, and pointed 
out that it was quite distinct from epilepsy, at the same time admitting 
that nothing was known with reference to its pathology. He remarked: 
“ By vertigo—as synonymous with megrims—I do not mean any simple 
or single symptom of giddiness which a ‘ staggered’ horse may evince, 
but I mean an assemblage of vertiginous symptoms which suddenly 
attack, and as suddenly disappear, after the manner of a fit, and to which 
horses all their lives may be at times subject, and yet never experience 
what we understand by staggers—t.e., encephalitis or phrenitis, or even 
coma. This makes me say megrims is a disease sua generis, though of 
what precise or definite nature I am not, at present, prepared to give an 
opinion.” 

Robertsony regarded the affection as depending on cerebral congestion 
(mechanical hyperemia), due to obstructed venous circulation, and 
occasioned by the pressure of a tight or badly fitting collar. 

W. Williams{ devoted but a short space to the consideration of the 
disease, and stated that the term “‘ vertigo ”’ or ‘‘ megrims”’ was applic- 
able to a condition of syncope arising from disease of the heart or peri- 
cardium, which occurs when the horse is at work or exercise. 

The connection between megrims and Meniére’s disease has not been 
established, but one would infer from some of the cases recorded of the 
latter affection that there was a marked similarity between them (see 
p. 1211). 

Errotogy.—Nothing is known definitely with reference to the etiology 
of megrims, although similar symptoms may occur in a variety of brain 
diseases and cardiac affections. We are well aware, from clinical observa- 
tion of a large number of cases of megrims, that the above maladies can 
be excluded as etiological factors in many instances. Robertson’s 
theory of mechanical hyperemia can be accepted in some cases, as 
attention to the proper fitting of the collar may prevent a return of the 

* “ Hippopathology.”’ t “‘ Practice of Equine Medicine.’’ 
t “Principles and Practice of Veterinary Medicine,” 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1209 


attacks, and, moreover, the affection is far more commonly met with 
in harness horses. But this theory often fails, as many instances occur 
in which the harness is not at fault, and besides, the disease may be 
observed in saddle horses. We surmise that digestive disturbance may 
be a predisposing cause of megrims, because we are aware that attention 
to diet and the administration of a cathartic may be the means of pre- 
venting an attack for an indefinite period, and we meet with instances 
in which one or two attacks occur, and after carrying out the above 
measures, the horse afterwards remains free from the disease. But on 
the other hand, it is not uncommon to encounter cases in which all forms 
of treatment fail to prevent the attacks. 

It is suggested by some authors that defects of vision may be a cause 
of megrims, as attacks are more likely to appear on a bright sunny day, 
especially when the horse is being driven along a dusty, limestone road. 
According to Percivall, the condition may be hereditary in some cases. 

Morsip ANATOoMY.—Owing to the fact that opportunities for post- 
mortem examinations are seldom afforded in cases of megrims, we have 
no definite knowledge of any morbid changes in the brain which would 
account forthe symptoms. Robertson recorded indications of hyperemia 
distributed throughout the entire extent of the cerebral structures, such 
as engorgement of the venous sinuses and of the vessels of the pia mater, 
- and small hemorrhages in the grey substance of the brain. C. Percivall 
observed dropsy of the lateral ventricles in post-mortem examinations of 
horses which had suffered from megrims. 

Symptoms.—The clinical picture in megrims is very characteristic. 
The horse leaves the stable in apparently perfect health, and alter 
travelling a variable distance, and especially when ascending a hill, he 
slackens his pace, or suddenly stops, and shakes his head as if some foreign 
body had entered one of his ears. The ear may be directed backwards, 
the head is carried to one side or it may be elevated, and the neck is 
held ina stiffmanner. Rapid twitching of the facial and cervical muscles 
may be observed, also a wild staring condition of the eyes, dilatation of 
the nostrils, accelerated respirations and sweating. If the horse 1s 
quickly taken out of harness and the collar removed, the symptoms may 
rapidly subside, and he is able to resume his journey. But more severe 
cases are met with in which excitement is well-marked, general muscular 
tremors are present, the animal may rear, or plunge forward and rush 
into surrounding objects, or he may turn rapidly in a circular direction, 
and then fall prostrate to the ground. When down he may struggle in 
a convulsive manner, but soon recovers, and is able to rise. When on 
his feet again, he manifests a dazed appearance, which soon passes off, 


1210 SYSTEM OF VETERINARY MEDICINE 


and he is able to complete his journey. Marked variations are observed 
in the symptoms. In some cases a preliminary warning is given by the 
animal shaking the head in the peculiar manner mentioned, or “ lying 
back in the harness,” and leaning towards the shaft on one side. If the 
driver is aware of the horse having already suffered from megrims, or — 
if he has had previous experience of the disease, he will promptly take 
the animal out of harness, and may thus avert an attack. Butif, on the 
other hand, he forces the horse onwards, then all the violent symptoms 
mentioned above will be manifested. In other cases no warning is given, 
and the symptoms occur so suddenly that the horse goes down before the 
driver has had time to unharness the animal. 

Percivall drew attention to a peculiarity in the appearance of horses ~ 
subject to megrims—viz., an elevation of the head, protrusion of the 
nose, and a wild, vacant stare—but admits that animals may be sufferers 
from the malady, and yet do not show the indications mentioned. In 
all the cases we have met with the animals were to all appearance in 
pertect health between the attacks. 

DIFFERENTIAL Diacnosts.—The history of the case and the presence 
of the symptoms described renders the diagnosis easy. The affection 
is differentiated from epilepsy by the absence of convulsions in the 
former. These convulsions may appear while the animal is at work, or 
while at rest in the stable (see p. 1213). We met with one case of megrims 
in which there were distinct convulsions when the horse fell to the ground, 
but they were of short duration. 

TrEaTMENT.—The horse should be taken out of harness on the first 
appearance of symptoms, and the collar removed. Cold water may be 
applied to the head. Care should be taken to prevent the animal from 
injuring himself in case he falls to the ground. If it be a first attack, it 
is advisable to adopt treatment which consists of the administration 
of a cathartic and attention to diet. It is of importance to see that 
the collar fits the animal in a proper manner. The owner should be 
cautioned with reference to the risk of a recurrence of the attack, so that 
he may adopt precautions on the first appearance of symptoms. In 
confirmed cases treatment is not advisable, as there is considerable 
danger to the owner should an attack occur in a crowded thoroughfare. 

Mepico-Lecaut Aspect or Mecrims.—Horses subject to this affection 
frequently change hands. There are no indications by which the veter- 
inary surgeon can detect the tendency to the disease in examining a horse 
as to soundness. In the case of a warranty, it would be necessary to 
prove that the animal had previously been subject to the disease, as we 
are not aware of any means by which we can decide whether the attack 


KUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1211 


after sale is the first one from which the animal had suffered or otherwise. 
We are well aware that an attack may develop in a horse that for years 
had been perfectly healthy, and we also know that one attack may occur 
and not be followed by another. 


MENIERE’S DISEASE. 


It is not definitely known whether this disease occurs in the horse. 
In man the affection is also known as “auditory vertigo,” and is charac- 
terised by noises in the ear, vertigo (which might be associated with 
momentary loss of consciousness), vomiting, and in many cases progres- 
sive loss of hearing, and depends on disease of the membranous labyrinth 
(the vestibular nerve and its central connections). The lesions may 
arise in connection with various morbid conditions.* Cases simulating 
the above disease have been recorded in the horse by Fleming, and also 
by Friedberger and Frohner, and W. Williams. 

Fleming} read a paper on the subject before the Central Veterinary 
Society, May 7, 1891, and recorded two cases in the horse. In the first 
case—an aged gelding used as wheeler in the regimental drag—the symp- 
toms observed were: shaking of the head while at work, and inclining it 
_ to the left side as if a fly had got into the ear and could not be dislodged. 
On several occasions the horse staggered towards the left side, and could 
not go forward. On one occasion, when urged to proceed, he became 
greatly excited and fell, and it was some time before he was sufficiently 
recovered to bring him home. No cause could be discovered to account 
for the symptoms, and the horse gave so much trouble from recurring 
attacks that he was sold. In the next case an Irish hunter, seven years 
old, when driven in double harness and going along quietly, would 
suddenly give a start, become excited, shake his head rapidly and con- 
vulsively towards the left side, carrying 1t much as a horse does when a 
twitch is severely applied to one of his ears, or as if something very 
irritating had entered the ear. At the same time he pressed against the 
pole on the near side with such force as to drive the other horse off the 
road into a hedge, and then fell. He was taken out of harness, and did 
not appear unconscious, but was stupefied, and his eyes moved as 1f he 
were much startled. In a few seconds he got up, but was so much 
depressed and agitated, that he was not put to the carriage for some time. 
No abnormal condition could be detected. He was placed under treat- 
ment, but the next time he was driven he exhibited the same symptoms. 
On this occasion he was timeously pulled up and prevented from falling. 


* Qsler’s “‘ Practice of Medicine.”’ + Veterinary Journal, vol, xxxii. 


1212 SYSTEM OF VETERINARY MEDICINE 


The attacks recurred several times at intervals of a few days. There 
was no evidence of attacks in the stable, and as the horse was not tried 
in the saddle, it could not be determined whether he would show similar 
symptoms if ridden. 

In the discussion which followed the reading of the paper, C. Sheather 
said he had observed about twelve similar cases. Intermittent attacks 
occurred about once a fortnight, but in one instance the horse was only 
attacked once, and showed deafness afterwards. The cases occurred 
in coach-horses, and were never observed in saddle horses, nor in short- 
necked common-bred animals. He regarded the cause as collar-pressure, 
which in mild cases produced congestion of the labyrinth, and in severe 
cases induced hemorrhage of this structure. The animals never stopped 
suddenly, but always went forwards and sideways, sweated profusely, 
and recovered in four or five minutes. Kendall met with five instances: 
the animals, when driven, would lay one ear down and bore towards the 
right side. One case occurred in a saddle horse. 

The above cases bear a striking resemblance to the affection described 
as megrims, especially with regard to the ear symptoms, and it is quite 
possible that some at least of the cases of the latter disease may depend 
on abnormal conditions of the membranous labyrinth. Of course, the 
matter has not been tested by post-mortem examination. 


SEA-SICKNESS. 


This is described by Hutyra and Marek as occasionally occurring in 
animals, and evidenced by vertigo. Damoiseau recorded a case in an 
Arab horse shipped from Syria to France. The symptoms observed 
were: depression, alternate bending and stretching of the head, frequent. 
neighing, trembling, and vomiting after each feed forfour days. Recovery 
took place in eight days. Hering has seen the same condition in dogs. 


EPILEPSY. 


This is a chronic affection characterised by attacks of loss of conscious- 
ness, followed by muscular spasms. The attacks are of short duration, 
and occur at irregular intervals. True epilepsy is rarely met with in the 
horse, and probably in general practice is confounded with megrims or 
allied affections. Percivall does not describe the disease, but it receives 
attention from all the other authors. 

True, Genuine, or Idiopathic Epilepsy must be distinguished from 
symptomatic epilepsy or epileptiform spasms. The true form may be 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1213 


regarded as a functional neurosis of the brain, of unknown etiology, 
chronic in its nature, showing no lesions on post-mortem examination, 
and. believed to be hereditary. 

Secondary, Symptomatic, or Reflex Epilepsy depends on lesions of 
the brain or on other pathological conditions of the body, and is charac- 
terised by the occurrence of epileptiform spasms. If the morbid con- 
dition on which the symptoms depend disappears, the attacks will cease. 

Jacksonian Epilepsy.—This is a form of the symptomatic type, and 
is believed to depend on cortical lesions of the brain. The convulsions 
are limited to certain groups of muscles, but other muscles are successively 
attacked. According to Cadéac, incomplete attacks of epilepsy, of the 
Jacksonian type, are more commonly met with in the horse. 

According to Hutyra and Marek, little attention has been devoted 
to the distinction between true and symptomatic epilepsy in animals, 
so that in practice they are seldom differentiated. These authors state 
also that true epilepsy probably occurs very seldom, and the symptomatic 
form is more frequently met with, especially in dogs, less often in cattle 
and swine, and only exceptionally in the horse. 

HittoLocy.—Nothing is definitely known with reference to the cause 
of true epilepsy. It is assumed to depend on increased irritability of 
_the cortex of the brain or of the subcortical centres, but its real nature 
is not determined. Certain external influences are said to be capable 
of inducing an attack in animals having an hereditary predisposition to 
the disease. These include fright, excitement, shock, falls, etc. The 
hereditary nature of the affection is recognised by all authors. | 

Symptomatic epilepsy may depend on various lesions of the brain, 
or it may arise in a reflex manner from diseases of other OREANS, OF from 
painful wounds of the skin. 

Morpip ANAToMy.—In true epilepsy no lesions can be discovered 
in the brain, either by macroscopical or microscopical examination. 
Bassi observed asymmetry of the skull in nine out of fifteen horses suffer- 
ing from epilepsy. 

Symptroms.—These vary according to the severity of the pinel 
In some instances prior to the attack the horse is dull and sluggish, and 
may shake his head, but in the majority of cases preliminary symptoms 
are absent or escape notice. 

In the severe epileptic attack (“‘ grand mal”) the animal shows an 
anxious expression of countenance, and if in the stall he hangs back on 
the halter, while if at work he suddenly stops and shows evidences of 
excitement and fear. The eyes are fixed and staring, the pupils are 
dilated, the respiration accelerated, he staggers and endeavours to pre- 


1214 SYSTEM OF VETERINARY MEDICINE 


serve his equilibrium by straddling widely with his limbs, and soon falls 
to the ground in an unconscious condition. Tonic contractions of the 
muscles of the neck and extremities are observed, also nystagmus and 
strabismus; these are succeeded by clonic spasms, commencing in the 
muscles of the head and neck, and soon spreading over the body. The 
membrana nictitans is protruded, there is constant blinking of the eye- 
lids, and twitching of the muscles of the face and lips, and the ears 
are rapidly moved to and fro. The jaws are moved in a spasmodic 
manner, and salivation is profuse. Or the jaws may be tightly pressed 
together, and grinding of the teeth occurs. In some cases primary mus- 
cular contractions are observed while the animal is in the standing 
posture. When in the recumbent position, the convulsions are well 
marked, and the animal struggles with fore and hind limbs. The head ~ 
and neck may be turned to one side, and the spine may also be bent. 
Involuntary passage of urine and feces may occur, the visible mucose 
are cyanotic, and the respirations are deep and laboured. 

The duration of the attack varies. It generally lasts from one to 
five minutes; in some instances it may be continued for a quarter to half 
an hour. Consciousness gradually returns and the horse rises, but may 
manifest for a time depression and exhaustion. In rare cases the spasms 
may commence in the extremities, and gradually extend to other parts 
of the body. 

In the slight epileptic attack (“ petit mal’’) loss of consciousness 1s 
also observed, and the spasms may be localised in certain areas. Ocular 
symptoms, such as nystagmus, strabismus, and blinking of the eyelids 
occur, and spasmodic twitching of the facial muscles. According to 
Hutyra and Marek, cases are recorded in which local spasms were present, 
and, provided the animals could lean against a supporting object, they 
maintained the standing posture. The above authors, and also Fried- 
berger and Froéhner, state that it is very difficult to distinguish these 
slight attacks of epilepsy from megrims. 

Symptomatic Epilepsy may show similar symptoms to the true form 
of the disease, but there may be other phenomena present, as the con- 
dition depends on either some lesion of the brain or on diseases of other 
organs. 

Jacksonian Epilepsy.—tn this form, in addition to loss of conscious- 
ness, the spasms affect certain groups of muscles, but later on they become, 
generalised. 

CoursE.—In the true form epilepsy is a chronic affection. The 
attacks occur at irregular intervals. In some instances only a few attacks 
are observed during the life of the animal. In severe cases the attacks 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1215 


may follow each other so rapidly that consciousness does not return, and 
a fatal termination takes place. The course of symptomatic epilepsy 
depends on the primary disease which is the cause of the symptoms. 

DIFFERENTIAL DraGNnosis.—The diagnosis of true epilepsy is based 
on the chronic nature of the affection, the presence of spasms accom- 
panied by loss of consciousness, and the absence of any evidences of lesions 
of the brain or other diseased conditions. In the differentiation of true 
epilepsy from the symptomatic form, there may be considerable difficulty, 
and careful observation of the case is necessary before arriving at a definite 
conclusion. According to Hutyra and Marek, hereditary taint and long 
‘intervals between the attacks generally denote a true epilepsy. 

According to Friedberger and Frohner, the slighter epileptic fits may 
be confounded with megrims. The absence of convulsions in the latter 
affection is regarded as a distinguishing feature, but in slight cases of 
epilepsy they may be so feeble as to be overlooked, while per contra the 
struggling movements of the limbs in severe attacks of megrims, when the 
animals fall down, closely resemble convulsive spasms. 

Some authors state that epilepsy can be differentiated from megrims 
by the fact that the former may occur in the stable or otherwise, while 
the latter is in the majority of cases observed while the horse is at 
work. 

Proenosis.—In true epilepsy this is unfavourable. In the sympto- 
matic form the prognosis depends on the nature of the disease, of which 
the epileptiform spasms are but symptoms. 

TREATMENT.—Considering the dangers to the rider or driver which 
are likely to ensue from a horse suffering from epilepsy, 1t becomes a 
question as to whether treatment should be advised or otherwise. Inthe . 
case of a first attack treatment may be tried, but the owner should be 
warned of the risks of a recurrence. During the attack precautions 
should be taken to prevent the horse from injuring himself. If the con- 
~ vulsions succeed each other rapidly, the inhalation of chloroform is 
indicated. When the attack has passed off, a cathartic should be adminis- 
tered. 

The treatment of symptomatic epilepsy depends on the nature of the 
primary disease. In cases depending on lesions of the brain, therapeutic 
measures are of no avail. If due to reflex irritation from other organs, 
suitable measures must be prescribed. 


1216 SYSTEM OF VETERINARY MEDICINE 


CATALEPSY. 


This is a condition in which rigidity of certain muscles occurs. The 
muscles first affected are those which happen to be in action at the time 
of the attack, but all the voluntary muscles soon become involved, and 
become tense and firm, and sometimes stand out in a prominent manner. 
At first there is increased resistance to any passive change of attitude, 
but later on the limbs, head, or neck can be placed by the examiner in 
any position, and this posture is maintained. Consciousness and sensa- 
tion are more or less disturbed. The condition is said to be extremely 
rareinanimals. Nothingis known with reference toitsetiology. Accord- 
ing to Hutyra and Marek, in the recorded cases the symptoms did not 
originate as a distinct neurosis, but resulted from organic diseases of the 
nervous system and severe intestinal disorders. These authors consider 
that such cases should not be designated as ,catalepsy, but should be 
termed “ cataleptic rigidity of the limbs.” 

Henning recorded an instance in the horse in which the entire muscular 
structure was involved; there was also anesthesia of the skin and loss of 
consciousness. The case recovered in twenty-four hours, after an injec- 
tion of morphine was administered. 


ECLAMPSIA. 


This term is applied to epileptiform spasms, occurring as a pure neurosis, 
and independently of organic diseases. It is difficult (if not impossible) 
to differentiate the condition from epilepsy. The affection is said to 
be more frequently met with in dogs than in other animals. 

Puerperal Eclampsia is of comparatively frequent occurrence in bitches 
(see p. 1274), but seems to be very rare in equines. 

Tapken recorded a case in an aged mare which, after previous parturi- 
tions, had shown slight spasms. On the last occasion parturition was 
difficult, and in two hours afterwards clonic spasms of the muscles of the 
head and neck, and one hind-limb, were observed. The attack lasted for 
five minutes. On the following day a few attacks were noticed. These 
disappeared after removal of the placenta. 


CHOREA. 


SynonyM.—St. Vitus’s dance. 
In human medicine chorea is defined as “a disease chiefly affect- 
ing children, and characterised by irregular involuntary contraction of 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1217 


the muscles, a variable amount of psychical disturbance, and a re- 
markable liability to acute endocarditis” (Osler). The affection lasts 
on an average from eight to ten weeks, and there is a tendency to 
recurrences, but recovery is the rule. 

According to Hutyra and Marek, the disease termed “chorea ’”’ in 
animals is not analogous with the affection in man. Similar remarks 
apply to the so-called chorea that occurs so often in dogs as a sequel 
to distemper (see p. 1273). The above authors also state that in a great 
many of the recorded cases in horses, cattle, and swine, the character of 
the spasms was not similar to human chorea, and in the very small 
number where the twitchings were similar to true chorea, a careful post- 
mortem examination of the nervous system was not made, so that 
organic diseases, or lesions of other organs, could not be eliminated. In 
true chorea there are no definite post-mortem lesions. 

Percivall does not mention chorea in his section on Nervous Diseases. 
W. Williams described stringhalt as a form of chorea, but obviously there 
is no resemblance between the affections. Robertson described chorea 
as occurring in the horse, but admitted that it was not identical with 
the disease in man, and regarded the affection termed “ shivering ’”’ as 
an example of the malady as it affects equines. But we are unable to 
recognise any similarity between the two diseases. Friedberger and 
Frohner give a number of recorded cases of chorea in the horse, but 
offer no opinion with reference to the correctness of the diagnosis in such 
instances. Cadéac states that the observations on chorea in the horse 
are few in number and incomplete; some appear to be forms of sympto- 
matic epilepsy, and the majority are not sufficiently definite to enable 
us to recognise the existence of the disease in equines. 

The recorded cases appear to be in~reality local spasms of certain — 
muscles, especially those of the head, face, and eyes. In an instance 
recorded by Leblanc irregular muscular twitchings occurred over the 
entire body. 


TETANY. 
See Vol. L., p. 248. 


LOCAL SPASMS OF MUSCLES. 


Hither a single muscle or a group of muscles may be affected by 
clonic spasms or twitchings. These spasms show a certain uniformity 
or regularity, and the condition is not associated with loss of conscious- 
ness. It is very probable that the majority of cases of chorea recorded 
in the horse are in reality of this nature. 

VoL, II, 1M; 


1218 SYSTEM OF VETERINARY MEDICINE 


ErroLocy.—In some cases the spasms depend on central lesions of 
the nervous system, and occasionally on disease of the peripheral nerves. 
They may also be due to neuroses of unknown origin, and possibly to 
reflex causes. Gunning recorded a case in a horse recently castrated; 
adhesions had occurred between the severed end of the spermatic cord — 
and the scrotal wound, and when these were separated the spasms ceased. 
Instances have also been observed in which spasms of muscles pecureed 
as the result of a wound. 

Symptoms.—As a rule the spasms are more or less rhythmic in 
character, and although usually continuing while the animal is at rest, 
they become less frequent in number and in intensity. They may dis- 
appear in a few days in some instances, while in others they continue for 
several weeks. Unless depending on central lesions, they do not interfere 
with health; but cases may occur in which a considerable area is involved, 
and the working capability of the horse is then impaired. 

The symptoms vary according to the muscles affected and the area 
involved. Thus, spasm of the muscles of mastication may cause grinding 
of the teeth, while spasm of the facial muscles induces movements of the 
lips and closure of the eyelids. When the cervical muscles are involved, 
the head shows nodding movements, or it may be drawn to one side in a 
convulsive manner. Bilateral spasm of the oblique abdominal muscles 
causes contractions of the abdominal wall and bulging of the intercostal . 
spaces, while unilateral spasm of these muscles produces a curvature 
of the body to the same side, also contractions of the abdominal wall on 
this side (Hutyra and Marek). 

It must be remembered that clonic spasms of certain muscles may be 
observed in various nervous diseases, and also in pericarditis and endo- 
carditis. 

TREATMENT.—The cause of the spasms must be sought for, and treat- 
ment prescribed accordingly. Nerve sedatives, such as chloral hydrate 
and bromide of potassium, may be required to reduce the irritability of 
the nervous system. 


BASEDOW’S DISEASE. 


Also known as Graves’ disease and exophthalmic goitre. 

This affection is descibed by Hutyra and Marek, Cadéac, and Fried- 
berger and Froéhner, under the heading of Nervous Diseases, but as it 
depends on a morbid condition of the thyroid gland, we consider it should 
be placed under the section of Diseases of the Ductless Glands, and to 
this section the reader is referred. 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1219 


SPASM OF THE DIAPHRAGM. 
_ See Diseases of the Diaphragm, p. 991. 


SHIVERING. 


This term is applied to a peculiar nervo-muscular affection of the 
hind-limbs, which is manifested especially during the act of backing or 
turning round, Although it is a condition of common occurrence, 
particularly in the heavy breeds of horses, nothing is definitely known 
with reference to its etiology or pathology. Various theories have been 
advanced as regards the seat of the disease, but up to the present time 
the matter has not been decided. From a consideration of the symptoms 
it is assumed by many observers to depend on some lesion of the spinal 
cord, yet no definite evidence can be adduced on this point. 

As already remarked, Continental authors do not recognise the affec- 
tion as a disease per se. 

Robertson described “‘ shivering’ under the head of chorea, but as 
we have already pointed out there is no similarity between the two 
conditions. Percivall made no mention of the disease. 

_ Ertotoey.—Many writers on the subject believe that “ shivering ”’ 
is hereditary. Falls, sudden frights, shock, the operation of docking, 
etc., are sometimes stated to be etiological factors, but probably they 
can only act as such when the hereditary tendency is present. Influenza 
and strangles are also said to be causes of the affection, and probably the 
toxins produced may be capable of inducing “ shivering ”’ in a horse 
predisposed to the disease. | 

It is not uncommon to find that whén a “ shiverer”’ is attacked by 
influenza the nervous phenomena become greatly exaggerated, but during 
convalescence the symptoms may return to their ordinary degree of 
severity. We must confess that nothing is definitely known with refer- 
ence to the etiology of the affection. We are unable to account for the 
gradual appearance of the disease in some cases, and the rapid develop- 
ment of the symptoms in other instances, nor can we offer an explanation 
of the intermittent character of the malady which is so frequently 
observed. 

Morsip ANATOMY.—In a well-marked case of “* shivering,” recorded 
by McCall,* a careful post-mortem examination, also a histological 
examination of the brain and spinal cord, did not reveal any lesions. 


> 


66 


* National Veterinary Association, 1910. 


1220 SYSTEM OF VETERINARY MEDICINE 


Wolstenholme also had a careful histological examination made of the 
brain and spinal cord of an advanced case of “shivering,” but no lesions 
were discovered. 

Symptoms.—In “shivering” irregular and involuntary movements of 
the hind-quarters, associated with spasms of the gluteal muscles and 
the abductor muscles of the thigh, are observed, especially when the act 
of backing is performed. These muscles become more or less rigid, and 
show marked tremors. The intensity of the symptoms varies in different 
cases, and also depends on the stage of the affection. As we shall point 
out later on, the disease is intermittent in many instances—a very 1m- 
portant matter in connection with the examination of horses as to 
soundness. . 

In the early stages nothing abnormal may be detected until the horse 
is forced to back, then we observe a want of control over the muscles of 
the hind-quarters. It is at this stage that the affection is most likely 
to be intermittent. In ordinary cases the horse may walk or trot in a 
normal manner, but when suddenly stopped or backed the muscular 
spasms are observed. Some writers describe the spasms as tonic, others 
as clonic. W. Williams stated that the muscles contract and relax in 
an irregular manner, and regarded the spasms as clonic. Robertson drew 
attention to the peculiar tremulous nature of the muscular contractions. 
The muscles of the tail are involved in well-marked cases, causing this 
organ to be jerked upwards during the act of backing. 

‘Shivering ”’ can be best detected by observing the horse under the 
following conditions: 

In the Stall—The examiner stands behind the horse, and causes him 
to pass from side to side of the stall. The hind-limbs are observed to be 
lifted in a rapid manner from the ground, projected slightly backwards, 
and abducted, while at the same time the muscles of the haunch show 
tremulous movements. Hach hind-limb is kept suspended in a hesitating 
manner, and then quickly replaced on the ground. It is not uncommon 
to find one hind-limb more affected than the other. 

Turning Round.—If the horse be turned quickly in a small circle, the 
hind-limbs show a lack of co-ordination, and the limb next to the cir- 
cumference of the circle is markedly abducted and carried in a stiff 
manner. On reversing the direction of turning, a similar condition is 
observed in the other hind-limb, but the symptoms may be more marked 
in one leg than in the other. | 

During Backing.—The phenomena observed during this act have been 
already mentioned. In severe cases backing may be impossible. The 
horse arches his back, and the muscular spasms are intense. 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1221 


During Shoeing.—Not infrequently in the case of a new purchase the 
presence of “‘ shivering” is first detected by the shoeing smith. The horse 
resists any attempt to pick up the hind-limbs; in some instances this 
applies to one limb only. If the smith overcomes the resistance, the 
muscular tremors in the limb can be both seen and felt. We have observed 
cases in which it was impossible to pick up either of the hind-limbs, the 
animals successfully resisting the attempts of the farrier, and it was 
necessary to resort to casting in order to shoe the hind-feet. If a rope 
was fixed to the pastern, and an attempt made to bring the limb forward, 
violent spasms occurred in the latter, with marked distress on the part of 
the animal. 

Other Phenomena.—In many instances the characteristic twitching of 
the muscles of the quarter, thigh, and tail are specially apparent when 
the horse is engaged in the act of drinking. McCall* has observed that 
in severe cases of the affection, spasms of the muscles of the neck, lips, 
and eyelids may occur when the horse is forcibly backed on a slippery 
surface, or is otherwise excited. The same writer has occasionally met 
with instances in which the fore-limbs were also involved; the knee was not 
freely flexed, and on attempting to pick up the foreleg the horse extended 
it in front like a prop, and resisted any attempt at knee-flexion. When, 
-however, flexion was accomplished, distinct tremors resembling those in 
the hind-limb could be detected. McCall has also observed that the ner- 
vous temperament of a “‘ shiverer”’ frequently shows a peculiar irritability 
and want of uniformity, being some days quiet or even sluggish, and on 
others nervous and excitable; or he may absolutely refuse to do certain 
work until changed for a few days to another occupation. 

** Shivering” is a progressive disease, and tends to become more severe - 
with age. Another point worthy of attention is that, should a horse 
suffering from the affection receive a punctured wound of the foot (a 
gathered nail), serious results are likely to follow owing to the high degree 
of nervous irritation produced. In some instances “ shiverers ’’ never 
lie down in the stable. Asa rule the symptoms are well marked when 
the horse rises from slumber in the morning, a marked stiffness of the 
muscles of the quarters and hind-limbs is then observed, and in some 
cases he shows a temporary difficulty in standing steadily. 

Railway journeys have been found to accentuate the symptoms of 
“shivering.” Probably this result is due to the excitement which is 
produced. 

Diacnosis.—In well-marked cases the affection is readily recognised. 
Difficulty is experienced in the early stages and when the disease is of 

* Paper on “ Stringhalt and Shivering,”’ National Vetérinary Association, 1910. 


1222 SYSTEM OF VETERINARY MEDICINE 


an intermittent character. In the examination of horses as to soundness, 
special care is necessary in order to avoid overlooking the presence of the 
affection, and the points mentioned under the heading of Symptoms 
(p. 1220) are of importance. When the examination has to be conducted 
at a horse-fair, it is obvious that we cannot adopt all the tests mentioned, 
especially those which must be carried out with the horse in the stable. 
Intermittent cases cannot, of course, be detected by the most careful 
method of examination. : 

Macqueen* drew attention to a very important test in the detection 
of “ shivering ”’—viz., active exercise in the way of galloping and then 
allowing the horse to cool down; if the disease is present, evidences of it 
will then be likely to appear. He also mentioned that it is the practice 
with a certain class of dealers who wish to dispose of horses suffering 
from slight shivering to place the animals in a loose-box or a paddock 
for three weeks or a month and feed them well, and at the end of that 
time the animals are likely to pass a veterinary examination. 

In the examination of unhandled horses, or in those recently “ broken,” | 
it must be remembered that the act of backing may be performed in an 
awkward manner, and care must be taken not to mistake this for evidence 
of disease. : 

Proanosis.—As already remarked, “‘ shivering” 1s a progressive 
disease, and tends to increase in intensity with work and age. Although 
in slight cases the animals are able to perform their work, yet they are 
much depreciated in value, as the effect of heavy traction is to cause an 
increase in intensity of the symptoms, and the difficulty in backing is 
a serious defect in many instances. Moreover, the fatal results which 
are apt to ensue when a ““shiverer”’ receives a punctured wound from 
a nail in one of the hind-feet must be taken into consideration. The 
difficulty of shoeing the hind-feet also renders a horse suffering from 
“* shivering ”’ a very undesirable purchase. 

‘* Shivering ’’ should also be regarded as a serious unsoundness in the 
case of stallions or mares for breeding purposes. 

TREATMENT.—‘‘ Shivering”’ is an incurable affection, and nothing 
can be done in the way of treatment. 

Mepico-Leacat Aspect oF “ SHIVERING.”’—The reports of medico- 
legal cases in which the question at issue is the existence or otherwise 
of “shivering ’”’ in a horse, show the marked difference of opinion that 
may exist between members of the profession on the subject. The inter- 
mittent nature of the affection is the explanation of the apparent diversity 
of opinion which is so frequently met with. All veterinary surgeons of 


* National Veterinary Association, 1910. 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1223 


experience are aware of the fact that a horse may show evidences of 
“shivering” at one time, and these may be absent on another occasion—of 
course, we are referring to cases of the disease which are not of a severe type. 

As an example we cite the following case: 

We examined a valuable five-year-old cart-gelding as to soundness; 
the animal had side-bones, but was otherwise sound, and we advised 
purchase. All the usual tests for ‘‘ shivering”? were adopted, and the 
fore and hind feet were examined by the farrier. The horse was tried in 
a lorry by the purchaser’s men, and found satisfactory. Next day the 
animal was sent to us in double harness, with a report that the stableman 
had observed distinct evidences of ‘‘ shivering” that morning. While 
the horse was standing in harness he occasionally snatched up one hind- 
leg, but on testing him he was found to back without any difficulty. 
He was taken out of harness, and on lifting up each hind-leg alternately 
slight shivering was detected. We visited the stable two days afterwards, 
and in the presence of the purchaser adopted every test, but without 
eliciting any symptom of “ shivering.” The purchaser was surprised, 
because on the previous day he saw distinct evidences of the disease, and 
accused us of overlooking its existence. But although we admitted that 
the horse was a “ shiverer,” we declined to accept any responsibility in 
the matter. Ina short time afterwards, when the animal was subjected 
to heavy work, the symptoms of the disease were so apparent that they 
could be recognised by a novice. | 

With reference to the period of time in which “ shivering” may take 
to develop, nothing is definitely known. In medico-legal cases the ques- 
tion is likely to arise in connection with a breach of warranty, or with a 
charge of neglect on the part of a veterinary surgeon in an examination 
as to soundness. Weare aware that under certain circumstances, such asa. 
long journey by train, a slight case of “‘ shivering ’’ may be so accentuated 
as to lead the examiner to believe that it must have been in this condition 
for a considerable period of time. But provided the veterinary surgeon 
in the first instance adopted all the resources at his command, and failed 
to detect the disease, he could not be held responsible. 

Another matter merits consideration—viz., Is it safe to cast a 
“shiverer”’ for a surgical operation? Although we have carried out 
this procedure on several occasions without any untoward results, we 
consider that the owner of the animal should always be informed before- 
hand of the possible risks, and his consent should be obtained. We have 
observed that some “shiverers’’ when cast manifest the most acute 
distress, but we have no evidence that there is any special risk of spinal 
injury resulting from the procedure. 


1224 SYSTEM OF VETERINARY MEDICINE 


STRINGHALT. 


This is a peculiar neurosis of unknown origin, characterised by spas- 
modic, rapid flexion of one or both hind-limbs, and best seen when the 
horse is walking, turning round, backing, or turning from side to side in 
his stall. There is no lameness, and except in far-advanced cases the 
capacity for work is not interfered with. Like the disease termed 
““ shivering,” it is most marked when the horse first comes out of the 
stable, or if he is excited; it tends to increase with age and hard work, 
it becomes aggravated after an attack of influenza, and, in the early 
stages, it may be of an intermittent character. The peculiar movement is 
not manifested at every step the horse takes, but only at irregular intervals. 

In severe cases the affected limb is elevated from the ground in a 
convulsive manner, and brought down with considerable force. In shght 
instances the abnormality is only observed when the horse turns in a 
small space. McCall states that stringhalt is most prevalent in heavy 
draught-horses, but in our experience it is more common in the lighter 
breeds of horses. It is not uncommon in well-bred stallions, and is also 
met with in the mule and donkey. In rare instances a fore-limb may be 
affected. | 

Et1oLogy.—The disease is generally regarded as hereditary. Beyond 
this we know nothing with reference to its causation. W. Williams 
described the affection under the heading of Chorea, but we fail to see 
any resemblance between stringhalt and either chorea in man or the 
so-called chorea of the dog. The affection is progressive, and is more 
commonly met with in aged than in young horses. W. Williams recorded 
cases In which the symptoms of the disease appeared in one night. 

Morpip Anatomy.—McCall,* in the case of a donkey badly affected 
with stringhalt in both hind-limbs, conducted a careful post-mortem 
examination, but failed to discover any lesions, although a microscopical 
examination of the brain, spinal cord, nerves, and muscles was carried out. 

W. Williams found in two cases an exostosis on the shaft of the ilium, 
involving the sciatic nerve; also in grey horses suffering from the disease 
he observed a deposition of melanotic material in the sheath of the crural 
nerve. 

Goodwint observed a well-marked case of stringhalt affecting both 
hind-limbs, in which the animal fell while at work and expired. The. 
post-mortem showed anchylosis of the three last dorsal vertebre and 
considerable narrowing of the spinal canal. 

Youatt{ described the results of an autopsy on a case of the disease © 


* Op. cit, t Veterinarian, 1829. t Lbid., 1838. 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1225 


ina racehorse. The animal was so badly affected that the abdomen was 
struck by the pastern joints when the horse was walking. The investiga- 
tion was conducted by Spooner, Sewell, and Ferguson. The great sciatic 
nerve as it entered the sacro-sciatic foramen was of a yellowish-brown 
hue, its texture was softened, and its fibrille were loosely connected 
together. Several ecchymoses were found on the epineurium of the 
nerve, in the portion passing from the ischium through the muscles of 
the haunch. These ecchymoses were confined to the sheath of the nerve, 
and the nerve substance was normal. No lesions were discovered in the 
brain, spinal cord, joints, or muscles. 

Spooner conducted several other post-mortem examinations on cases 
of stringhalt, and found similar lesions in every instance. Percivall 
asks the pertinent question: How do these lesions account for the 
symptoms ? 

It must be confessed that we possess no knowledge of the lesions on 
which stringhalt depends, and in this respect we have not advanced since 
the days of Youatt and Spooner. 

Symptoms.—We have already mentioned the chief symptoms of the 
disease. The course of the affection varies. In some instances, especially 
in harness horses well cared for and not overworked, the symptoms may 
not increase in severity for years. In heavy draught-horses doing hard 
work in cities the condition becomes accentuated after a variable time, 
and may interfere with backing heavy loads. General muscular atrophy 
has been observed in some advanced cases. 

An enzo6tic type of stringhalt is met with in Australia,* affecting large 
numbers of horses in certain districts. It comes on suddenly, without 
any assignable cause, and usually in the autumn. Kendall recognises 
three forms as follows: . 

Local Form.—This is the most common. The mild type resembles 
ordinary stringhalt, but in severe cases both hind-legs may be so badly 
affected that progression can only be accomplished by a succession of 
bounds and plunges. The hind-limbs may be jerked up simultaneously, 
or in quick succession, and the hocks remain flexed to their utmost extent 
until the haunches almost reach the ground, before the horse has power 
to bring the feet down. This form seldom proves fatal, and the cases 
recover spontaneously in from twelve to eighteen months. 

Generalised Form.—In this the fore-limbs are generally affected as well 
as the hind, but they are not jerked up, being carried forward in a stiff 
manner, with little flexion of the knee. If the horse be chased or excited, 
he plunges about, and may fall, or after violent struggles to get away he 

* McCall, paper on “ Stringhalt,” National Veterinary Association, 1910. 


1226 - SYSTEM OF VETERINARY MEDICINE 


comes to a standstill, the head is elevated, the nostrils dilated, and there 
is violent cardiac palpitation. 

Acute Form.—This is characterised by frequent stumbling, dragging 
of all the limbs, knuckling over of the fetlocks, atrophy of the muscles 
of the thighs, debility, sweating if made to move any distance. If the — 
horse falls or lies down, he may be unable to rise, and struggles violently ; 
but if raised to his feet by means of slings he can both stand and walk, and 
with care usually recovers. 

Nothing is known with reference to the etiology of the affection. 
The tendency to recovery is in marked contrast to stringhalt as it occurs 
in the British Isles. 

Proenosis.—In ordinary cases of the disease the utility of the horse 
is not interfered with, but owing to its progressive nature it must be 
regarded as a cause of unsoundness. It must be remembered that, as in 
cases of “shivering,” wounds of the foot of an affected limb are liable to 
cause serious results. The affection is incurable, but in severe cases 
operative measures may produce considerable alleviation of the symptoms. 

Diaenosis.—There is no difficulty in recognising well-marked cases of 
stringhalt. But in slight cases considerable care is essential in order to 
detect the presence of the affection. Similar methods of examination 
must be carried out to those advised for the detection of shivering. In 
many instances the symptoms may not be apparent until the horse is 
moved from side to side, and turned round sharply in a narrow stall. 
We may also point out that a horse should be tested for stringhalt when 
he has cooled down after a gallop, as well as when he is first brought out 
of the stable. Intermittent cases of the disease in the early stages are 
not uncommon, and obviously they are likely to be overlooked. 

TREATMENT.—Medicinal treatment is of no value. In exaggerated 
cases peroneal tenotomy has been adopted with a varying degree of 
success by some practitioners. For details of the operation, the reader 
is referred to “ Surgical Anatomy of the Horse,” by J. T. Share-Jones. 

Mspico-Lecat Aspect oF StrincHatt.—As the intermittent char- 
acter of the disease is now recognised by all practitioners of experience, 
it is quite apparent that cases may be overlooked during an examination 
as to soundness. Provided that all precautions have been taken by the 
practitioner, he cannot be held responsible if he passes a horse as sound, 
and the animal is found shortly after to be affected with stringhalt. 

With regard to the period of time in which stringhalt may develop 
in a horse previously free from the affection, nothing definite is known. 
We have already referred to instances in which the disease developed in 
one night. Hence, when the query is put to the practitioner, How long 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1227 


has the horse suffered from the affection ? his reply must be based on 
the severity of the symptoms, bearing in mind that these may be aggra- 
vated by various circumstances. In any case, a definite period of time 


cannot be suggested, and in ordinary instances the query is impossible 
to answer. 


CRIB-BITING AND WIND-SUCKING. 

SynonyM.—Hrophagy. 

Various theories have been advanced to account for the occurrence 
of these conditions, but up to the present time nothing definite has been 
determined. That we should confess ignorance on such subjects may, 
to the owners of horses, be a matter of surprise, seeing that the conditions 
are of such common occurrence, and are so readily recognised by even 
amateurs. But, like many other affections, familiar enough so far as 
symptoms are concerned, very little attention has been directed in the 
British Isles to the questions of their etiology, nature, pathology, preven- 
tion, and treatment. It is universally accepted that, once a horse 
develops crib-biting or wind-sucking, nothing can be done to overcome 
the conditions. The animal, although capable of performing work, is 
depreciated in value, as there are circumstances connected with, or arising 
from, the defects which render him a very undesirable purchase. These 
defects have been regarded by some as stable vices, and by others as 
causes of unsoundness. In our opinion, they should be classed as un- 
soundness, for reasons to which we shall refer later on. 

With reference to the incidence of these defects, it is interesting to 
note the following figures, taken from the Army Reports, 1911-12, and 
1912-13: 


| | India. 


al 

















1911-12. | 1912-13. 
1911-12, | 1912-13, 
Crib-biting. . ay oe 13 17 1 0 
Wind-sucking 7 - 43 37 1 3 








Crib-Biting is characterised by the following phenomena: The horse 
seizes the manger or some projecting object with his teeth, arches his 
neck, and, according to some authors, swallows a quantity of air, emitting 
during the act a peculiar sound, which is characteristic. The act is 
repeated at variable periods of frequency. According to Malkmus, “ as 
the head is thrown forward the larynx is drawn down. The pharynx is 
opened with a jerk, and the air rushes into it, giving rise to the charac- 


1228 SYSTEM OF VETERINARY MEDICINE 


teristic grunting sound.” Friedberger and Frohner state that during 
the act either all or a part of the air may escape forwards, or the whole 
may be swallowed. Some practitioners in the present day believe that 
the act consists of the eructation of gases from the stomach, but the — 
evidence in support of this view is not convincing. 

Wind-Sucking.—In this the horse performs the act without seizing 
the manger or any projecting body with his teeth. The head is bent 
towards the breast, the lips move in a peculiar manner, the head and 
neck are jerked upwards, and air is swallowed, the act being accom- 
panied by a similar sound to that heard in crib-biting. Wind-sucking 
may be carried on outside as well as inside the stable. 

M. Pécus, Vétérinaire Militaire & Fontainebleau, has devoted special 
attention to the subject of crib-biting and wind-sucking, and published 
several papers thereon, of which he has kindly sent us copies. Lack of 
space prevents us from drawing attention to his investigations in full, 
but we give the following extracts: According to this writer, the affec- 
tion was first described by Carlo Rivini in 1618, then by Jourdain in 
1655, and by Solleysel in 1664. Various views as to the nature of the 
condition were held by these writers, and also by others in the years 
following. | 

According to Pécus, a form of the affection occurs characterised by 
the swallowing of air, or of air with saliva, but no sound is produced. 
This may be the earlier stage of the ordinary crib-biting or wind-sucking. 
He gives records of post-mortem examinations of cases which showed 
dilatation of the cardiac extremity of the stomach, and during life con- 
stantly licked the manger and swallowed saliva mixed with air, prior to 
manifesting any symptoms. Observations and experiments showed that 
in certain cases eructations of gas occur. A form of the affection is thus 
recognised in which the stomach is filled with air by the repeated swallow- 
ing of saliva, with or without licking the manger or surrounding objects, 
or during the ingestion of food. This air is then eructated from the 
stomach, and strikes the vibrating parts of the bucco-pharyngeal orifice, 
causing a sound, and the air escapes by the mouth and nostrils. In 
another form the stomach becomes more or less distended by the air 
which has been swallowed. Air is still being drawn into the esophagus, 
and is then rapidly expelled through the pharynx without having entered 
the stomach, the act being accompanied by an eructating pharyngeal | 
sound. This form was observed by Hertwig in sixteen cases, and in nine 
of these dilatation of the esophagus was present. 

Other types of the affection are also described by Pécus as follows: 
(1) A certain amount of air coming from the lungs during the act of 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1229 


expiration is arrested in the pharyngo-csophageal cavity, the orifices of 
which are closed by combined contraction of the muscles of the soft 
palate, the glottis, and the base of the tongue. Sudden contraction of 
the cofistrictor muscles of the pharynx occurs, and forces the air through 
the mouth, a deep vibratory sound being produced. This is a purely 
pharyngeal eructation; there is no swallowing of air, and no air enters 
the stomach. Cases of this nature have been observed by Zundel and 
by Friedberger and Frohner. According to Joly, wind-suckers who do 
not swallow air are not affected by gastric or intestinal tympany. 
(2) Atrophagy with pharyngeal eructation and swallowing of expired air. 
In this form the air which accumulates in the pharyngeal cavity does not 
pass out directly by the mouth, but is swallowed, and enters the stomach. 
By clonic spasms of the pharyngeal muscles both gastric eructations and 
pharyngeal eructations can occur. This form was observed by Malkmus 
and by Friedberger and Frohner. 

Other forms recognised are: erophagy with increase in size of the 
abdomen and permanent tympany ; eructating erophagy with cesophageal 
eructations; non-eructating erophagy, in which air is swallowed and 
enters the stomach, but no eructations follow, and no sound accompanies 
the act. The sound can, however, be detected by auscultating the 
region of the cesophagus. 

Pécus records typical instances of each of these forms of crib-biting 
and wind-sucking.* 

With reference to the source of the sound which accompanies crib- 
biting or wind-sucking there is some difference of opinion, but the bulk 
of experimental evidence points to the pharynx. 

With reference to the question of eructations of gas from the stomach, 
it is pomted out by several writers that under normal conditions gases 
cannot pass through the cardiac end of the stomach. Of course, we 
must remember that in some cases of gastric tympany eructations of gas 
occur. Pécus states that in erophagy, eructations of gas, although pos- 
sible, are extremely rare in horses. In most instances the resulting 
gastric tympany is relieved by the gas escaping through the pylorus and 
entering the intestines. Probably in those cases in which eructations 
occur there may be a certain degree of relaxation of the cardia and 
resistance of the pylorus. 

The question has been raised as to whether the air enters by the 
mouth or by the nostrils, or by both ways. According to Pécus, it can 


* See “ Pathologie Comparée des Diverses Variétés d’ Aérophagies et de leur 
Bruit Eructant, chez l’Homme et chez le Cheval,’? Revue Générale de Médecine 
Vétérinaire, 1*-15 Aofat, 1-15 Septembre, 1912, 


1230 SYSTEM OF VETERINARY MEDICINE 


enter by the mouth, but Liautard holds that it gains access to the pharynx 
by the nasal passages. According to Malkmus, in the normal condition 
air cannot enter the pharynx from the mouth, owing to the large size 
of the soft palate; but during the act of crib-biting or wind-sucking the 
contraction of the sterno-hyoideus and of the subscapulo-hyoideus - 
muscles causes a depression of the hyoid, the base of the tongue, and 
the larynx. As a result, the free border of the soft palate does not 
come into contact with the base of the tongue, the pharyngeal cavity 
is enlarged at its base, and there isa momentary communication between 
the mouth and the pharynx through which air is able to pass. 

Et1oLogy.—Opinions differ as to the causes of crib-biting or wind- 
sucking. Some writers regard the condition as depending on gastric 
disorder, others hold that the gastric affection is the result of the swallow- 
ing of air. The theory of the condition depending on a neurosis has 
much to recommend its acceptance. According to Pécus, it should be 
regarded as a nervous form of ewrophagy caused by a chronic gastric 
disorder, and occurring in a subject affected with an acquired or heredi- 
tary neuropathy. The condition is most often found in horses which 
lead a more or less idle life, and are kept in the stable for long intervals. 
Pécus points out that the early symptoms may be constant licking of the 
manger, which is associated with constant movements of the jaws and 
excessive secretion of saliva. The latter, mixed with air, 1s swallowed 
(sialophagy), and gradually the animal acquires the habit of swallowing 
air. This habit of licking the manger is a very common symptom of the 
early stages of the affection. 

Imitation is held by some authors to be an etiological factor, and 
many examples are cited to show that young horses, especially, soon 
learn the vice from their neighbours. On the other hand, Youatt did 
not believe in this mode of causation, and stated that he had never 
observed two cases of the vice in the same stable. 

Hereditary Influences.—According to Friedberger and Fréhner, the 
vice may be inherited, especially from the sire. Collin reported that 
forty-five descendants of an Anglo-Norman stallion were all crib-biters— 
viz., one foal at three months, two at seven and eight months, five at 
from ten to twelve months, the majority in their second and third years, 
and one after three years. Although young horses may become affected, 
we find in practice that adult and aged horses are the most likely subjects. 
It has rarely been observed in foals. 

Symproms.—We have already drawn attention to the prominent 
characters of the affection. In addition to these, we may mention 
hypertrophy of the sterno-maxillaris, subscapulo-hyoideus, and sterno- 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE = 123] 


hyoid muscles, due to excessive use, and in crib-biters the incisor teeth 
are worn and rounded at their anterior borders. 

In;many instances the affected animals are subject to attacks of 
tympany, indigestion, loss of condition, etc., but cases are occasionally 
observed in which the general health is not disturbed. The crib-biter 
may sometimes rest the chin on the manger instead of seizing it with his 
teeth. Giinther observed foals using their mother’s hock-joints as a 
support for carrying out the act of crib-biting. In some cases the act is 
carried on while the animal is feeding. The horse, if placed in a strange 
stable, or if in the presence of strangers, may cease from crib-biting for a 
variable time. 

Pécus recognises a form of the affection in which there is simple 
swallowing of air and saliva, without the emission of any sound (aérophagie 
simple, silencreuse, ou stalophagie). 

TREATMENT.—The affection is generally regarded as incurable. 
Pécus, however, claims that by the employment of a special apparatus 
designed by him cases in the early stages may be cured, while in con- 
firmed cases the horses can be rendered useful for work. The apparatus 
consists of a flexible steel collar, fitted with a special hinge. The latter 
is covered by leather, so as not to cause any injury to the skin. The 
apparatus exerts pressure on the sterno-maxillares muscles, but does not 
compress the trachea. It is kept in position by a strap attached to the 
head-piece of the halter. When the horse bends his head, the sterno- 
maxillares muscles are compressed by the apparatus, and the antago- 
nistic muscles—viz., the extensors—exert their action in a reflex manner, 
so that the head returns to the normal position. Hach attempt at bend- 
ing the head is followed by the same result, so that after a time the horse 
learns that it is impossible for him to perform the act, and desists. In | 
addition to the use of the above, Pécus advises dry food and a liberal 
supply of water. He also prescribes salines for about a month in the 
form of 20 grammes of artificial Carlsbad salt twice a day in 5 litres of 
water, which the animal usually takes spontaneously. 

For full particulars of the technique of the above treatment the 
reader is referred to an article by M. Pécus,* entitled ‘‘ Mécanisme et 
Action Auto-Educatrice du ‘ Contre-Tic’ Pécus, basée sur l’Immobilisation 
des Muscles du Tic par l’Emploi des Mouvements Réflexes Antagonistes.”’ 

Mepico-Lecau Asprct or Crip-Bitine AND WIND-Suckine.—These 
defects are very properly regarded as causes of unsoundness. Although 
in rare instances crib-biters and wind-suckers may not show any dis- 
turbance in health, yet in the majority of cases the animals so affected. 


* Journal de Médecine Vétérinaire, November, 1911. 


1232 SYSTEM OF VETERINARY MEDICINE 


cannot be got into proper condition, and are subject to attacks of gastric 
and intestinal tympany and indigestion. Hence they must be regarded 
as very undesirable purchases, and every effort is made on the part of 
buyers to avoid them. As sellers are quite as anxious to dispose of 
animals so affected, 1t follows that every possible form of deception is 
practised in order to conceal the defect. Such attempts are assisted by 
the fact that affected animals may not show any evidences of the defect 
when put into a strange stable, or when in the presence of strangers; 
while in the case of crib-biters, unless a wooden manger is convenient, 
the act may not be performed. The peculiar alterations in the incisor 
teeth already referred to are no doubt suggestive, but a horse cannot be 
condemned on these alone, because similar appearances may result from 
the habit many animals have of catching at the manger or the halter- 
chain while being groomed. The medico-legal aspect may be considered 
from two points of view: 

1. In Cases of a Warranty.—If the seller warrants a horse as sound, 
and in a short time after sale the animal shows evidences of being a crib- 
biter or a wind-sucker, it becomes a question as to whether he was so 
affected prior to sale. In the case of a crib-biter, if the incisor teeth 
show the evidences of abnormal wear already alluded to, it is clear that 
the defect has been in existence for some time. In the absence of this 
symptom, or in the case of a wind-sucker, we have no means of deciding 
with reference to the length of time the horse has been affected. We 
- do not mean to infer that the affection starts suddenly, as we know from 
observation that preliminary symptoms, such as constant licking of the 
manger, chewing movements of the jaws, and swallowing of saliva, occur 
in many instances; but as to the period of time in which the horse first 
commences to crib-bite or wind-suck we have no definite knowledge. 
We may, however, surmise that if the animal shows well-marked evidences 
of the affection within a few days alter sale, the probability is that he 
was affected prior to sale. We must point out, however, that a crib- 
biter or a wind-sucker may, when removed to new surroundings, cease 
to perform the act for three or four days. Goubaux and Barrier* state 
that long periods of intermittence have been recorded, and that in the 
case of a crib-biter, if there is no suitable object within reach, the symp- 
toms may disappear temporarily, but reappear after a time. It is not 
uncommon to find that buyers make no complaint of the existence of the 
defect until a week after sale, or even longer, and the question then 
arises as to whether it was in existence prior to sale or developed after- 


wards. 
* The Exterior of the Horse.”’ 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1233 


The legal limit is not a definite one, and in reported cases the term 
“reasonable time ”’ has been laid down as referring to the period in 
which 'a horse may be returned, if warranted sound and found to be a 
crib-biter or a wind-sucker. In our present state of knowledge it is 
difficult to say the number of days which should be regarded as a reason- 
able time. Of course, if the purchaser could prove by evidence that the 
defect existed prior to sale, and was not apparent until some time after 
sale, then the time-limit would not affect the issue. 

A dispute may arise as to the existence of crib-biting and wind-suck- 
ing, or otherwise, and the animal may be submitted to the veterinary 
surgeon to decide the matter. In such a case great discrimination is 
necessary on the part of the practitioner, and unless there are plain 
evidences of the existence of the defect, he should insist on the animal 
being placed under his care, so that he can observe the case carefully for 
some days before giving a definite opinion. It is a good plan to place 
the horse in a stall containing a wooden manger, as we know that many 
crib-biters will not perform the act with an iron manger, especially in 
strange surroundings. Some authors say that occasionally the affection 
will only be manifested at night-time; hence it is advisable to visit the 
horse after dark. 

2. Responsibility of the Veterinary Surgeon.—It is quite apparent 
from the points we have mentioned that the defect cannot, except in 
isolated instances, be detected during an examination as to soundness. 
Of course, every precaution should be taken, such as observing the horse 
in the stable when such is available, etc., but in spite of this, the affection 
is likely to be overlooked, for the reason already alluded to. In order to 
protect himself and his client, the veterinary surgeon should demand a 
special warranty stating that the horse is nota crib-biter or a wind-sucker. 
It might be said on the part of the seller that he should not be compelled to 
give such a warranty, seeing that he sells the horse subject to a veterinary 
examination; and, besides, there are other obscure affections which 
cannot be detected, and he is not asked to warrant against these. But 
we would point out that crib-biting and wind-sucking are defects which 
are palpable to anyone accustomed to horses, while the other affections 
might or might not be recognised by them. Hence, if the horse suffers 
from the former defects, the owner is perfectly aware of the fact, while 
itis impossible for the veterinary surgeon to detect them during his 
examination of the animal. When we consider the enormous deprecia- 
tion in value which results from the presence of these defects it is quite 
apparent that we should either instruct the purchaser to obtain the 
warranty, or demand it ourselves, before the certificate of soundness is 

VOL. II, 78 


1234 SYSTEM OF VETERINARY MEDICINE 


given. If we omit to do this, we are not doing our duty towards our 
client. In the case where the seller is not of good financial standing, the 
most advisable plan is to advise the client to defer payment until he has 
had an opportunity of observing the horse in the stable for a few days. 
Obviously the warranty should be given in writing, or in the case of a — 
verbal one it should be made before a reliable witness. 


WEAVING. 


This is described by some authors as a vicious habit, and by others 
as a neurosis. It is characterised by continuous lateral movements of 
the head and neck, and sometimes accompanied by analogous and 
alternate movements of the body on the anterior limbs, and only occurs 
in the day-time while the horse is at rest in the stable, and especially in 
the intervals between feeding times. In some cases the limbs are not 
moved, while in others one fore-foot is slightly raised from the ground— 
e.g., if the left foot is raised, the movements take place towards the right, 
and vice versa. It would appear to be a habit acquired during prolonged 
idleness in the stable. Beyond causing the animal unnecessary fatigue, 
and being displeasing to the owner, it does not seem to produce any evil 
effects. Some authors advise as a means of preventing the habit that 
two straps should be attached from the halter to the surcingle, of such a 
length that the horse can raise or lower his head, but cannot turn it to 
the right or left side. 


JIBBING. 


This term is applied to a vice in which the horse refuses to move 
forwards, or to proceed in a certain direction. All means of punishment 
fail to have any effect. In some instances it only occurs at intervals. 
Although classed by some authors as a neurosis, there is no evidence to 
support such a view. Improper handling and bad treatment are the 
most likely causes of the vice. It is not infrequently observed in mares 
during the period of cestrum, and disappears when this is past. The 
consideration of the subject properly, belongs to the management and 
training of horses rather than to veterinary medicine. 


SUNSTROKE AND HEAT-APOPLEXY. 


SynonymMs.—Heat-stroke; Insolation; Thermic fever; Coup de soleil; 
Coup de chaleur. 

According to Friedberger and Froéhner, a distinction should be made 
between sunstroke and heat-stroke. In sunstroke the nervous disturb- 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1235 


ance depends on the action of the direct rays of the sun falling on the 
cranium, while in heat-stroke the phenomena are due to overheating of 
the body, combined with overexertion and a diminution in the loss of 
heat from the body. Hutyra and Marek, and also Cadéac, describe 
both conditions together. According to the former authors, a sharp 
distinction between sunstroke and heat-stroke is impracticable and 
unnecessary. 

ErroLocgy.—Both conditions are comparatively of rare occurrence in 
temperate climates. Exposure to the direct rays of the sun during hot 
weather, especially if the animals are at work, or transported in open 
waggons, is recognised as the cause of sunstroke. Heat-stroke can occur 
without exposure to the sun, and has been observed in army horses 
during drill and manceuvres in very hot weather. 

In slight cases of sunstroke it is said that cerebral hyperemia is 
present, but in severe instances the effect of the direct rays of the sun 
on the cranium is believed to cause excessive heating of the central 
nervous system, which induces paralysis of the vaso-motor and respira- 
tory centres, with consequent lowering of blood-pressure and disturbance 
of respiration. In heat-stroke the temperature of the animal is raised 
to a marked extent, especially if he is subjected to muscular exertion. 
Moist heat is more likely to induce the condition than dry heat, as the 
former retards evaporation from the surface of the body, and the loss of 
heat is thereby diminished. Marinesco has shown experimentally that 
the nervous phenomena may be caused not only by the direct rays of 
the sun, but also by an increase in the body temperature in animals 
confined in very hot but dark stalls. Various views are held with refer- 
ence to the actual causation of both conditions. 

Symptoms.—According to Friedberger and Frohner, in sunstroke the 
symptoms usually appear suddenly. There may be no rise of tempera- 
ture at the commencement, nor often during the whole course. The 
symptoms vary according to the lesions in the brain. Hxcitement, 
spasms, trismus, pawing, extreme injection of the visible mucose, may 
be observed. Death may occur rapidly from cerebral hemorrhage, or 
from gradual paralysis of the respiratory centre. 

In heat-stroke sweating is observed, the animal shows marked de- 
pression, a stumbling gait, an anxious expression of countenance, cardiac 
palpitation, laboured respiration, hyperpyrexia (108° F.), staggering, and 
finally collapse. We have observed in very hot weather cases in which the 
above symptoms to a slighter extent were manifested, and recovery ensued. 

In severe cases recovery is rare. The affections may be confounded 
with meningitis and cerebral apoplexy. In the diagnosis reliance must 


1236 SYSTEM OF VETERINARY MEDICINE 


be placed on the sudden appearance of the symptoms, the presence of 
very hot weather, and on the exposure to a strong sun. 

TREATMENT.—The animal should be placed in shaded surroundings. 
The surface of the body should be sponged with cold water, and an ice- 
bag applied to the cranial region. Hnemata of cold water are indicated. 
If stimulants are indicated, Hutyra and Marek recommend subcutaneous 
injections of camphorated oil, also caffein. Strychnine and quinine are 
advised by some authors. If convulsions are present, 1 ounce of chloral 
hydrate should be given in solution per rectum. 


LIGHTNING-STROKE. 


This occurs as the result of being struck by lightning. Similar 
phenomena may occur from contact with powerful electric currents, such 
as a broken electric tramway wire. 

Injury from lightning is said to result more frequently when animals 
seek shelter under trees; but we must point out that fatalities often 
occur in the open field. 

The effect is chiefly exerted on the nervous tissues, but, as pointed 
out by Hutyra and Marek, pronounced disturbance of function may be 
present without any obvious nervous lesions. 

Morpip ANAaToMy.—The lesions vary according to the intensity of 
the current which strikes the animal. Scorching of the hair and burning 
and destruction of the skin and soft structures may be observed. On 
the unpigmented parts of the skin dark-coloured streaks or branching 
lines may be seen (“ lightning figures ’’). Wounds or fractures are some- 
times met with. Occasionally no lesions are found. Distension of the 
venous system, non-coagulation of the blood, incomplete rigor mortis, 
rapid decomposition of the carcass, and ecchymoses on the internal 
organs and beneath the serous membranes, are said to be fairly often 
met with. Jellinck found on microscopical examination of the apparently 
uninjured nervous structures, numerous small hemorrhages, destruction 
of the nervous tissue in patches, and degeneration of nerve fibres, in 
cases that did not succumb suddenly. 

SYMPTOMS.—Strong currents produce sudden death by paralysis of 
the nervous system. In cases where the current is less active the animal] 
may remain recumbent and in a comatose condition for some time, 
and then recover. Or local symptoms may be manifested, either tem- 
porarily, or they may be permanent. These include paralysis of one ear, 
or of the lower lip, or of the muscles of deglutition. Paresis or paraplegia 
may also be observed, and a temporary or permanent loss of vision. 


FUNCTIONAL DISEASES OF NERVOUS SYSTEM: HORSE 1237 


Coursr.—According to Hutyra and Marek, a fairly rapid recovery 
generally ensues from disturbances caused by lightning. We presume 
these atithors refer to the effect of slight currents, as the recorded cases 
show that deaths from this cause are not uncommon. 

TREATMENT.—If the animal is unable to rise, a straw bed should be 
provided, and he should be turned from side to side at proper intervals. 
Stimulants are indicated if coma is present. These include the hypo- 
dermic injection of camphorated oil, caffein, and strychnine. 


DISEASES OF THE NERVOUS SYSTEM IN 
CATTLE 


By B. HARVEY MELLON, F.R.C.V.S., anp E. WALLIS HOARE, F.R.C.V.S. 


General Remarks.—The knowledge we possess with reference to 
diseases of the nervous system in cattle is very limited. While clinically 
we are familiar enough with the nervous phenomena which so often accom- 
pany or result from gastric disorders in these animals and are probably 
reflex in origin, we find it a very difficult matter to differentiate the above 
from nervous affections per se. No doubt the latter do occur, as demon- 
strated by the clinical records and the lesions described by observers on 
the Continent, where the subject receives more attention than in the 
British Isles. 

Another point which has some bearing on the question of diagnosis 
of nervous diseases in cattle is that cases showing evidences of cerebral 
or spinal diseases are usually destroyed early, as on economical grounds 
it is not desirable to continue treatment; hence we do not often get an 
opportunity of observing the clinical phenomena, or of conducting post- 
mortem examinations on fully developed cases. 

While the excitement, frenzy, or mania which are so common in con- 
nection with acute affections of the brain in the horse are not so frequently 
observed in cattle, yet there are occasions on which such symptoms are 
in evidence. More frequently, however, the preliminary symptoms of 
excitement are soon succeeded by a semi-comatose condition and by 
paraplegia. 

It is of importance in cattle practice to remember that acute nervous 
phenomena are not uncommon in connection with certain gastric dis- 
orders, and care must be taken not to attribute such symptoms to brain 
lesions. Not infrequently the differential diagnosis presents great diffi- 
culty, and it may not be possible to decide the question until we treat 
the gastric affection and observe whether the nervous symptoms disappear 
or otherwise. ) 

Some authors describe the affection known as “ milk fever’’ under 
the heading of Nervous Diseases, but we consider that it more properly 
comes under the section entitled Diseases of Doubtful Etiology, and hence 

1238 


¢ ? 


DISEASES OF THE NERVOUS SYSTEM: CATTLE — 1239 


we shall discuss it with these affections. Although nervous phenomena 
are prominent in milk fever, the rapidity with which cases recover under 
modern treatment indicates that the affection should not properly be 
regarded as either an organic or a functional disease of the nervous 
system. 


DISEASES OF THE BRAIN. 


Meningitis.—Ii we except the tubercular and parasitic forms, menin- 
gitis may be regarded as of comparatively rare occurrence in cattle. An 
epizootic cerebro-spinal meningitis 1s recognised in cattle (see Vol. LI., 
p. 897), but, according to Moussu, a number of affections are included 
under this term. 

Krrotocy.—Tuberculosis is responsible for a number of cases of 
meningitis. Chronic catarrh of the facial sinuses, suppurative conditions 
of the structures in the orbital cavity, complicated fractures of the horns, 
unskilful dishorning, etc., are recognised as causes of the disease. Menin- 
gitis may also occur as a complication of malignant catarrh. In some 
instances no etiological factor can be determined. 

Symproms.—In the early stages dulness and depression may be 
observed, and later on excitement occurs, with fever, restlessness, stamp- 
ing of the feet, a staggering gait, bellowing, loss of vision, strabismus, 
and nystagmus. In some cases the symptoms are very violent, and the 
animal rushes at any object in its way. The period of excitement is soon 
followed by inability to maintain the standing posture, the animal goes 
down, general convulsions set in, and death occurs in a short space of 
time. Tuberculous meningitis is generally subacute in character, and 
for a description of the symptoms see Tuberculosis (Vol. I., pp. 137, 142). 
Poulsen observed cases of meningitis which occurred one or two days. 
after calving, and were said to be differentiated from “ milk fever” by 
the presence of fever, contracted pupils, and in some cases by general 
convulsions. According to Hutyra and Marek, this form of meningitis 
is often curable, provided early treatment is adopted. 

TREATMENT.—This is to be conducted on similar lines to those advised 
for the analogous disease in equines. The large majority of cases die in 
spite of treatment. 

Encephalitis.—Very little seems to be known with reference to this 
affection in cattle, and in the cases recorded the symptoms resemble 
those occurring in meningitis. It is admitted that both conditions are 
frequently associated. Moussu describes the following symptoms: Dis- 
turbances in locomotion, difficulty in deglutition, lameness which may 
affect two diagonal limbs simultaneously, inco-ordination of movements, 


1240 SYSTEM OF VETERINARY MEDICINE 


diminution or loss of vision, inequality in the size of the pupils, nystagmus, 
strabismus, a tendency to turn in a circle towards the right or left, or to 
thrust the head against a wall, vertigo, and finally the animal goes down 
and dies in convulsions. 

Treatment is of no avail. 

Cerebral Abscess.—According to Cadéac, this is a very rare lesion in 
cattle. The majority of the recorded cases depended on traumatic 
injuries to the cranial walls. Violent traction exerted on the icetus 
during a difficult parturition is said to have been the cause of a cerebral 
abscess the size of a nut. A number of small abscesses may result from 
purulent infection consecutive to traumatic pericarditis. Suppurative 
conditions of the eye and tumours in the orbit are occasionally followed 
by cerebral abscesses. 

Symproms.—In a case recorded by Haase, of an abscess in the left 
cerebral hemisphere, the animal carried its head to the left side, and if 
attempts were made to straighten the head attacks of mania were pro- 
duced. Cadéac states that the symptoms resemble those observed in 
sheep suffering from “ gid,’”’ and also are similar to the phenomena mani- 
fested in tuberculosis of the brain. Treatment is useless. 

Hydrocephalus.—Chronic dropsy of the ventricles is a rare condition 
incattle. Casesare recorded by Cruzel, Harms, and Angerstein. Nothing 
is known with reference to its etiology. The symptoms resemble those 
manifested in the analogous affection in the horse. ‘Lhe animal tends to 
remain in one position, and may force his head against any available 
object; he has a stupid expression of countenance, and soon loses condition. 
Tn some cases he assumes the recumbent position, and refuses to rise, and 
the eyes may be retracted within the orbits. The disease is incurable. 

Congenital Hydrocephalus is observed with equal frequency in the calf 
as in the foal (see p. 1152). 

Cerebral Hypereemia.—According to Cruzel, this condition is met with 
in working oxen, and is due to injuries to the cranial region resulting 
from an ill-fitting yoke, especially when the animals are working on 
rough ground. It may also result from narcotic poisons, and from 
exposure to the direct rays of the sun. Passive congestion of the brain 
may occur in connection with traumatic pericarditis and acute tympany 
of the rumen. 

Symproms.—In some instances violent symptoms are observed. In | 
others the animals show evidences of a semi-comatose condition, a stag- 
gering gait, interference with vision, and a tendency to fall if forced to 
move. ‘The course varies; the symptoms may disappear rapidly, or death 
may occur from encephalitis or cerebral hemorrhage. 


DISEASES OF THE NERVOUS SYSTEM: CATTLE 1241 


TREATMENT.—Karly venesection, followed by the administration of 
an active cathartic, is advised, also the application of cold water or ice 
to the cranial region. 

Cerebral Heemorrhage.—This may occur in cattle under a variety of 
conditions, which include microbial diseases, such as anthrax, hemor- 
rhagic septicemia, and malignant foot and mouth disease. It may also 
be observed in connection with tumours, parasites, and sunstroke. 
According to Hutyra and Marek, hemorrhages between the membranes, or 
between the dura mater and the cranium, occur more frequently than 
cerebral hemorrhage in cattle, and the hemorrhage tends to be more 
extensive. 

Symproms.—The symptoms are similar to those met with in cerebral 
hemorrhage in the horse, and treatment is conducted on the same lines. 

Embolism and Thrombosis of the Vessels of the Brain.—These lesions 

are of very rare occurrence. A case of thrombosis of the venous sinuses 
was recorded by Moussu in a cow, associated with an cesophageal abscess. 
Huynen observed an instance of extensive calcification of the small and 
medium-sized meningeal arteries in a calf aged ten months. This author 
also met with a similar lesion in a steer, depending on suppuration in the 
submaxillary gland; the infection reached the sinus by way of the internal 
carotid artery, and set up thrombosis. 
- Tumours of the Brain.—Cadéac states that the majority of cerebral 
tumours in cattle are tuberculous in origin. Amongst other tumours 
recorded are sarcomata (always secondary), melanomata, and lipomata. 
Osseous tumours have also been met with, and cysts in very rare instances. 
Morot and Rolland recorded a case of dermoid cyst, which was attached 
to the meninges by a fibrous pedicle and contained four teeth. 

SyMpPtToms.—In some cases the animal carries the head low, and may 
show marked depression and emaciation, associated with a semi-comatose 
condition. In others, violent symptoms are manifested at irregular 
intervals, also epileptiform convulsions, and sometimes nystagmus. 
Movements in a circular direction may be observed in some instances, 
also inability to avoid contact with surrounding objects. In cases of 
tumour of the cerebellum the head is turned to one side, and there is 
inco-ordination in movement. 

Treatment is useless. 

Progressive Bulbar Paralysis.—According to Cadéac, the cases recorded 
of this affection in cattle were in reality associated with enzootic cerebro- 
spinal meningitis, and depended on compression of the posterior region of 
the medulla oblongata by meningeal exudates. The lesions were not 
confined to the medulla, but also involved the first pair of cervical nerves, 


1242 SYSTEM OF VETERINARY MEDICINE 


and paralysis of the mastoido-humeralis, sterno-maxillaris, and masseter 
muscles was present. 

The symptoms resembled those of cerebro-spinal meningitis. 

Parasites of the Brain.—See section on Parasites. 


DISEASES OF THE SPINAL CORD. 


Spinal Meningitis.—Very little is known with reference to this affection 
in cattle, and Continental authors state that it is generally confounded 
with cerebro-spinal meningitis. A case was recorded by Leconturier.* 
Pachymeningitis was observed by Emmerich consecutive to a sarcoma 
of the orbit, and a suppurative form of the disease was recorded by 
Strése. 

Myelitis—We have not been able, after a perusal of various authors, 
to discover any references to this affection in cattle. Law suggests that 
it may occur, but gives no specific instances. 

Compression of the Spinal Cord.—The majority of cases of this con- 
dition in cattle depend on tuberculosis, or on the presence of tumours. 
Occasionally compression may result from traumatic influences. Tuber- 
culosis of the vertebree (most frequently of the dorsal) may lead to hyper- 
trophy and softening of the vertebral bodies, causing considerable 
diminution in the lumen of the spinal canal. Tuberculous neoplasms 
may also develop between the dura mater and the bones, or a tuberculous 
meningo-myelitis may occasionally occur in the lumbar portion of the 
cord, or caries of the vertebre followed by infiltration of pus into the 
spinal canal. Any of these lesions may produce compression of the 
spinal cord. 

Actinomycosis has occasionally been observed, affecting the meninges 
and the bodies of the vertebrae, and associated with the formation of pus 
cavities, especially in the cervical region, and has given rise to com- 
pression of the cord. Tumours of the cord exert a similar effect; these 
include gliomata, gliosarcomata, sarcomata, and lipomata. Parasitic 
invasion of the cord may also be a cause of compression. 

Symptoms.—These are practically similar to the phenomena occurring 
in compression of the cord in equines. 

For obvious reasons treatment is not advisable. 

Injuries and Concussion of the Spinal Cord.—These are not so com- 
monly met with in cattle asin equines. The etiology, lesions, symptoms, 
and treatment are practically similar in both species. 


* Ann. de Méd. Vét., 1872. 


DISEASES OF THE NERVOUS SYSTEM: CATTLE 1243 


DISEASES OF THE PERIPHERAL NERVES. 


These are of comparatively rare occurrence in cattle. The symptoms 
are similar to those observed in the analogous conditions in equines. 

The following cases have been recorded: 

Paralysis of the Facial Nerve rarely occurs in cattle as the effect of 
injuries, as in these animals the nerve is protected by the horns at the 
point where it is usually subject to traumatic influences in the horse. 
The affection has been observed as the result of inflammation of the middle 
ear, actinomycosis of the parotid region, and tuberculosis of the brain. 

Paralysis of the Suprascapular Nerve.—A few cases have been recorded 
by Kovacs, Bru, and Székely. 

Paralysis of the Radial Nerve.—This is occasionally met with in cattle, 
and has resulted from falls and kicks, or injuries to. the region of the 
caput muscles. 

Paralysis of the Tibial Nerve and of the External Popliteal Nerve.—A 
case of the former condition was recorded by Schultz, and one of the 
latter by Fillecke. 

Paralysis of the Crural Nerve.—This is said to occur in rare instances 
in paralysis following milk fever, and is attributed to stretching of the 
nerve. 

Paralysis after Parturition (Lumbar Paralysis)—Some authors recog- 
nise this condition, but there is considerable difficulty in distinguishing 
it from milk fever, more especially when various observers have found 
the treatment by inflation of the udder with air to give good results. It 
has been ascribed to compression of the sacral plexus, the sciatic, and the 
obturator nerves, owing to luxation of the sacro-iliac articulation. But, 
according to Hess, it occurs after easy and rapid parturition. 

Paralysis before Parturition.—This 1s not uncommonly met with, 
especially in old cows in poor condition. It has been attributed to many 
causes, but little definite is known on the subject. Treatment proves of 
no avail in many instances. It must be remembered that milk fever 
may occur just prior to calving, and give rise to similar symptoms. The 
success of the treatment by inflation of the udder will be of marked value 
in the differential diagnosis. 


FUNCTIONAL DISEASES OF THE NERVOUS SYSTEM. 
Epilepsy.—Cases of true epilepsy have been recorded in cattle, but 
are rare. The symptoms may be manifested while in the stable or in the 
field, and appear suddenly. The following symptoms are recorded: 


1244 SYSTEM OF VETERINARY MEDICINE 


General muscular trembling, bellowing, in some cases the animal falls 
heavily to the ground, clonic spasms of the muscles, the eyes may be fixed, 
or nystagmus may be present, the pupils are dilated and insensible to light, 
sight, hearing, and cutaneous sensibility are impaired, the head and neck 
may be turned to one side, the respirations are laboured, the cardiac 
action is tumultuous. Grinding of the teeth and salivation are also 
observed. The attack is usually of short duration, and recovery takes 
place rapidly. Occasionally after rising, the animal walks with a stag- 
gering gait, but this is temporary. 

Secondary epilepsy is more frequently met with; the convulsions 
may be limited to the muscles of the head, and the animal does not fall 
down if there is any object close by from which support can be gained. 
The spasmodic movements of the head may be very rapidly performed. 
The attacks vary as regards frequency; in some instances a recurrence 
may not take place for three months or longer, in others several attacks 
may be observed in the same week.* According to Cadéac, epilepsy in 
cattle does not interfere with the condition of the animals. This author 
also states that the differential diagnosis of this affection often presents 
marked difficulties. Nothing can be done in the way of treatment, and if 
the affected animal is in good condition it should be sent to the butcher. 

Chorea.—This affection is said by Cadéac to be of more frequent 
occurrence in cattle than in horses. In the cases recorded choreic move- 
ments were observed, especially in the muscles of the fore-limbs, neck, 
and head. Anacker met with instances in which there were rhythmical 
movements of the head and neck, with “ dancing’? movements of the 
hind-limbs. According to Hutyra and Marek, in a great many of the 
recorded cases in cattle the character of the twitchings was not that of 
chorea. 

Eclampsia (Puerperal Convulsions).—In cows, Saint-Cyr and Violet, 
Albrecht, Lameris, and others, observed attacks of eclampsia, which 
occurred soon after parturition, and were distinct from milk fever. The 
symptoms manifested were: Clonic spasms of the muscles of the trunk, 
extremities, neck and head, rotation of the neck, grinding of the teeth, 
unconsciousness, falling down, etc. The attacks lasted from a few 
minutes to half an hour, and sometimes as long as two or three hours, 
and usually recurred several times. Recovery followed in every case 
with one exception, in which intermeningeal hemorrhage occurred with — 
a fatal result. 

Wind-Sucking.—This condition is described as occurring in cattle 
by Continental authors. According to Friedberger and Fréhner, various 


* Hoffmann, Ann. de Méd. Vét., 1875. 


DISEASES OF THE NERVOUS SYSTEM: CATTLE = 1245 


forms may be observed, but the following is the most common: The anima] 
opens Its mouth widely, raises the head, stretches out the tongue, swings 
it to right and left, the secretion of saliva is increased, it becomes foamy, 
and collects in the corners of the mouth, and with a clucking sound is 
swallowed along with air. Owing to this process being frequently re- 
peated the ramen becomes tympanitic, and after a time the air is gradually 
ejected by repeated belching. Cases are also described by Weinmann 
and Johne. The latter observed a cow which forced her head firmly into 
the corner of the food-trough, and by means of her tongue pumped the 
rumen full of air; the act was accompanied by a peculiar clucking noise. 
She stood still for thirty or forty seconds, and then ejected the air in an 
unbroken stream, the process appearing to give her satisfaction. 

Sunstroke and Heat-Stroke.—This affection may occur in cattle, es- 
pecially those in very fat condition, when extreme hot weather prevails, 
and the animals are driven a journey by road, or exposed in a show-yard. 
It is of uncommon occurrence in temperate climates. The symptoms 
resemble those met with in the analogous condition in horses. 

Lightning-Stroke.—The description given with reference to this 
condition in horses will also apply to cattle. 


DISEASES OF THE NERVOUS SYSTEM IN 
SHEEP, GOATS, AND SWINE 


By G. MAYALL, M.R.C.V.S. 


SHEEP. 


Simple Encephalitis—Eriotocy.—Encephalitis due to infection or 
auto-intoxication is sometimes seen in sheep. Various foodstuffs, such 
as distillery residues, spoilt rye, etc., are exciting causes, and sudden 
transitions of temperature and changes from spare and innutritious keep 
to plentiful and rich food are predisposing factors. 

Symproms.—Dulness, torpor, uncertain gait, sunken eyes, small 
appetite, much lying down, interrupted rumination, and constipation. 

TREATMENT.—Get up from pasture, and give 4 ounces of linseed oil 
to which 4 or 5 minims of croton oil have been added. Administer 
frequent enemata. Change food and give light, easily digested fare. 
Prescribe vegetable tonics in convalescent stage. 

Trembles (“‘ Trotting Disease’’)—This disease has been known in 
Great Britain for a long time, and is more prevalent in sheep north of the 
Tweed than south of it. It has been recognised on the Continent since 
1750, when Leopold saw itin Spanish sheep. The product of Merino rams 
seem to be peculiarly liable to the complaint in some districts.. The 
disease appears to resemble “ louping-ill ’’ in many respects (see Vol. I., 
p. 1251). McGowan describes the affection under the title of “ scrapie,” 
and attributes it to the presence of a protozoal parasite, the Sarcocystes 
tenella, in the muscular fibres and other parts of the system. The ail- 
ment has also been noticed in goats. 

Hit1oLocy.—The exact cause is unknown. Inbreeding, excessive 
improvement of breeds, pampering, the use of too old ewes—all tend to 
bring about the disease. In rams, excessive use has been claimed as a. 
cause. Also too rich food, too poor food, and sudden changes of diet. 
Unfavourable localities and pasture (very swampy or very dry). 

Symproms.—A shy, timid, aspect of the ailing subject, easily frightened 
or excited; nodding of the head, drooping of the ears. Later on (after 

1246 


DISEASES OF THE NERVOUS SYSTEM: GOATS 1247 


a few weeks) weakness of the quarters, trotting movements, high-step- 
ping, stumbling about; gnawing or nibbling at the feet, rubbing the 
hind-parts against the walls; falling out of the wool, and dry, scurly 
condition of the skin. Emaciation, anemia, and paralysis bring about 
death in from two to six months. The disease is said to be exceedingly 
contagious. It occasions heavy losses, especially among lambs. 

TREATMENT is of no avail. 

PropHyLactic MEasurEs.—Rational feeding and breeding; avoidance 
of too early mating (two-year-old animals recommended); isolation of 
affected animals and removal of remainder of the flock to high-lying 
land. 


GOATS. 


Fainting—Nervous or Stiff-Legged Goats.—Drs. White and Plaskett, 
of Nashville, Tennessee, report on these goats, which they claim to be a 
new breed. They are peculiarly subject to nervous fits when scared or 
excited. There is over-stimulation of the motor nerve tracts, which lasts 
for fifteen to twenty seconds. When under the influence of these attacks, 
they may be dragged about as if dead, and their bodies are quite stiff 
and rigid. The nervo-muscular system in these animals is very highly 
developed. The characteristic is hereditary, and is uniformly trans- 
mitted to the progeny. It is said that one advantage possessed by this 
caprine breed is that it can easily be confined on enclosed ground. 

Lumbar Paralysis in the Goat (Adynamia Nervosa Generalis).—Patho- 
logical states which prevent a she-goat from rising during the later stages 
of pregnancy are sometimes met with. The complaint is similar to that 
encountered in the cow (see p. 1243). Opinions vary as to the origin of . 
the affection. By some it is attributed to pressure of the uterus con- 
taining the foetus on the posterior aorta; by others to the demands of 
the foetus on the nutritive material of the blood, muscular weakness, and 
inability to support a heavy body-weight; and, by a recent writer (Horst 
Tempel), to lesions of the hock-joint. 

TREATMENT.—Stimulate the spine with ammonia liniment; give a 
soft, dry bed, and frequently turn the animal over. Administer a purga- 
tive drench of 4 ounces of castor oil, and follow up with nerve stimulants. 
Rubbing the hocks and fetlocks with a cooling lotion of chloride of 
ammonium and nitre, and afterwards bandaging the legs, or in obstinate 
cases blistering the hocks, help to bring about recovery. 


1248 SYSTEM OF VETERINARY MEDICINE 


SWINE. 


Epilepsy.—It is questionable whether epilepsy ever occurs as a primary 
and distinct disease in swine. As a secondary or reflex ailment due to 
infection, parasitic invasion, or auto-intoxication, it is not uncommon. 
It is, moreover, seen in young pigs when teething, and as a result of 
infestation with worms. Overfilling of the stomach and concretions in 
that organ (the so-called “‘ oat-hair balls ’’) also bring it about. Young 
boars at the time of puberty, and yelts at the period of cestrum, are 
occasionally attacked. 

Symproms.—Young pigs when being fed may come up to the trough 
eagerly, take a few mouthfuls, run back, topple over, and lie kicking on 
their side and champing their jaws. In a short time they get up, reel 
about with a vacant look, and finally recover consciousness. The con- 
vulsions may be intense, and the whole frame of the animal may be 
violently shaken. They may last a few minutes or extend to half an hour. 
The symptoms noticeable in older animals are much the same. There is 
sudden falling, kicking, and gradual recovery of consciousness, followed 
by dulness and weakness for a time. 

TREATMENT.—Endeavour to locate and ascertain the cause of second- 
ary epilepsy. In possible cases of true epilepsy due to hereditary taint 
no good can be done. Where irritation from teething is suspected, an 
aperient dose of Epsom salt should be given to the dam, and care must 
be taken in the feeding of the sow, so that her milk-supply may be good 
and plentiful. Where parasites are the cause of the complaint, santonin 
(10 to 15 grains) may be given in milk, and followed by castor oil. 

At the time of an attack the animal must be protected from injury: 
the mouth may be propped open, the tongue pulled forward, and cold 
water dashed on the head. 

Encephalitis—This may occur from an attack of cysticercosis, in- 
fectious rhinitis, or may be due to tuberculosis or swine fever. As a 
sporadic ailment it occasionally arises from a bacillus naturally sapro- 
phytic in the body which becomes pathologically active (K. Glasser). 
Bacteria may be conveyed to the meninges by the blood or lymph 
streams, or gain access thereto from the nasal mucosa. Bad weather, 
transport by train, intensive feeding, and over-exertion, are predisposing 
causes of brain affections. 

Symproms.—Vomiting, loss of consciousness and sensation, squealing, 
rooting about in the litter, and trying to climb the walls of the sty, high- 
stepping, and delirium. The delirium may be followed by coma, par- 
alysis, and death. 


DISEASES OF THE NERVOUS SYSTEM: SWINE = 1249 


Morsip ANAtomMy.—Congestion of the bloodvessels of the brain, 
serous or fibrinous inflammation of the dura mater, or purulent or 
serous inflammation of the pia mater, with thickening of this mem-~ 
brane. The lesions may occasionally be chiefly confined or limited 
solely to the brain itself, and be of a serous, purulent, or hemorrhagic 
character. 

TREATMENT.—Subcutaneous injection of arecolin, or morphine (to 
check vomiting), cold applications to the head. Potassium iodide may 
be given with a view to promote absorption of cranial exudates. House 
in a dark, quiet sty, attend to the action of the bowels by enemata, and 
give easily digested food in moderate quantities. 

Spinal Meningitis.—Bacterial intoxications and infections may bring 
about this disease. A few observers (Glasser, Rohde-Schmidt, and 
others) have seen it in boars that have been over-used at stud—not that 
we think excessive sexual intercourse is a direct, but only perhaps a 
predisposing cause. 

Symproms.—Standing with the limbs all together, reeling with the 
hind-quarters, staggering and falling, one-sided or total paralysis. 

TREATMENT.—Rest from serving, quietness, easily digested laxative 
food, counter-irritants to the spine, hypodermic injections of strychnine, 
or yohimbine (aphrodine) tablets in the food. 

' Eclampsia.—This occurs in young animals when teething and in sows 
at parturition. The pathology of the latter form of the disease (puerperal 
convulsions) is not distinctly known, some authors attributing it to acute 
peripheral epilepsy, and others to ureemic poisoning due to faulty secretion 
of the kidneys. 

Symproms.—Muscular twitchings, chewing movements, rolling of the 
eyes, repeated convulsions (a bad sign). 

TREATMENT.— When occurring in delayed aareun tion rupture the 
foetal membrane and effect delivery, if possible. Chloroform inhalations, 
and chloral hydrate or potassium bromide administered per rectum, or 
given as in an electuary in doses of 2 to 3 drachms. A milk diet after- 
wards is good for either the supposed epilepsy or uremia. 

As a prophylactic measure it is beneficial to give chloral hydrate in 
solution to the sow in her food, near to and previous to the time of par- 
turition, and the writer has frequently given it with good results in the 
case of nervous, excitable sows. 

Milk Fever.—This occurs occasionally in sows after parturition. 

Symproms.—Listlessness, apathy, weakness, or paralysis of the hind- 
quarters, lack of milk-supply, constipation. 

- TREATMENT.~—-Laxatives, such as calomel, 15 to 45 grains. Potassium 

VOL. II. 79 


1250 SYSTEM OF VETERINARY MEDICINE 


or sodium bromide, $ to 1 drachm, in electuary. Cold applications to 
the head, liquid mustard to the spine, and frequent enemata. Rear the 
progeny on artificial teats with a liquid nourishment made up in the 
following proportions: Warm cow’s milk, 13 pints; two raw eggs; one to 
two teaspoonfuls of sugar. 

Chorea.—This is seen in young pigs at or shortly after birth. 

Causrs.—Hereditary influences, inclement weather, and cold sties. 

SYMPTOMS.—Spasmodic contractions of the hind or of all four ex- 
tremities. The twitchings gradually disappear as time goes on. 

TREATMENT.—Quietness, warmth, and dryness. Feed the sow to 
produce a good milk-supply, and prescribe doses of Fowler’s solution 
of arsenic for her in sloppy milk diet. 

Sows Eating their Young.—This abnormal inclination is not uncommon 
in sows, even when parturition has been easy and uneventful. It is 
accompanied by signs of irritability and excitement (if not dementia), 
and no doubt maternal instinct is deranged or disturbed. 

ETr1oLoGy.—Many reasons have been given for the vice, among the 
most feasible theories being lack of flesh nourishment and consequent 
increased appetite for it, irritability due to the pain of parturition, hered- 
itary vice, pain from irritation of the youngsters’ pointed teeth when 
sucking, deficiency of lime salts in the food, leaving dead progeny or 
after-births in the sty. 

TREATMENT.—Temporary separation of the young from the dam, 
and administration of an emetic to the latter. The writer has had most 
success by giving the sow a dose of chloral hydrate and dressing the 
youngsters all over with a decoction of juniper berries to which a little 
eucalyptus-oil has been added. Break off any pointed teeth in members 
of the litter. Some veterinary surgeons claim to have cured the bad habit 
in the dam by pouring linseed oil or tincture of iodine into her ears. 
Sometimes sows attack their progeny in a few days after birth, and a 
watch must be kept on suspected mother animals. It also happens that 
for some unaccountable reason one member of a litter will become an 
object of special aversion to his companions, and they will always be 
worrying or harassing him. Here the rubbing of the body of the hated 
subject all over with the above-mentioned decoction has also been effective 
in the author’s experience. 

Sunstroke and Heatstroke.—Pigs driven in droves under a scorching 
sun, or travelling by railway or waggons and exposed to the full rays of 
the sun, suffer occasionally from sunstroke. If crowded together after 
severe exertion on a hot day, or housed in a sty, or packed in waggons or 
carts on which the rays of the sun beat down, they may be afiected with 


DISEASES OF THE NERVOUS SYSTEM: SWINE 1251 


heatstroke. If transported in a fat state to shows, and then exposed to 
a hot sun, a similar result may occur. 

Symproms.—Dulness and depression, staggering gait, weak pulse, 
laboured breathing, a rise of temperature to 108° or 112° F., excitement, 
trembling, and convulsions. A very high temperature is an unfavourable 
sign. Death results from suffocation, as a result of paralysis of the 
respiratory centre through intoxication by carbonic dioxide. 

TREATMENT.—Place in the shade. Pour cold water over the head, 
and apply cooling applications thereto. Subcutaneous injections of 
camphorated oil, 1 to2drachms. Give laxative diet. 

Lightning-Stroke.—Pigs are liable occasionally to be struck by light- 
ning or to receive accidental electric shocks. Sudden death or survival 
for a few hours are the usual results. 

Symproms.—Sudden death, a comatose condition ending in death, or 
gradual recovery, with unsteady gait persisting for a short period, or local 
paralysis existing for a time or permanently. Singeing of the hair and 
skin. Dark coloured stripes or branching lines on the body. In one 
case recorded by K. Glasser the straw on which the pig lay when struck 
by lightning was impatterned on the whole under-surface of its body. 


DISEASES OF THE NERVOUS SYSTEM IN 
THE DOG AND CAT 


By B. HARVEY MELLON, F.R.C.V.S., anp E. WALLIS HOARE, F.R.C.V.S. 


General Remarks.—In canine medicine more attention has been 
devoted to diseases of the nervous system than is the case with similar 
affections in horses and ruminants. The sentimental value which is 
attached to dogs renders it possible to carry out the clinical observation 
of nervous diseases in a more extensive and thorough manner. Treat- 
ment can be adopted without involving considerable expense, and when 
therapeutical measures fail, or when the animal suffers pain or distress 
as the result of the nervous affection, destruction can be carried out. 
Taking everything into consideration, the clinician has better oppor- 
tunities for observation and research than in the case of the larger 
animals. Moreover, nervous diseases in the dog are of far more frequent 
occurrence than in other animals. Probably the higher development of 
the nervous system may be a predisposing factor in this direction, but 
we cannot ignore the influence which canine distemper exerts on the 
production of such diseases (see Canine Distemper, Vol. I.). 

Much has been learned of late years with reference to the etiology, 
pathology, and clinical phenomena of nervous diseases in the dog, but 
there is yet a large field for observation and research in connection with 
the subject. The popular term “ fits”’ is about as exact a designation 
to cover a multitude of nervous affections as the term “ staggers’”’ in 
equine medicine, and it would be well for all concerned if such names 
were expunged from veterinary nosology. We do not wish to lead our 
readers to infer that the diagnosis of nervous affections can be carried 
out with an equal degree of exactness in dogs as in man. But we do 
believe that more attention to clinical observation and to autopsies 
would improve our knowledge in diagnosis to a large extent, and probably 
would also enable us to treat the cases in a more rational and successful, 
manner. 

Nervous symptoms in the dog are not uncommon as the result of 
reflex irritation arising from various morbid conditions of internal organs, 
and care is essential in order to differentiate such cases from organic 

1252 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1253 


diseases of the nervous system. No doubt the presence of certain 
parasvtes in the gastro-intestinal canal is sometimes associated with the 
manifestation of nervous phenomena, but this influence is often greatly 
exaggerated. The dog-breeder, the empiric, and the kennel-man, firmly 
believe that “‘ worms ”’ are responsible for many and varied affections of 
the nervous system, with the result that the patent medicine vendors 
find vermicide nostrums the most profitable part of their stock-in-trade. 
A familiar example occurs in the nervous type of distemper in young 
puppies; it is not uncommon to find the symptoms ascribed to ‘‘ worms,”’ 
and the patients are dosed accordingly, with disastrous results. 


DISEASES OF THE BRAIN AND ITS MEMBRANES. 


Meningitis —As a complication of canine distemper, meningitis is an 
affection of comparatively common occurrence (see Vol. I., p. 685). 
Occasionally it occurs as a disease per se, and in the absence of appre- 
clable causes. An acute and a chronic form are recognised, but the 
latter is with difficulty differentiated from other chronic affections of the 
brain. Acute meningitis is probably always associated with a varying 
degree of encephalitis, as is the case with other animals, and attempts to 
distinguish clinically between the affections are rarely successful. 

Cerebro-spinal meningitis, although rare in the dog, has been observed 
by. various writers. For a description of the disease see Vol. I., p. 898. 

Kit1oLocy.—As already remarked, the majority of cases depend on 
distemper. Occasionally meningitis occurs in connection with tuber- 
culosis (see Vol. I., pp. 179 and 181). Injuries to the cranial region, 
depressed fractures of the skull, and canker affecting Hi middle and | 
internal ear, may also be etiological factors. 

Parasites in the gastro-intestinal canal are said by some authors to be 
a cause Of meningitis, but there is no evidence to support such a view, 
and the meningitis in puppies, attributed to “‘ worms,” in the majority 
of instances depends on distemper. 

Morsip AnatomMy.—The lesions are similar to those described as 
occurring in meningitis in the horse. In some cases associated with dis- 
temper no macroscopical lesions can be detected. 

Symproms.—These are subject to marked variations. In the early 
stages the animal whines, is restless, and shows an anxious expression of 
countenance; the sclerotic is congested; the appetite is in abeyance; 
vomiting may or may not be present; the temperature is elevated. In 
_ some instances marked excitement is observed, and spasmodic convulsions 
occur at intervals, accompanied by loud cries, and a tendency to bite 


1254 SYSTEM OF VETERINARY MEDICINE 


if handled. The animal walks in a stiff manner if forced to move, and 
hyperesthesia of the skin is present, alsonystagmus. Internal strabismus 
and protrusion of the membrana nictitans may occur. Cases are occa- 
sionally observed in which rabiform symptoms are manifested (see Vol. L., 
p. 685). In other instances the dog has a tendency to turn in a circle, 
amaurosis may be present, and he is unable to avoid obstacles in his 
path; at times he cannot maintain the standing posture, and the super- 
ficial muscles, especially those of the neck, are in a state of contraction. 
The affection may be complicated with spinal meningitis, and paraplegia 
is then observed. 

Chronic Meningitis may be manifested by a partial loss of muscular 
co-ordination, so that the animal tends to move sideways when walking; 
the head is carried in a stiff manner, a varying degree of strabismus may 
be present, also deafness. The disease is progressive, and ultimately 
intermittent attacks of convulsions occur, and various nervous com- 
plications depending on compression of the brain and nerve roots. Lecar- 
pentier observed a case of chronic meningitis associated with ossification 
of the tentorium cerebelli and compression of the motor branch of the 
trigeminal nerve. The symptoms manifested were twisting of the head 
and a tendency to fall towards the right side. 

DIFFERENTIAL Dracnosis.—In cases which manifest rabiform symp- 
toms, the differential diagnosis from rabies presents considerable diffi- 
culty (see Rabies, Vol. I.). 

As regards the clinical distinction between meningitis and encephalitis, 
we are of opinion that such is not possible. Miiller describes both con- 
ditions under the heading of “‘ inflammation of the brain.”’ 

Cases of auricular acariasis must be distinguished from meningitis. 

Proenosis.—In our experience every case of true meningitis either 
terminates fatally, or permanent nervous lesions remain which ultimately 
render destruction of the animal inevitable. 

TREATMENT.—The animal should be placed in perfectly quiet sur- 
roundings, and an active cathartic administered. Chloral hydrate and 
potassium bromide are indicated to relieve the irritability of the nervous 
system and to check the convulsions. An ice-bag may be applied to the 
cranial region. Further details of treatment will be found under the 
Meningeal Complications of Distemper (see Vol. I., p. 685). In cases 
depending on canker affecting the middle ear, surgical treatment is: 
necessary. ; 

Encephalitis.—From a pathological point of view, encephalitis can 
be distinguished from meningitis; but, as already remarked, it is not 
possible to differentiate the conditions clinically. Hence it is not neces- 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1255 


sary to discuss the subject further than to remark that the lesions resemble 
those described in connection with the analogous condition in equines. 
It is generally admitted that encephalitis in the dog is usually associated 
with distemper. See Vol. I., p. 685, for a full description of the subject. 

Abscess of the Brain.—This condition is not so frequently met with 
in the dog and cat as in the horse. The usual location of the abscess is 
in the cerebrum, but occasionally it occurs in the cerebellum. 

ErroLogy.—The most common cause of cerebral abscess is suppura- 
tion or caries of the petrous temporal bone, due to canker affecting the 
middle ear. Severe contusions of the cranial walls due to blows, 
kicks, etc., are also regarded as etiological factors. Loubet recorded 
a case of abscess of the cerebellum in the cat, following an injury to 
the cranial region. Accumulation of pus in the frontal sinus, occur- 
ring as a complication of distemper, is an occasional cause of abscess 
of the brain. | : 

Symptoms.—These vary according to the location of the abscess. 
In some instances acute symptoms are manifested similar to those 
occurring in meningitis. In others, vertigo, rotatory movements, moving 
in a circle, and ataxia, may be observed. Others, again, show epilepti- 
form convulsions, and finally paralysis. 

DiFFERENTIAL DiaGnosis.—All authors agree that a definite diagnosis 
is difficult. In the case of canker, when the above symptoms are mani- 
fested, the diagnosis of cerebral abscess may be made with a tolerable 
degree of accuracy. 

TREATMENT.—When a diagnosis is possible, and the abscess 1s encap- 
suled and superficially situated, operative measures may prove successful, 
Cadéac states that a complete cure is rarely obtained. According to 
Hutyra and Marek, it is seldom that the disease can be localised, and 
treatment is hopeless in cases where the abscesses are multiple and deeply 
situated. 

Hydrocephalus (Ependymitis).—According to Cadéac, this condition 
is usually congenital in origin, and rarely occurs as a disease per se in 
adult dogs. He also states that it is not possible to give a clinical 
description of the disease. 

The affection is not infrequently present as one of the nervous com- 
plications of distemper (see Vol. I., pp. 665-686). According to Fried- 
berger and Frohner, the symptoms observed are persistent stupidity, a 
heavy appearance of the head; when forced to move, the animal does so 
in an uncertain manner, and tends to run against objects in his path; 
amaurosis, deafness, a deficient sense of smell, and digestive disturbances, 
are also present. In the Berlin dog hospital, for a period of nine 


1256 SYSTEM OF VETERINARY MEDICINE 


years, out of 70,000 dogs treated, only 29 cases of hydrocephalus were 
reported. 

Gray has observed the condition more commonly in bulldogs and 
Pomeranians, especially associated with in-breeding. In some cases the 
skull was so enlarged that the head seemed too heavy for the body, and — 
the dog could not actively raise it. Beyond this enlargement of the 
cranium, and nystagmus, no other symptoms may be present. 

TREATMENT of any kind is useless. | 

Heemorrhage of the Brain.—This lesion may occur 1n the cerebrum, the 
cerebellum, the pons varolii, the crura cerebri, and the medulla oblongata. 
Cerebral hemorrhage is, however, more frequently met with than the 
other varieties. Meningeal hemorrhage may also be included under the 
above heading, as clinically it cannot be differentiated from that in- 
volving the brain itself. 

ErroLogy.—Injuries to the cranial region may produce the lesions in 
any of the structures mentioned. The presence of parasites, such as 
cysticerci, Filaria immitis, etc., may wound or perforate the vessels of 
the brain, and cause hemorrhage in any part of the organ to which these 
vessels are distributed. 

Distemper is said by some authors to be the most frequent cause of 
cerebral hemorrhage in the dog, and cases are recorded in which multiple 
hemorrhages were observed in the cerebrum, the crura cerebri, the 
medulla oblongata, and the spinal cord, in connection with the above 
disease. It may also be observed in connection with tuberculosis of the 
brain. Amongst other etiological factors which have been recorded we 
may mention lesions of the mitral and of the aortic semilunar valves, 
septicemic conditions, rabies, and certain toxic agents. 

According to Miller, atheromatous degeneration of the vessels of the 
brain predisposes to cerebral hemorrhage; but Dexler states that such 
changes in these vessels have not yet been demonstrated in cases of 
cerebral apoplexy in animals. 

Symproms.—The following symptoms are observed in cases of cerebral 
hemorrhage: The dog may fall down suddenly and show convulsive 
movements of the head and limbs, or he may remain on his feet, and 
move ina circle. The head may be inclined towards the right or the 
left side, and the limbs are moved in an irregular manner, being either 
abducted or adducted. Unconsciousness is often observed; the pupils, 
may be dilated or contracted; the respirations become irregular, deep 
and stertorous; and the pulse may be small and rapid. 

In cerebellar hemorrhage, which has been specially studied by Mauri,* 

* Revue Vét., 1893. 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1257 


the animal at the commencement shows great difficulty in maintaining 
the standing posture. As the disease progresses, standing is impossible, 
the animal lies on the side corresponding to the lesion, with the head 
resting on the shoulder. If excited, he may move along the ground by 
a series of “ rolling’? movements. Strabismus is present, the eye on the 
affected side of the body being deviated downwards and slightly inwards, 
and that of the sound side being directed upwards and slightly outwards. 
The prehension of food may be impossible, but sensibility and hearing 
are unimpaired. The case generally terminates fatally in about twenty- 
four hours from the first appearance of symptoms. In some cases death 
may be delayed. Cerebral hemorrhage and tumours of the cerebellum 
may cause similar symptoms, so that a differential diagnosis presents 
marked difficulties. 

In hemorrhage of the pons Varolii a variety of symptoms have been 
observed. Paresis of the fore and hind limb on one side of the body may 
occur, with a rigid condition of the limbs on the opposite side. Ina 
case recorded by Leisering there was external strabismus, the neck 
deviated towards the right, and the nose to the left and in an upward 
direction. The animal could not walk in a straight line, but deviated 
always towards the right; he was unable to stand up, and was destroyed. 
Korber observed simultaneous paralysis of the mouth, pharynx, and 
cesophagus, and of the muscles of the neck and thorax. In hemorrhage 
of the crura cerebri, Cadéac observed that the animal constantly lay on 
the left side, and on rising walked in a circle; the hind-limbs became 
rigid, and the reflexes were exaggerated. 

CoursE.—Partial or complete paralysis of the limbs may result, 
owing to the presence of extravasated blood on the brain. In 
cases of extensive hemorrhage of the medulla death may occur 
suddenly. In other instances the fatal termination may be delayed 
for some days. Complete recovery is said to be possible when the 
hemorrhage is small in extent and in the centre of the hemisphere. 
The acute symptoms may disappear, and partial or complete paralysis 
may remain. 

TREATMENT.—Perfect rest and quiet surroundings are essential. An 
ice-bag should be applied to the cranial region, and a purgative adminis- 
tered. Cadéac states that treatment has no effect on the ultimate result 
of the condition. Adrenalin is contra-indicated, owing to its action in 
raising the blood-pressure. After the severe symptoms have disappeared, 
the paralysis that may remain will require attention. The internal ad- 
ministration of potassium iodide is said to assist in the absorption of the 
extravasated blood, but some observers doubt its value. The application 


1258 SYSTEM OF VETERINARY MEDICINE 


of electricity, and massage of the affected limbs, may be tried. Cadéac 
states that a complete cure is rarely obtained. | 

Thrombosis and Embolism of the Vessels of the Brain.—Very little is 
known with reference to these conditions in the dog. The lesions pro- 
duced are degeneration of the nerve elements and neuroglia cells, with 
“ softening’ of the brain,as a result. Hutyra and Marek state that 
there are scarcely any references in veterinary literature on the subject, 
and that the symptoms will depend on the portion of the brain that is 
affected. 

Tumours of the Brain.—These are of rare occurrence in the dog. The 
following have been recorded: Sarcomata, endotheliomata, melanomata, 
cholesteatomata, enchondromata, and osseous tumours on the interna] 
aspect of the cranial bones. Tuberculous tumours are not rarely met 
with. 

Symproms.—The clinical phenomena resemble those met with in the 
horse, and include vertigo, epileptiform convulsions, ocular symptoms, 
hemiplegia, circular movements, etc. The duration varies, but the 
termination is always fatal. Cadiot and Rogier recorded a case of 
sarcomatous tumour which invaded the left lobe of the cerebellum, and 
cerebellar ataxia was manifested. Hébrant reported a case of sarcoma 
situated between the cerebellum and the right supero-lateral surface of 
the medulla oblongata, and observed vertigo, an unsteady gait, swinging 
movements of the limbs, an exaggeration of the patellar reflexes, and 
in the later stages movement in circles to the right, and right-sided facial 
paralysis. 

Tumours of the pons Varolii have been recorded by Gratia and Generali. 
The former met with an instance of a glioma situated in the vicinity of 
the Gasserian ganglion. The latter observed an enchondroma of the 
udder, which invaded the pons Varolil in a secondary manner, and 
neoplasms of various sizes were formed. The symptoms recorded were 
paralysis of various cranial nerves, epileptiform convulsions, extension 
of the head on the neck, ptyalism, spasmodic movements of the jaws, 
nystagmus, followed by a comatose condition. 

Chauveau observed a sarcoma involving the right crus cerebri. The 
symptoms manifested were paresis of the limbs, the latter were dragged 
along the ground during progression; the head was carried low; the pupils 
contracted; and, finally, right-sided hemiplegia resulted. | 

Gray has observed a tumour in the vicinity of the root of the trigemi- 
nus, which caused keratitis, unilateral atrophy of the muscles of the 
head and face of the same side, and vertigo when the animal attempted 
to walk. 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1259 — 


TREATMENT.—Medicinal treatment is useless. If a definite diagnosis 
can be made of a tumour close to the roof of the cranium, surgical treat- 
ment might be attempted. 

Injuries and Concussion of the Brain.—These conditions occur in the 
dog and cat as the result of falls from a height, blows or kicks on the 
cranial region, bites on the head received from a large dog, injuries due 
to being run over by a vehicle, etc. The morbid alterations which 
result resemble those described as occurring in the horse under similar 
conditions. The symptoms depend on the lesions present, and, generally 
speaking, resemble those met with in equines. Vomiting, however, is 
often observed in dogs as the result of injuries to the brain. In cases 
where cerebral hemorrhage is present the symptoms of that condition 
will be in evidence (see p. 1256). Hicke observed an instance in which 
a dog received a kick from a foal on the cranial region, and hemorrhage 
of the brain resulted. The symptoms presented were: a tendency to 
bite and chase other animals and also persons, a stumbling gait, frequent 
falling, paralysis of the lower jaw, and foaming at the mouth. In cases 
where the injury involves the peduncle of the cerebellum in the posterior 
portion of the optic thalamus, ‘‘ waltzing’? movements, or falling over 
on one side, are observed (Hutyra and Marek). Injuries to one of the 
hemispheres or to the peduncle of the cerebellum may cause lateral 
displacement of the head and neck, and, if movement be possible, the 
animal turns in a circle. In many instances injuries of the cerebral 
hemispheres are followed by epileptiform convulsions. In cases of 
fracture of the base of the skull the vessels of the pharynx or auditory 
canal may be injured, and hemorrhage from the nostrils or ears may be 
observed, either coincident with the injury or occurring soon afterwards. 

TREATMENT.—A similar line of treatment to that advised for the 
analogous condition in the horse should be carried out. In cases of 
depressed fractures, operative measures are indicated. 

Atrophy of the Brain.—This condition is described by Cadéac and 
other writers. The cerebral hemispheres, the cerebellum, and the 
medulla, may be affected by atrophy. The lesion may be congenital 
or due to a pathological alteration. Risien Russell observed a case in 
a cat in which the posterior lobes of the cerebrum and the anterior part 
of the right hemisphere were atrophied. The cranial nerves of the right 
side, the right pyramid of the medulla, the restiform body, and the 

-erura cerebri, were also atrophied. Blanc met with a case in a dog in 
which atrophy of a cerebral lobe resulted from a chronic inflammation 
of the nasal cavities and facial sinuses. The lesions observed were 
necrosis of the ethmoid bone, the infection reaching the cerebrum by the 


1260 SYSTEM OF VETERINARY MEDICINE 


right olfactory lobe. The latter showed putrid changes, and a greyish 
sanious liquid issued from the lateral ventricles when they were exposed. 
The right cerebral hemisphere showed marked atrophy, and was not in 
contact with the cranial bones. Its surface was of a yellowish colour, 
except in the vicinity of the parietal convolution. On section it was. 
found that the atrophy only involved the grey substance; this was 
reduced to a thin pellicle. 

Symptoms.—The animal seemed to seek imaginary objects in the air, 
and snapped asifattempting tocatchafly. The left eye showed evidences 
of conjunctivitis and ulcerative keratitis. When made to move, he 
walked in a series of circles, always towards the right. He was sleepy 
in appearance, and constantly assumed the recumbent position. The 
fore and hind limbs on the left side were incapable of extension, and 
showed choreic movements; the head and trunk remained motionless. 
All these symptoms gradually abated, but the animal died as the 
result of a fall. 

Parasites of the Brain.—See section on Parasites. 


DISEASES OF THE SPINAL CORD AND ITS MEMBRANES. 


Acute Spinal Meningitis.—Cadéac states that acute spinal meningitis 
is very rare in the dog, and almost exclusively occurs in connection with 
distemper. It is characterised by an entensive accumulation of clear 
liquid in the intermeningeal spaces, analogous to chronic hydrocephalus. 
Frohner also describes the affection as associated with distemper. On 
the other hand, Hutyra and Marek state that they have never observed 
any clinical evidence of spinal meningitis in the many hundreds of cases 
of distemper that have come under their notice. Moreover, they do not 
regard the presence of a clear serous fluid between the membranes as in 
itself a proof of the existence of spinal meningitis, as such a condition 
often occurs in advanced cases of emaciation. However this may be, 
it seems desirable to describe the symptoms as met with by Frohner and 
other observers. 

Symptoms.—In many instances symptoms of distemper are mani- 
fested at the commencement; then evidences of spinal meningitis appear. 
As in the horse, there is first a stage of nervous excitability, followed 
in a variable time by a period of depression. The early symptoms are 
usually manifested by generalised cramps of the muscles, and hyper- 
sesthesia of the spinal region. The back is arched, and marked pain is 
evinced on palpation of the spine or of the muscles. The animal is 
restless, and may even utter cries without being handled; fever is also 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1261 


present. In the period of depression the hind-quarters show weakness, 
and the hind-limbs are dragged along the ground during progression, 
and finally paraplegia sets in with complete loss of sensibility in the 
posterior part of the body and limbs. These symptoms depend on morbid 
alterations in the roots of the spinal nerves. In the majority of cases 
the disease extends to the brain, and cerebral meningitis occurs as a com- 
plication. The course is more or less rapid, and, if the medulla is in- 
volved, death takes place in a few days. In other cases the course is 
subacute, and in rare instances chronic. Circumscribed meningitis is 
recorded in which the disease persists for months. 

TREATMENT.—The majority of cases either prove fatal, in spite of 
treatment, or have to be destroyed in consequence of paralysis. Chloral 
hydrate and potassium bromide are indicated to relieve the painful 
muscular spasms. Sodium salicylate is also advised to relieve pain. 
Cold applications to the spine are recommended by some authors, fol- 
lowed by cataplasms of kaolin and glycerine when the stage of excita- 
bility has disappeared. Iodide of potassium may also be prescribed at 
this stage. 

Pachymeningitis—Inflammation of the spinal dura mater in a 
chronic form is a very common affection inthe dog. In consequence of the 
character of the lesions, it is known as “ chronic ossifying spinal pachy- 
meningitis.” Formerly the affection was regarded as a type of rheu- 
matism involving the lumbar or cervical region, and the older authors 
often described it as rheumatism of the abdominal muscles, or under the 
vague heading of “ paralysis,’ depending on obesity or on impaction of 
the bowels. The disease was first described by Mauri,* in 1878, under 
the title of “‘ locomotor ataxia.” It was studied by Bonnet in 1881-82, 
by Kitt and Stoss in 1883, by Kowalewski in 1885, and by Frohner in 
1893. Dexler, in 1893 and 1896, devoted special attention to the clinical 
characters of the affection, and also to the microscopical examination of 
the lesion. In Great Britain the attention of the profession was first 
directed to the disease by H. Gray.t He gave a full description of the 
post-mortem appearances of the affection and the clinical phenomena, 
based on the examination of a large number of cases. The leading 
character of the disease is a chronic inflammation of the dura mater, 
resulting in the formation of osseous plates of various sizes, which cause 
compression of the roots of the spinal nerves and of the cord itself, fol- 
lowed by a painful neuralgic condition of the peripheral nerves, which 
may terminate after a series of attacks in paraplegia. For a variable 
length of time the lesions may not cause any appreciable symptoms, 


* Revue Vét., 1874. t Veterinary Record, July 16, 1904. 


1262 SYSTEM OF VETERINARY MEDICINE 


Although any breed of dog may suffer from the disease, the yellow 
dachshund seems to be specially susceptible to it. 

ErioLocy.—Nothing is definitely known with reference to the causes 
of the affection. Gray is of opinion that the affection may depend on 
rheumatism, as he has frequently treated dogs for the latter disease for 
several years prior to the appearance of symptoms characteristic of 
pachymeningitis. Moreover, once the spinal lesions are developed, 
changes of weather are very likely to bring on an attack. Gray holds 
that the affection is without doubt hereditary, as he has observed several 
instances in which members of a family of various generations became 
affected. 

Morprp ANatomy.—The following description of the lesions was 
given by H. Gray: 

‘The characteristic lesion is thickening of the dura mater in patches, 
which ultimately increases to such a size as to press on the spinal cord 
and cause corresponding loss of function posterior to the lesion. During 
the active stage of the disease, especially if the spinal nerves are im- 
plicated, we have increased sensibility of the parts supplied by sensation 
from that portion of the cord in the vicinity of the lesion. If the exudate 
is of recent origin it becomes absorbed, and if the irritation is removed 
we find that the pain ceases, and the pressure and the corresponding 
paralysis disappear. If the lesion causing the paralysis cannot be 
reduced so as to relieve pressure, the paralysis or paresis remains, to 
increase in degree every time the animal gets a fresh attack. 

‘The thickening of the dura mater may be of the consistence of 
cheese or hard as stone. It is soft when recent, or fibrous when older, 
and is calcareous, bony, or stony when of long standing. Itmay resemble 
fibrous tissue, cartilage, bone, orivory. The patches may be found any- 
where on the dura mater of the spinal cord, but principally in the lumbar — 
region, and not rarely in that of the cervical. They may even extend the 
whole length of the cord. They are usually elongated, and take the 
course of the cord; sometimes they are ovoid, circular, or irregular; 
usually they have a flattened appearance, occasionally prominent. 
Sometimes they coexist with disease of the intervertebral cartilages, and 
even of the vertebral bony canal. The ultimate effect of these enlarge- 
ments is a narrowing of the spinal canal and pressure on the cord.”’* 

Cadeéac describes secondary lesions involving the nerve roots, the 
muscles, and the spinal cord. The nerve roots show an increase in the 
amount of connective tissue and degenerative changes in the nerve fibres. 

The muscles of the hind-quarters, and sometimes of the neck, shoulders, 

* Veterinary Record, July 16, 1904. 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1263 


and rarely of the head, are atrophied to a marked extent. The spinal 
lesions observed are a distension of the dura mater with fluid, and at the 
region where compression occurs the cord is often softened and shows 
cavities (syringomyelia). Trasbot observed lesions of an acute localised 
myelitis of the cervical enlargement of the cord. Generally the lesions 
do not extend beyond the area of compression. 

Gray has found that if an animal is destroyed during an acute primary 
attack, very few, if any, macroscopic lesions will be detected. 

Symptoms.—It is well recognised that the lesions may be in existence 
for a variable time without any appreciable symptoms being mani- 
fested by the animal. Goubaux has met with osseous plaques in the 
meninges of old dogs, which during life did not show any spinal symp- 
toms. According to Dexler, the affection may remain latent, or show 
no characteristic signs for one and a half to two years. 

The primary symptom is generally the manifestation of pain on 
movement; this depends on compression or stretching of the sensory 
nerve fibres by the altered dura mater. The pain is evinced by crying 
out when the dog is getting up or lying down, or when he is lightly 
handled. In some cases he utters cries if approached, or even when left 
alone. The pain may be intermittent, and is often more marked at 

night. The animal moves in a stiff manner, and has considerable diffi- 
culty in going up or down stairs. Firm manipulation in most cases does 
not elicit evidences of pain. In another type of the disease the neck 
appears to be chiefly affected, and the cervical muscles are swollen, or 
the abdominal muscles may become painful and rigid. These symptoms 
continue for a variable length of time, and in a first attack may disappear 
completely, but are likely to recur at irregular intervals. 

In some cases contraction of the extensor and adductor muscles are 
observed, and the hind-limbs are held in a position of maximal extension 
and adduction. Paraplegia occurs owing to compression of the motor 
nerve roots. It may be more marked in one hind-leg than in the other. 
It usually develops gradually, and may commence by weakness of the 
hind-quarters, but ultimately the animal drags the hind-legs in his efforts 
to move about. Cases are observed in which the paraplegia sets in 
rather suddenly, but such are usually secondary attacks. In rare in- 
stances the paralysis may be limited to the fore-limbs. In the later stages 
sensation is lost in the affected parts. In the early stages all the reflexes 
are exaggerated, and muscular contractions are readily induced. The 
patellar reflex is increased, and, according to Hutyra and Marek, in many 
instances percussion of the tendo Achillis, the extensor tendons in the 
lower third of the fore-arm or in the metacarpal region, the flexor meta- 


1264 SYSTEM OF VETERINARY MEDICINE 


tarsi, etc., causes active and very rapid contractions of the particular 
muscles. These reflexes disappear in the later stages in the regions where 
motor and sensory paralysis have occurred. Retention of urine and 
feeces is often observed. 7 

CoursE.—In a primary attack the symptoms may gradually dis- 
appear, and recovery may result, even though loss of power in the hind- 
limbs may have been present. As already mentioned, recovery depends 
on absorption of the exudate. Recurrence is the rule, although a long 
period may elapse between the attacks in some cases. Fresh attacks are 
more likely to occur if the animal is exposed to cold or damp, and the 
lesions increase 1n degree until ultimately permanent paraplegia results 
and the animal is destroyed as hopeless. Complications may occur, such 
as hypostatic pneumonia, cystitis, bed-sores, etc. 

Proenosis.—When paraplegia is present, the prognosis is grave, but 
hasty conclusions should be avoided, as it is not uncommon to find 
that cases, apparently hopeless, recover sufficiently to walk. In such 
there is usually weakness remaining in the hind-limbs, and more or less 
atrophy of the muscles of the hind-quarters. Gray has observed that 
early atrophy of the muscles of the hind-quarters usually precede a 
recovery. He has also met with instances in which a pseudo-hypertrophy 
of the muscles of the loins and croup persisted during the life of the 
animal, although permanent paraplegia was present. As a rule, if no 
improvement occurs within a period of from two to six weeks, further 
treatment is rarely advisable. Gray has seen cases recover after six 
months’ treatment, but the animals showed weakness in the hind-quarters, 
and in some years afterwards they gradually became paraplegic. 

DIFFERENTIAL Draanosis.—The history of the case must be taken 
into consideration. If we meet with paraplegia, in the absence of a 
history of intermittent attacks of pain and of the other phenomena 
described above, the diagnosis proves difficult, as we are aware that 
paralysis of the hind-limbs may result from various lesions of the spinal 
cord. We are familiar with cases in aged obese dogs in which paraplegia 
occurs rather suddenly in the absence of any evidences of pain, and no 
history of injury. Some of these cases recover after the administration 
of an active cathartic, and their real nature is obscure. 

Muscular rheumatism is frequently mistaken for pachymeningitis, 
and vice versa. We must admit a striking similarity in the symptoms, 
especially when rheumatism affects the muscles of the lumbar region, 
abdomen, or neck. Moreover, many authors state that rheumatism of 
the lumbar muscles (lumbago) is often followed by either temporary or 
permanent paralysis. | 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1265 


TREATMENT.—An active cathartic should first be administered, also 
enemata. To relieve the pain, either sodium salicylate or aspirin in full 
doses should be prescribed. Potassium iodide is indicated to promote 
absorption of the effusion. It is obvious that when permanent lesions 
of the dura mater exist, treatment will fail. The bladder should be 
relieved by the use of the catheter when necessary. The hind-limbs 
should be protected by means of wool and bandages in cases where para- 
plegia is present. 

Spinal Heemorrhage.—According to some authors, this condition is of 
comparatively frequent occurrence in the dog. 

Errotogy.—Blows, injuries from being run over by a vehicle, etc., 
may cause spinal hemorrhage in the dorso-lumbar region, with or with- 
out fracture of a vertebra. St. Cyr, Dexler, and Galli-Valerio have 
shown that spinal hemorrhage may occur in connection with canine 
distemper. 

According to Gray, the condition may occur in the quiescent stage of 
pachymeningitis, especially if the dog exerts himself suddenly and 
violently, as in the act of chasing a cat, etc. 

Morsip AnAatoMy.—The extravasation of blood is found chiefly in 
the brachial and lumbar enlargements of the cord. The effect is to pro- 
duce compression of this structure. The diameter of the spinal canal 
may be considerably narrowed by a blood-clot. Chauveau recorded a 
case in which a well-marked interstitial apoplexy was localised in the 
grey substance of one half of the cord, especially in the superior cornua. 
On microscopical examination, small disseminated hemorrhages in the 
substance of the cord have been observed by Galli-Valerio. 

SyMPToMs.—These will depend on the degree of hemorrhage present. 
Muscular inco-ordination is the leading feature in spinal hemorrhage. 
The animal is unable to control the movements of the limbs during 
progression. In some instances he shows a staggering gait, and stumbles; 
one limb may be twisted around another, or he may fall at each attempt 
to move. Paraplegia is the usual termination. 

In severe cases paraplegia may set in at the commencement, and 
continue until death occurs. 

TREATMENT.—The indications for treatment are similar to those men- 
tioned for spinal meningitis. 

Myelitis—This affection has been specially studied by Continental 
authors. It is of more interest to the pathologist than to the clinician, 
as its diagnosis is very difficult, and treatment unsatisfactory. 

ErroLogy.—Trasbot, Cadéac, Galli-Valerio, and others, have observed 

VOL. I. 80 


1266 SYSTEM OF VETERINARY MEDICINE 


myelitis as a complication of distemper. It is evidenced by the sudden 
or gradual appearance of paraplegia in from eight to ten days from the 
commencement of the attack. Myelitis may also depend on vascular 
lesions in cases of chronic valvular diseases of the heart, excessive 
fatigue, exposure to cold, injuries to the region of the spine, compression 
of the cord from any cause. According to Gray, rheumatism plays a 
part in the etiology of myelitis, and the affection shows an hereditary 
tendency. 

The lesions resemble those described in the analogous affection in the 
horse. | 

Symproms.—These vary according to the location of the lesions. 
Cadéac recognises various types of the disease, as follows: 

The lumbar type, met with especially as a complication of distemper, 
and affecting the hind-limbs. Muscular contractions are observed, the 
limbs are strongly flexed, and may be crossed in the form of an X, the 
cutaneous reflexes may be abolished, and choreic movements may be 
manifested. 

The dorso-lumbar type is most commonly met with. It is evidenced 
by choreic movements, pain on palpation of the spine, weakness of the 
hind-quarters, and finally paraplegia. Incontinence of urine and reten- 
tion of faeces are also present. 

The cervical type is characterised by a staggering gait, a tendency to 
fall, emaciation, difficulty in locomotion, especially after slight exercise, 
stumbling, crossing of the limbs, accelerated respiration, a spasmodic 
rigidity of the limbs, walking on the toes, cutaneous anesthesia, exaggera- 
tion of the tendinous reflexes. 

The diffuse or generalised type. In this, cerebral symptoms are asso- 
ciated with the spinal phenomena. Vertigo, epileptiform convulsions, 
amaurosis, clonic contractions of the muscles of the hind-limbs, ataxia, 
followed by paraplegia, etc., may be observed. Symptoms attributable 
to lesions of the medulla oblongata may be present, such as paralysis of 
certain nerves, a flaccid condition of the tongue, and ocular phenomena 
(diminished sensibility of the cornea, and dilatation of the pupil). 

TREATMENT.—This is generally unsatisfactory, and in the large 
majority of cases the animals have to be destroyed. 

Injuries and Concussion of the Spinal Cord.—These conditions are not 
uncommon in the dog. Falls from a height and accidents, such as being 
run over by a vehicle, are the chief causes. The lesions produced are 
similar to those mentioned in analogous conditions in horses. The symp- 
toms depend on the location of the lesions and on the extent of the 
crushing or compression of the cord which results, and resemble those 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1267 


met with in equines, and treatment is to be conducted on similar 
lines. 

Compression of the Cord.—This occurs under a variety of conditions, 
as follows: 

Fractures of the Vertebre may cause compression of the cord in a similar 
manner to the analogous condition in the horse. 

Degeneration of the Intervertebral Discs.—This lesion was first described 
by Dexler, and was found especially in dachshunds. According to this 
author, the cervical vertebre are involved as frequently as the dorsal and 
lumbar. Cadéac found the seats of predilection to be the upper cervical 
and the lumbar region, while Hutyra and Marek state that the tenth and 
thirteenth dorsal, the first and fourth lumbar, and more rarely the second 
and fourth cervical vertebre, are those most frequently involved. The 
lesions consist of osseous growths in the vertebral canal, and also on the 
external surfaces of the vertebra. Later on the osseous growths extend 
from one vertebra to another, and form a connection between them; and, 
owing to persistent irritation, chronic pachymeningitis is induced in the 
vicinity, new cartilaginous tissue is produced, which ultimately becomes 
calcified. Finally, the altered dura mater becomes adherent to the inter- 
vertebral growths, and the lumen of the spinal canal is further reduced 
(Hutyra and Marek). 

Intervertebral Ossification.—This is sometimes observed in aged dogs. 
The vertebral joints become joined together by growths of new bone, and 
the spinal canal becomes narrowed, compression of the cord resulting. 

Chronic Ossifying Pachymeningitrs ultimately causes compression of 
the cord (see p. 1262). 

Tumours.—These are a rare cause of compression of the cord. They 
may develop in the vicinity of the vertebre, and gain access to the spinal 
canal either through the intervertebral foramina, or through the bones, 
or they may develop in connection with the vertebre or the meninges, 
and in rare instances occur in the cord itself. The following tumours 
may be met with: Sarcomata, gliomata, and chondro-sarcomata. 

Parasites.—Cases are recorded in which echinococci and cysticerci 
were found between the meninges, and caused compression of the cord. 

Symptoms.— When severe compression is present, such as occurs from 
fracture and displacement of the dorsal or lumbar vertebre, paraplegia 
occurs rapidly, asin the horse. When the cervical vertebre are involved, 
death may take place from paralysis of respiration. 

In cases where the compression is gradually produced, the early 
symptom is the manifestation of pain when the animal gets up or lies 
down; stiffness in movement is also observed. The phenomena. are 


1268 SYSTEM OF VETERINARY MEDICINE 


similar to those occurring in cases of chronic ossifying pachymeningitis. 
Motor disturbances may be observed simultaneously with the evidences 
of pain, or may not appear until a later stage. In some cases pain may 
beabsent. Loss of power occurs in the hind-limbs, and is usually bilateral. - 
Occasionally the compression is limited to one side of the cord, and the 
paralysis is then unilateral. The animal tends to lie down for long in- 
tervals, and when movement is attempted the toes are dragged along 
the ground. In the later stages the animal is unable to raise the hind- 
quarters, and finally complete paralysis sets in, the fore-limbs being also 
involved. In some cases a spastic paralysis of the hind-lmbs is observed. 
The muscles of that part of the body posterior to the seat of compression 
being in a state of rigidity, the limbs are extended, and may be held in 
such a manner that one leg is crossed by the other, these phenomena 
being most marked when the animal is sitting or lying down. Sensation 
posterior to the seat of compression may be decreased or abolished, but 
in some instances this sensory disturbance may be slight or absent. In 
cases of extensive compression the reflexes may be completely abolished. 
Occasionally in instances of tumour formation a circumscribed swelling 
can be detected on the region of the spine. Retention of urine and feces 
is usually present in compression of the lumbar portion of the cord. In 
the majority of cases complete paralysis occurs, and the animal either 
succumbs to complications or is destroyed as incurable. Instances are 
met with in which temporary improvement is observed, but the paralysis 
recurs. 

TREATMENT.—This is usually unsatisfactory, and in the rare instances 
in which recovery takes place after treatment it is doubtful whether 
medicinal agents have had any influence on the result. Some prac- 
titioners advise the administration of potassium iodide and strychnine, 
but the value of the latter agent is extremely doubtful. 

Syringomyelia. — This term signifies an increase of the neuroglia in 
the cord, followed by a destruction of this tissue and the formation of 
cavities. It is a chronic condition of variable duration, and always 
terminates fatally. Hutyra and Marek state that only two cases of the 
disease are recorded in the lower animals—viz., one in the dog by Lié- 
naux, and one in the guinea-pig by Rogier. On the other hand, according 
to Cadéac, cases of syringomyelia are not rare in the dog, and have been 
recorded by Kronthal, Dexler, Kahler, and others. Nothing is known 
as regards the causes of the affection. In the case recorded by Liénaux 
(a two-year-old Newfoundland dog), Hutyra and Marek state that the 
histological examination did not definitely settle the question as to 
whether the lesions exactly correspond with those of syringomyelia in 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1269 


man. The symptoms observed by Liénaux were: gradual paraplegia, 
and after four months there was loss of sensation in the hind-quarters, 
and later on clonic contractions of the digastricus muscle, which caused 
occasional opening of the mouth. After six months the gait was unsteady, 
the croup was sunken owing to excessive flexion of the joints of the 
limbs, the muscles of the left side were paralysed so that lateral curvature 
of the spine resulted, the convex side of the curve being on the left. The 
animal assumed the recumbent position, and only got up in order to feed, 
or when called. There was loss of sensation on the left half of the body 
from the scapular region backwards, while the right side showed marked 
hyperesthesia. Later on the anesthetic area spread to the neck. The 
patellar reflex was exaggerated on both sides. 

On post-mortem a cavity was found extending the entire length of 
the cord. Its walls were lined by ependyma, and in the dorsal and 
lumbar portions of the cord it communicated with small cavities scattered 
throughout the grey matter, and contained a clear serous cavity. A 
microscopical examination showed atrophy of the nerve cells, increase 
of the neuroglia cells, and secondary degeneration extending to the 
medulla oblongata. 

No treatment was suggested. 

Secondary Degenerations of the Spinal Cord.—These are of more interest 
to the pathologist than to the clinician, as the symptoms are by no means 
diagnostic, and, according to Cadéac, are similar to those of compression 
of the cord. The morbid anatomy has been thoroughly studied by 
Dexler, and Bouchard and Charcot. For a full description the reader 
is referred to “‘ Pathologie Interne,” par Cadéac, vol. viii. 


DISEASES OF THE PERIPHERAL NERVES. 


These resemble in many respects the analogous affections in the horse, 
and we shall only refer to any special phenomena that occur in the dog. 

Paralysis of the Trigeminal Nerve.—This may occur in distemper, 
rabies, encephalitis in the vicinity of the pons Varolti, concussion or con- 
tusion of the brain, a blow on the peripheral portion of the nerve, or a 
tumour surrounding the intracranial root of the nerve. Cases are re- | 
corded in which the motor branches of the nerve were crushed between 
the masseter and temporal muscles during powerful contraction of these 
muscles, owing to the animal catching hold of a heavy object with the 
teeth or biting a large hard bone. It is believed that in such cases the 
nerves mentioned are pressed against the condyloid process during active 
contraction of the temporal muscle. Gray has observed paralysis of the 


1270 SYSTEM OF VETERINARY MEDICINE 


trigeminus in distemper, also in connection with chorea, and in some 
instances the condition has terminated in general paralysis. The symp- 
toms of paralysis of the ophthalmic and the superior and inferior maxillary 
branches, either separately or combined, are similar to those described 
as occurring in the horse. 

In the case of paralysis of the trigeminus, due to crushing by contrac- 
tion of the muscles of mastication, the motor branches are alone involved. 
The lower jaw is “‘ dropped,”’ the tongue is dry, flaccid, and hangs out of 
the mouth; salivation is present; drinking and feeding are impossible, 
but if food be placed on the tongue it can be swallowed, although with 
some difficulty. 

Paralysis due to a blow on the peripheral portion of the nerve may 
end in recovery in one or two weeks, but in cases that persist, atrophy of 
the muscles of mastication occurs. A similar result may take place in 
some cases when the paralysis is due to concussion of the brain; but if 
depending on permanent lesions, the paralysis persists. 

The affection must be differentiated from dumb rabies, as in the 
latter “‘ dropping of the jaw”’ is a prominent symptom. According to 
some authors, in dumb rabies there is total inability to swallow, and no 
desire for food. But Gray has seen dogs suffering from dumb rabies 
that were able to swallow portions of meat given to them on a fork, and 
the jaws closed during deglutition. The peculiar aspect of countenance, 
and weakness of the hind-quarters or paralysis, also the prevalence of 
rabies in a district, are aids to diagnosis. But instances occur in which 
the differentiation is difficult, and it is wise to keep the animal under 
observation for a certain time before expressing an opinion as to the 
nature of the case. | 

TREATMENT.—If the case depends on permanent nervous lesions, 
treatment is useless. In other instances, the animal should be fed by 
placing pulpy food on the root of the tongue, also by nutrient enemata. 

Spasm of the Muscles supplied by the Trigeminus.—This condition 
occurs in tetanus, and is evidenced by trismus—.e., inability to open the 
mouth. Tetanus in the dog is generally localised, and affects the muscles 
which close the jaw—viz., the masseter, the temporal, and the internal 
pterygoid muscles. The course is subacute or chronic, and considerable 
atrophy of the above-mentioned muscles occurs. We have observed, a 
case in which trismus occurred in the absence of any tetanic symptoms 
or any apparent cause. The masseter and temporal muscles rapidly 
atrophied to such an extent that they could not be felt. The dog could 
with difficulty take very soft or fluid foods. Even when placed under 
the influence of chloroform the jaws could not be opened. The case was 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1271 


under observation for over two months. A slight improvement occurred, 
but up to the time of writing the animal is unable to open the jaws beyond 
a limited extent. According to Osler, trismus may be a symptom of 
organic disease due to irritation near the motor nucleus of the fifth nerve. 
It is possible that the above case may depend on a lesion of this kind. 
Gray has met with similar cases. 

Hutyra and Marek observed more or less rhythmic contractions of 
the muscles supplied by the trigeminus in cases of distemper. These 
contractions were unilateral in some cases and bilateral in others, and 
the teeth were brought together so as to produce a distinct cracking 
sound. The same authors also state that in some cases of acute cerebral 
meningitis tonic or clonic contractions of these muscles may be observed. 

Paralysis of the Facial Nerve.—According to some authors, this is 
rarely met with in the dog, but Gray has frequently observed it, espe- 
cially in bulldogs and pugs. The following causes are recognised: In- 
flammation of the middle and internal ear (canker), caries or tuberculosis 
of the petrous temporal bone, encephalitis associated with distemper, 
neoplasms in the parotid region, and exposure to chills, such as im- 
mersion in cold water. Hutyra and Marek state that the drooping of 
the upper eyelid does not appear to be constant in this affection in the 
dog. Miller recorded a case in which the palpebral fissure on the 
paralysed side was wider than normal. When the paralysis is associated 
with disease of the internal ear, twisting of the head and inability to 
close the eye on the affected side are observed. 

TREATMENT.—If the affection depends on permanent lesions, treat- 
ment is useless. In other instances, a spontaneous cure may result. 

Spasm of the Facial Nerve.—This has been observed in cases of en- 
cephalitis associated with distemper, and is attributed to inflammatory 
changes in the vicinity of the nucleus of the nerve. The symptoms 
observed were clonic spasms of the muscles supplied by the facial nerve. 

Paralysis of the Auditory Nerve.—Paralysis of the cochlear nerve has 
been observed in old dogs and cats, and also as a congenital defect in 
albinotic animals. It may also occur as the result of inflammatory 
changes in the internal ear, or disease in the vicinity of the medulla 
oblongata. 

Paralysis of the vestebular nerve may result from disease of the middle 
or internal ear (canker), caries of the petrous temporal bone, concussion 
or hemorrhage of the brain, hemorrhage of the internal ear, diseases of 
the medulla or cerebellum, auricular acariasis, etc. 

Symproms.—Bilateral paralysis of the cochlear nerve is evidenced by 
complete deafness. In unilateral paralvsis of the vestibular nerve the 


1272 SYSTEM OF VETERINARY MEDICINE 


symptoms observed are: The head is held in an oblique position, walking 
in a circle towards the sound side, rolling movements towards the 
diseased side, inability to walk in a straight line, nystagmus, etc. In 
_ bilateral cases ataxic movements limited to the head and neck are 
observed. 

TREATMENT.—Cases due to injury may recover spontaneously. If 
depending on canker, suitable treatment should be attempted. When 
arising from permanent lesions, treatment is hopeless. 

Paralysis of the Recurrent Nerve (Roaring).—See p. 975. 

Paralysis of the Radial Nerve.—This is occasionally met with in the 
dog, and is due to blows, kicks, or contusions in the region of the elbow. 
Frohner and Miller observed the condition in this animal, and ascribed 
it to the result of distemper. 

The symptoms are similar to those occurring in the horse, and treat- 
ment is to be conducted on the same lines. 

Radial Cramp.—This condition is described by Hutyra and Marek, 
and is ascribed to distemper. The muscles supplied by the radial nerve 
show more or less rhythmic contractions. In one instance the nerve 
was surrounded by a callus which involved the distal ends of the radius 
and ulna. While the animal was at rest the toes were extended, and the 
slightest attempt at movement caused marked extension of the limb. 

Paralysis of the Brachial Plexus.—This is rarely met with. It may 
depend on an injury to the brachial plexus resulting from jumping, when 
the axilla comes into contact with a hard obstacle. 

The symptoms are similar to those occurring in the analogous condi- 
tion in the horse, and recovery is more likely to occur in the dog. 

Paralysis of the Sciatic Nerve.—The causes recorded were kicks, punc- 
tured wounds, falls from a height, and myelitis associated with distemper. 

The symptoms are similar to those met with in paralysis of this nerve 
in the horse. 

Paralysis of the Crural Nerve.—Occurs in the dog, and the symptoms 
resemble those met with in the analogous condition in the horse. 

Femoral cramp has been observed on several occasions by Gray. 


FUNCTIONAL DISEASES OF THE NERVOUS SYSTEM. 


Vertigo.—In the dog this should be regarded as a symptom in certain 
affections of the nervous and circulatory systems rather than a disease 
per se. Thus it occurs in various affections of the brain, in auricular 
acariasis, also in chronic valvular disease of the heart, and sometimes in 
a reflex manner from the presence of intestinal parasites or gastric dis- 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1273 


turbances. “Being a symptom, it must be treated according to the 
nature of the disease on which it depends. 

Paralytic Vertigo.—Gerlier observed in the Canton of Geneva a 
peculiar form of vertigo in cats associated with temporary paralysis of 
various muscles. A similar affection occurred in epidemic form in 
labourers and herdsmen in the same district. The symptoms observed 
in the cat were as follows: The animal while walking suddenly stopped, 
shook the head often to one side, and finally bent it until the nose touched 
the ground. In severe cases the animal fell on its abdomen, and remained 
motionless on the ground, and when the attack passed off got up and 
moved about in a normal manner. In several cases, owing to relaxation 
of the muscles which open the jaw, trismus occurred. During the attack 
vision was interfered with, but there was no loss of consciousness. The 
attacks recurred at intervals, and only when the animal was walking or 
partaking of food. They were only observed during winter, and in cats 
that constantly remained in warm surroundings. The duration of the 
disease was a few weeks, and then the attacks disappeared. The cause 
of the affection was not definitely ascertained. 

Meniére’s Disease.—A case of this disease was recorded by Sellman 
inacat. The symptoms were similar to those observed in the horse, but 
in addition the animal ultimately became deaf. Auricular acariasis may 
cause this condition. 

Epilepsy.—In the dog, as in the horse, this condition may occur as 
true epilepsy or as the secondary or reflex form of the disease. It is 
generally admitted that true epilepsy is rarely met with, but Gray, on 
the contrary, holds that 1t is very common in the dog. The secondary 
form may depend on similar causes to those mentioned in the analogous 
condition in the horse, but in the dog and cat, in which the affection is 
of far more frequent occurrence, there are certain causes which merit 
special attention—viz., the presence of intestinal worms, parasites in the 
ear, especially in the cat (auricular acariasis), and also pentastomes in 
the nasal cavities. The hereditary nature of true epilepsy is recognised. 
Reynal recorded the hereditary transmission of the disease in three suc- 
ceeding litters of an affected cat. 

Kpileptiform convulsions may occur in distemper (see Vol. I., p. 683). 
According to Gray, a spinal form of epilepsy is sometimes observed in 
the dog and cat, due to irritation of the skin from the presence of parasites 
or of eczema. It may also depend on auricular acariasis. 

Symptoms.—In true epilepsy premonitory symptoms may be observed 
in some cases, such as restlessness, shaking of the head, and irritability 
of temper. In most instances the attack comes on suddenly, the animal . 


1274 SYSTEM OF VETERINARY MEDICINE 


has a fixed look, becomes unable to move, and shows trembling of the 
muscles. The muscles of the head, neck, shoulders, and back show 
spasmodic contractions. He may utter a loud shriek, and fall to the 
ground unconscious. Clonic spasms of the muscles occur, commencing 
in those of the head and neck, and soon involving the other parts of the 
body. The pupils are dilated, nystagmus is present, the mouth may be 
alternately opened and closed, or lateral movements of the jaws may be 
observed, or grinding of the teeth. A foamy saliva, which may be blood- 
stained, issues from the mouth. The muscular spasms may be so severe 
that the animal jerks up from the ground, the respirations become deep 
and laboured, the action of the heart may be tumultuous, and in some 
cases cyanosis of the visible mucose is observed. An involuntary dis- 
charge of feeces and urine may occur. The duration of the attack may 
be from one to five minutes, the symptoms gradually disappear, and 
recovery may be rapid. In some instances a temporary exhaustion or 
muscular weakness follows the attack. Slght attacks are sometimes 
observed (petit mal), in which various disturbances of consciousness are 
present, and the spasms occur in limited areas only for a short period. 

In secondary epilepsy (epileptiform convulsions) many of the clinical 
phenomena are similar to those observed in the true form of the disease. 
It may occur as the Jacksonian type, in which the spasms at first affect 
a certain group of muscles, and later on other muscles are successively 
involved. 

The course of epilepsy varies. In some instances a long interval 
occurs between the attacks, in others the seizures may take place at 
frequent intervals. In severe cases consciousness may not return in the 
intervals, and death may take place during an attack. Gray has ob- 
served that when epilepsy occurs in adult animals it is generally per- 
manent, although it may be held in check by prolonged treatment. 

In secondary epilepsy the course depends on the nature of the primary 
disease. As regards the differentiation of true epilepsy from the secondary 
form of the affection, considerable difficulty is experienced. Hutyra and 
Marek state that the proof of hereditary taint and long intervals between 
the attacks generally denote a true epilepsy. Some authors have ob- 
served alterations in the demeanour of the animal in the intervals between 
the attacks, such as loss of intelligence and of attentiveness, but others 
believe that such cases may in reality depend on lesions of the brain as 
the result of distemper. | 

TREATMENT.—In true epilepsy attention to diet is necessary, and the 
administration of the triple bromides (potassium, sodium, and ammonium 
bromide) is advised. In cases where the attacks succeed each other very 


DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1275 


quickly, anésthetics, such as chloroform or ether, may be administered 
per rectum by means of a special apparatus. In secondary epilepsy the 
treatment will depend on the primary disease. If the affection depends 
on permanent lesions of the brain, treatment is useless. 

Chorea.—As already remarked, true chorea does not occur in animals. 
In the dog the affection generally described as chorea is an organic nervous 
malady occurring either during the course of distemper or in a variable 
period after all the acute symptoms of the latter have disappeared. 
Hutyra and Marek term the condition “‘ distemper spasms.”” The affec- 
tion may appear quite suddenly during the course of distemper, but 
usually not before the third or fourth week. In some cases it may develop 
in from one to three months after an apparent recovery from distemper, 
and Gray has observed an instance in which eight months elapsed before 
the chronic symptoms appeared. Although some authors describe chorea 
as a disease per se, itis now generally admitted by those who have devoted 
special attention to the subject that the affection always originates from 
distemper. It is often associated with or follows a mild attack of dis- 
temper, so mild in some instances that the symptoms of the primary 
affection may be overlooked, but is also observed in connection with 
severe types of the disease. It may be accompanied by various nervous 
phenomena, such as meningitis, delirium, coma, or paralysis, or the 
choreic symptoms may pass off, and be succeeded by paralysis of. a 
progressive type. 

Morsip Anatomy.—Histological examinations have demonstrated 
that the affection depends on a myelitis caused by the toxins of distemper. 
Wood* observed well-marked alterations in the cells of the inferior cornua, 
such as disappearance of the nuclei, protoplasmic prolongations, and the 
transformation of the cells into small, irregular, opaque bodies. Car- 
rougeau, Taty, and Jacquin have observed various morbid alterations in 
the cerebrum and in the spinal cord. For a full description of these 
lesions, the reader is referred to ‘‘ Pathologie Interne,” par Cadéac, 
vol. viii. The lesions are best marked in the lumbar region of the cord, 
but occur throughout the entire length of this structure. 

Symproms.—Cadéac states that the choreic movements are always 
associated with paresis and paralysis, but this is not the usual experience, 
as we are well aware that in many instances the choreic movements may 
exist alone. 

Hither a single muscle, or one or more groups of muscles, may show 
the choreic movements. Thus the muscles of the head, neck, fore-limbs, 
and less frequently the hind-limbs, may be affected. The abdominal 

* Medical News, 1885. 


1276 SYSTEM OF VETERINARY MEDICINE 


panniculus or the diaphragm may. alone be involved in some instances. 
When the temporal or pterygoid muscles are affected, there are convul- 
sive movements of the lower jaw against the upper, and progressive 
paralysis of the jaw may result. The lingual muscles may be involved, 
followed by glossoplegia. Occasionally the choreic movements may be 
limited to one half of the body (hemichorea). The movements persist 
during sleep. They are subject to exacerbations if the animal be sud- 
denly disturbed. In some instances the affection is generalised. 
CoursE.—The malady is not necessarily fatal unless associated with 
other nervous complications. The choreic movements rarely disappear 
altogether, but may become lessened in intensity as the general health 
improves (see Canine Distemper, Vol. I., p. 684). Atrophy of the affected 
muscles may occur, and atrophic changes in the bones have been recorded. 
TREATMENT.—This is very unsatisfactory. The triple bromides with 
chloral hydrate give relief, but beyond this have no permanent efiect. 
Gray advises potassium iodide with potassium bromide. A long course 
of arsenic’is sometimes useful. When the affection is complicated with 
other nervous phenomena, treatment is useless. In most instances the 
owner desires to have the animal destroyed in consequence of the dis- 
tressing appearance of the symptoms. Gray has observed choreic move- 
ments in young puppies suckling the dam, and found that a large per- 
centage ultimately recovered (see Canine Distemper, Vol. I., p. 684). 
Eclampsia.—Under the heading of puerperal eclampsia or puerperal 
convulsions is generally described a peculiar affection in the bitch, 
occurring during the first few days after parturition. Nothing is definitely 
known with reference to the etiology of the affection. It is sometimes 
ascribed to nervous irritation and exhaustion, owing to the bitch having 
too many puppies to nurse. Cases have been observed in the last stages 
of pregnancy. Some authors met with instances in which the symptoms 
occurred in from four weeks to fifty days after parturition. 
SymMptoms.—These appear suddenly. The animal is restless, shows 
an anxious expression of countenance, quick and laboured respirations, 
injected visible mucous membranes, a rise in temperature, and some- 
times emits sharp cries. The gait is staggering, and in from ten to fifteen 
minutes the animal falls on her side, the limbs become rigid, and at 
intervals clonic convulsions occur, especially in the extremities. Marked 
panting is observed, the tongue protrudes from the mouth, chewing and 
swallowing movements occur at intervals, and saliva issues from the 
commissures of the lips. Consciousness is not disturbed, the secretion of 
milk is inhibited, the pulse is small and hard, and the visible mucose are 
cyanotic. According to Cadéac, albuminuria is always present. 


_ DISEASES OF THE NERVOUS SYSTEM: DOG AND CAT 1277 


Coursz.—In some instances the affection only lasts for a few hours, 
but severe cases may continue from twenty-four hours to three days. 
Spontaneous recoveries are not uncommon. Miiller states that in very 
acute attacks the animal may fall into a deep comatose condition, and 
die in about forty-eight hours. Gray has never met with a fatal case of 
the disease. 

TREATMENT.—The administration of chloral hydrate and potassium 
bromide often gives good results. They are best given in the form of 
enemata, as oral administration during a paroxysm is likely to be followed — 
by inhalation pneumonia. Some authors recommend the subcutaneous 
injection of morphine. If the bitch is nursing a large number of puppies, 
some of the latter should be removed. 

Hysteria.—In human medicine, this affection is defined as “‘a dis- 
order, chiefly of young women, in which emotional states control the 
body, leading to perversion of mental, sensory, motor, and secretory 
functions.”* According to Hutyra and Marek, the cases of alleged 
hysteria in dogs reported by Mainzer (1906) have been criticised by 
Dexler, who has shown that the affection occurs very seldom, if at all, 
in animals. Hygyer and Grobon claim to have observed hysteria in 
cats. Woodroffe Hillf stated that “‘ dogs, especially of the female sex, 
are subject to hysteria ’’; also he has observed “ peculiar hysterical ten- 
dencies in highly bred specimens—nervous and violently excited at an 
angry word or sudden sound, shrieking at a trivial injury, or convulsed 
with fear at an upraised hand.” 

Beyond these references, we do not find any description of hysteria 
in animals in the various textbooks. The affection is not mentioned by 
Blaine or Youatt. 

Heatstroke.—This is met with in show-dogs (especially bulldogs) in 
very hot weather. The symptoms recorded are accelerated respirations, 
weakness, trembling of the muscles, excitement, and in severe cases 
clonic convulsions. Benjamin has observed rabiform symptoms. Siedam- 
erotzky records cases in which coma occurred, succeeded rapidly by death, 
-and the autopsy revealed an abundant exudate in the meninges, and 
numerous hemorrhages in the cerebrum and medulla oblongata. 

TREATMENT.—The dog should be removed to a cool place, and ice 
should be applied to the cranial region. 


¢ 


* QOsler’s ‘“‘ Practice of Medicine.”’ 
+ “The Management and Diseases of the Dog.” 


DISEASES OF THE NERVOUS SYSTEM 
IN BIRDS 


By B. H. MELLON, F.RB.C.V.S., anp E. WALLIS HOARE, F.R.C.V.S. 


Cerebral Heemorrhage.—This may occur in poultry as the result of 
mechanical injuries to the cranial region, exposure to the rays of the sun, 
and it has also been observed in very fat birds during egg-laying. 

Symptoms.—Vertigo, staggering, rotatory movements, dilated pupils, 
irregular movements of the wings and feet, epileptiform spasms, especially 
if handled; the head and neck may be in a bent or twisted condition, so 
that the parietal region is turned towards the ground, and the beak 
directed forwards, and there is inability to take food or water. Cage 
birds may suddenly fall off their perch, stretch out the wings and tail, 
and show convulsive movements. In the case of a severe attack, the 
head is thrown backwards, and death follows quickly. Ina mild attack, 
consciousness returns, but a varying degree of paralysis persists. 

TREATMENT.—Cold applications to the head, perfect quietness, the 
administration of a dose of castor oil, and a restricted diet, are indicated. 
In severe cases treatment is hopeless. 

Myelitis—Marchand, Petit, and Bredo met with a case of cervical 
myelitis in a cock. The symptoms observed were paresis and hyper- 
eesthesia of the wing, and lateral flexion of the neck during repose, so that 
the beak was directed backwards. During feeding the head was carried 
in a normal position. 

Paralysis of the Vestibular Nerve.—This has been observed in fowl in 
connection with coccidiosis and fowl plague, also in injuries to the brain, 
purulent otitis, and purulent inflammation of the petrous temporal bone. - 
In pigeons it has been recorded in cases of contagious meningitis. The 
head is held in a twisted manner, so that the roof of the cranium is often 
in contact with the ground, and feeding is impossible (Hutyra and Marek). 

Polyneuritis.—In Batavia, Eykmann observed polyneuritis in fowls 
which were fed on decorticated rice. Balardini produced a similar 
disease by feeding fowl on mouldy maize. Marek recorded cases of poly- 
neuritis in cocks, the principal lesion being a chronic interstitial neuritis. 
The affection is also met with in parrots and other birds. 

1278 


DISEASES OF THE NERVOUS SYSTEM: BIRDS — 1279 


The symptoms observed in polyneuritis of the fowl due to feeding on 
decorticated rice were an unsteady gait, especially when the bird was on 
a perch, owing to inability to grip the perch sufficiently tightly with the 
toes. When on the ground the bird was unable to get up on its perch, 
but stood with the legs wide apart and the joints flexed. During move- 
ment the bird often fell down, and in the later stages was unable to stand. 
Paralysis of the muscles of the wings, body, and neck, sets in. Emacia- 
tion was marked, respiration was difficult, and death took place in five 
to ten days. Peracute cases were observed in which death occurred in 
two or three days. 

In polyneuritis of the cock, as described by Marek, the following 

symptoms were present: Gradual weakness of the feet, difficulty in move- 
ment, the whole length of the posterior surface of the metatarsus was in 
contact with the ground, copulation was impossible, and in the later 
stages there was complete paralysis of the wings, body, and neck. The 
course of the disease extended over several weeks, and no complete case 
of recovery was recorded. One case lasted for two years, and then died 
from other causes. 
_ Meniére’s Disease.—In fowl plague, attacks of vertigo, twisting and 
nodding of the head, circular movements, rolling, etc., have been ob- 
served in hens and also in geese. Hutyra and Marek met with similar 
symptoms in two hens affected with purulent otitis or purulent inflam- 
mation of the petrous temporal bone. 

Epilepsy.—This affection is met with in all varieties of birds. The 
following symptoms are described by Trasbot: The bird emits sharp 
sounds, makes flapping movements with the wings, falls on its side or 
back, moves its feet rapidly, shows nystagmus, bends the neck round to 
one side, opens and shuts the beak alternately, and moves the whole body 
to and fro. The spasms cease after one or two minutes, but the bird 
remains on its side in a semi-comatose condition. After a time it gets 
up, staggers, may support itself with its beak and outstretched wings, 
and finally stands on its feet. Cadéac states that the affected bird may 
attempt to fly, and falls suddenly in a fresh attack of epilepsy. An 
attack may sometimes be succeeded by symptoms of hemiplegia. In 
parrots epileptiform convulsions may be due to intestinal parasites. 

TREATMENT.—Care should be taken to prevent the bird from injuring 
itself during its convulsive struggles. When the attack is over, and all 
symptoms have disappeared, a dose of castor oil should be given. The 
administration of bromide of potassium for a few days may assist in 
preventing attacks. 


DISEASES OF THE BLOOD 
By E. WALLIS HOARE, F.R.C.V.S., anv J. F. CRAIG, M.A., M.R.C.V.S. 


GENERAL REMARKS. 


THE blood is such an important factor in the animal economy that its 
examination is claiming more marked attention than hitherto from the 
clinician. Not only is this becoming increasingly necessary on account 
of the maladies usually described as diseases of the blood, but also 
because of the important bearing of the blood upon many other patho- 
logical conditions, including quite a large proportion of specific diseases 
dealt with in Vol. I. of this work. Accordingly, a short account is here 
given of the clinical examination of the blood which may be of service to 
the practitioner. 
For estimating the total volume of blood in the body there is no 
practical clinical method. The redness or pallor of unpigmented skin 
or mucous membrane is of itself only a local condition, but it may point 
also to the general state of the circulation, and is generally one of the 
guides depended upon at a clinical examination. Haldane and Lorraine 
Smith caused animals to breathe a definite quantity of carbon monoxide, 
and afterwards removed a small quantity of blood, found the amount 
of carbon monoxide present, and from this estimated the total volume 
of blood in the body. The method is no doubt very accurate, but the 
agent used is objectionable, and the process is too complicated and tech- 
nical for clinical use. In the human subject this method has been occa- 
sionally used, and it has been shown that in chlorosis the quantity of 
blood is increased, and in megalosplenic and secondary polycythemia it 
is two or three times greater than normal. The volume of blood in the 
body varies normally within certain limits, and depends to. some extent 
on alterations in the natural capacity of the vascular system. If the 
capacity is diminished, e.g., by adrenalin, the volume is diminished. If 
the capacity is increased, as in shock, and blood-pressure falls, the volume 
is increased. In dogs into whose veins is injected a volume of saline 
solution equal to one-half the volume of blood, one-half of the injected 
fluid is got rid of by excretion in ten to fifteen minutes, the remainder 
1280 


DISEASES OF THE BLOOD 1281 


after a longer period. This also occurs with injections of tissue fluids, 
dextrose, and the fresh blood of another animal. If blood is removed 
from the body, liquid is at once taken into the vessels from the tissues. 
According to Sussdorf, the total volume of blood in the horse is 66 per 
cent. of the body-weight; in the ox, 7-7 per cent.; in the sheep, 8 per cent. ; 
in the pig, 4°6 per cent.; and in the dog, 7 to 8 per cent. For ordinary 
clinical examination only a few drops of fresh blood at most are required. 
These may be conveniently removed by puncture of a small vein in the 
external ear or tail, or by means of a small hypodermic syringe from the 
jugular vein. On the ear or tail the hair is clipped from a small area, 
and the latter is washed with a little alcohol or ether to remove the 
débris, fat, and organisms, and the alcohol or ether is allowed to evap- 
orate. One of the small veins which are raised up into a ridge on the 
skin is punctured, either with a mounting needle which has been passed 
through the flame, or with a Syme’s knife which has been previously 
boiled. The drops of blood which exude may be used for the following 
purposes: 

Microscopic Examination of the Blood.—A small drop of fresh blood 
is transferred to the surface of a perfectly clean slide free from grease. 
The edge of a second slide inclined is placed over the drop to spread it 
out, and is drawn with moderate pressure towards the side of the first 
slide towards which it is inclined, so as to form a perfectly even thin 
film. The making of the film requires a little practice, and must be 
done quickly before clotting setsin. The film is then dried as quickly as 
possible by waving in the air, so as to prevent any change in the cor- 
puscles; it is then fixed and stained. Staining is as a rule necessary to 
differentiate the structures to be noted. The fixing agents employed 
are numerous, but those in most general use are absolute alcohol and 
‘methyl alcohol. When Giemsa’s stain is used, methyl alcohol is the 
fixing agent recommended, and is applied for ten to fifteen minutes. 
The fixing agent is then washed off the film with water. The most 
common stains employed are combinations of eosin and methylene blue. 
One of these much in vogue at present is Giemsa’s eosin azure stain. 
It is sold ready for use by Griibler of Leipzig, and Kloiine and Miiller of 
Berlin. As required, a small quantity is diluted in the proportion of 
1 drop of the stain to 1 c.c. of distilled water. A little of this is poured 
over the blood-film, and allowed to act for ten to thirty minutes. The 
film is then washed in distilled or clean water, and dried in the air. The 
red blood-corpuscles are stained a pale red, the nuclei of the mono- 
nuclear and polymorpho-nuclear leucocytes bright red and violet respec- 
tively, the plasma of leucocytes blue, neutrophil granules violet red, 


VOL. II. 81 
® 


1282 SYSTEM OF VETERINARY MEDICINE 


eosinphil or oxyphil granules brown-red, mast cell or basophil granules 
a mauve colour. 

The red blood-corpuscles in normal mammalian blood are non- 
nucleated, biconcave, circular discs, save in the camel tribe, where they 
are oval. In birds the corpuscles are much larger, oval, biconvex, and 
nucleated. They are more or less uniform in point of size. 

RED CorPuscLEs.—lIn certain diseases various changes may be noted 
among the red corpuscles. 

1. Polychromatophilia, Polychromasia, a condition first described by 
Ehrlich, in which some of the red corpuscles take on different tints in 
stained films. They may be slightly bluish in colour or bluish-red. This 
is often noted in anemia, and is considered by Ehrlich to indicate that 
the corpuscles affected are in a dying condition, although Engil and 
others suppose them to be young elements. 

2. Punctated Corpuscles.—Small deposits which stain like chromatin, 
and are either fine or coarse, are often found in anemia and leukeemia in 
the red blood-corpuscles, which are hence called “ punctated corpuscles.” 
This probably results from young erythrocytes being thrown into the 

blood-stream from the bone-marrow before the nuclear matter has been 
entirely got rid of. 

3. Potkilocytosis.—This term indicates that the red blood-corpuscles 
vary greatly in shape. In addition to normal red corpuscles, large and 
small forms are met with (anisocytosis). This is observed in anemia. 
These cells are often irregular in shape, and resemble pears, dumb-bells, 
boats, etc. Very large forms (megalocytes) are found in very severe 
forms of aneemia. | 

4, Nucleated Red Blood-Corpuscles—Young forms of red blood-cor- 
puscles thrown out by the bone marrow into the blood-stream, are some- 
times observed in seVere anzemia and leukemia. Two forms are distin- 
guished: (1) Normoblasts, of the size and shape of red blood-corpuscles, 
each with a central large nucleus which stains very deeply, the proto- 
plasm staining as in the ordinary non-nucleated forms; (2) megaloblasts, 
two to four times larger than red blood-corpuscles, each with a rounded 
nucleus, often ill-defined and staining faintly. Guigantoblasts are similar 
cells of a larger type. Megaloblasts in the human subject are often 
identified in pernicious anemia. ‘These forms are believed to result 

from a toxic action upon the blood-forming elements in the red marrow 
of bones. 

THE WuitE Bioop-CorPusciEs, or Leucocytes, in the blood-film 
should also receive attention. Their number relative to the red blood- 
corpuscles may be noted. The usual proportion is 1 to 300 or 700 


DISEASES OF THE BLOOD 1283 


depending on the source of the blood. In leukemia the proportion 
is much greater, and may be even 1 to 50, or 1 to 10. In anemia, by 
the reduction of erythrocytes, the leucocytes appear to be more 
numerous. These nucleated ameeboid cells are classified according to 
the appearance of the nucleus and the character of the granules enclosed 
in the protoplasm. The granules are named according to their staining 
reaction—neutrophil, oxophil, basophil (see Giemsa stain). The varieties 
distinguished are— 

1. Polymorpho-nuclear Leucocytes (polymorpho-nuclear neutrophil 
leucocytes of Ehrlich), in which the nucleus is multilobed and the proto- 
plasm contain certain small neutrophil granules. They are derived 
chiefly from the bone-marrow. They form 50 to 70 per cent. of the 
leucocytes. 

2. Lymphocytes.—These are about the size of red blood-corpuscles, 
and with a rounded or oval nucleus occupying the large proportion of the 
cell. They form 20 to 25 per cent. of the leucocytes in the normal blood. 
They are derived from the lymphoid blood-forming tissues. 

3. Large Mono-Nuclear Cells are two or three times larger than the 
lymphocytes, have a large oval nucleus, and the protoplasm contains 
neutrophil granules. Sometimes the nucleus is reniform (transition 
forms). They form 6 to 8 per cent. of the leucocytes. 

4. Hosinophil Cells present a lobulated nucleus and numerous granules 
in the protoplasm, which stain of a deep red with Giemsa. In the horse 
they are the largest of the leucocytes. Their origin is the bone-marrow, 
and they form 2 to 6 per cent. of the white blood-corpuscles. 

5. Mast Cells are very scarce in normal blood. They have each a 
divided nucleus, and contain basophil granules, which stain very lightly 
of a mauve colour with Giemsa. 

In some pathological conditions other cells make their appearance in 
the blood—myelocytes, neutrophil, eosinophil, and basophil, containing 
granules in their protoplasm of these types respectively, and each pro- 
vided with an oval nucleus. These are cells of the bone-marrow, and 
are observed in the blood in myeloid leukemia, and even in anemia. 

LEUCOCYTOSIS is a temporary increase in the number of white blood- | 
corpuscles in the blood. It is due to a stimulation of the centres in 
which the leucocytes are formed by some chemical agents or toxins. 
The cells, which are increased in number; vary to some extent. The most 
common form of leucocytosis is that involving the polymorpho-nuclear 
leucocytes. Leucocytosis is noted in health after a meal, during preg- 
nancy, after exertion, and as the result of thermic stimuli. Pathologically 
it may be due to the action of toxing in various specific diseases, after 


1284 SYSTEM OF VETERINARY MEDICINE 


hemorrhage, in malignant tumours, and in poisoning with such agents as 
potassium chlorate, pyrodin, phenacetin, etc. 

EosINoPHiLiA, or PoLyMoRPHO-NucLEAR EosInopuiL LEUCcOcYTOSIS, 
in which there is an increase in eosinophil cells, has been observed in 
helminthiasis, pemphigus, and other skin diseases, and in the case of 
malignant tumours. 

Mast-Crextt Levucocytosis has been observed by Levaditi in animals. 

LEucopEntiA, or HyPoLEvUcocyTosis, is a temporary decrease in the 
number of leucocytes, and may be produced by an overdose of toxin or 
chemical substance acting on the cell-forming centres. It is a serious 
sign if it continues throughout an infectious disease, but this only occurs 
if the centres have been irretrievably injured by the first stimulus. It 
is often observed in the early stage of a specific disease, or as the primary 
negative phase during treatment by vaccines, and is followed later by a 
leucocytosis. 

THE Bioop PLATELETS may be recognised in the blood-films, often 
in clumps, and must be carefully distinguished from various organisms. 

ORGANISMS inside the corpuscles or between them may be easily 
recognised; they stain well with Giemsa. 

ESTIMATION OF THE NUMBER OF CORPUSCLES PER Cusic MILLIMETRE. 
—The most convenient and reliable instrument for the purpose is the 
Thoma Zeiss hemocytometer. It consists of a graduated pipette and a 
special slide. A small quantity of fresh blood is drawn up into the 
pipette, and diluted with a graduated quantity of diluting solution. The 
diluting solution for the estimating of the red blood-corpuscles must be 
one which will have no effect on these bodies, such as Hayem’s fluid 
(mercuric chloride, 0°25 gramme; sodium chloride, 0°5 gramme; sodium 
sulphate, 2°5 grammes; distilled water, 100 c.c.). The dilution made 
is1in100o0r200. Inthe pipette the blood and the solution are thoroughly 
mixed, and a small representative sample placed on the central disc of 
the excavation on the special slide. A perfectly flat cover-glass is laid 
over this, and in order to prevent error in the calculation it must come 
into complete and perfect contact with the fluid and the edges of the 
excavation. Any excess of fluid must be accommodated in the gutter 
around the disc. The fluid is then examined under the microscope. 
The surface of the disc is etched out in small squares, 73,5 square 
millimetre in size, and the height of fluid to the cover-glass is ;1, milli- 
metre, so that the column of fluid over each square is 7j55 cubic milli- 
metre. The red corpuscles in a number of squares are counted, and the 
average taken. From this is calculated the number of red _ blood- 
corpuscles in a cubic millimetre of blood by multiplying the average 


DISEASES OF THE BLOOD 1285 


number of corpuscles in each square by 4,000, by 100 if the dilutio. 
is 1 in 100.’ 

The average number of red blood-corpuscles in a cubic millimetre of 
blood is for the horse and pig 8,000,000; for the ox, 6,000,000; for the 
sheep, 9,000,000; for the dog, 5,000,000; for the fowl, 2,500,000; but the 
normal variations may extend to 1,000,000, or even more. 

The number of white blood-corpuscles is estimated in a similar way, 
but the dilution need only be 1 in 10, and the diluting solution 4 per cent. 
acetic acid tinted with gentian violet, to destroy the red blood-corpuscles 
and stain the leucocytes. The number varies from 5,000 to 15,000 per 
cubic millimetre. 

THe RELATIVE VOLUME OF CORPUSCLES AND PLasMaA in unclotted 
blood may be determined by the hematocrite method. A small quantity 
of fresh blood is centrifugalised in a graduated glass tube of small bore. 
This tube or hematocrite is made to rotate at such a high speed (10,000 
turns per minute for two to three minutes) that the separation of plasma 
and corpuscles may occur before clotting sets in. The corpuscles form a 
solid rod at the outer extremity of the tube equal to half the length of 
plasma in the normal blood. It is very useful to give the volume of red 
blood-corpuscles when the latter are irregular in size. The relative 
quantity of red blood-corpuscles may be determined in a simpler but 
rougher way by the method recommended by Zschokke. The fresh blood 
is placed in a small graduated tube, which is immersed for half an hour 
in water at a temperature of 10° to 12°C. The red blood-corpuscles fall 
to the bottom of the tube, and the ratio is taken between the depth of 
corpuscles and that of the supernatant plasma. The normal ratio is 
regarded as being as 2 is to 3. 

POLYCYTHZMIA is a condition in which the red blood-corpuscles are 
markedly increased in number in a given volume of blood. Physio- 
logically, this obtains in early life after birth, and when animals live at 
high altitudes. Pathologically, it has been observed in the early stages 
of azoturia in the horse. It may also be caused in some cases by an 
excessive loss or deficient intake of water, profuse diarrhcea, vomiting, 
complete starvation, by cardiac disease, and where there is an incom- 
plete oxidation of the blood. 

KsTIMATION OF THE H&MOGLOBIN CONTENT OF THE BLoop.—This is 
of some interest in cases of anemia. It has not, however, been much 
practised in veterinary work. Gowers’ or Fleischl’s hemoglobinometer 
may be used for the purpose. Gowers’ apparatus consists of two glass 
tubes, one of which is filled with glycerine jelly tinted with carmine and 
picrocarmine to represent the appearance of normal blood diluted to 


1286 SYSTEM OF VETERINARY MEDICINE 


1 in 100 of water. The other tube is graduated. Into it is passed 
20 cubic millimetres of the blood to be examined, and distilled water care- 
fully added until the same tint is obtained as in the first tube. The 
mark to which the fluid rises in the tube when it has obtained the appro- 
priate tint represents the percentage of hemoglobin present. In Fleischl’s 
heemoglobinometer the blood is diluted to a definite extent, and compared 
with several shades of stained or tinted glass. 

OTHER CHARACTERS OF THE BLOOD LESS COMMONLY NOTED are the 
alkalinity and the specific gravity. The alkalinity is taken with litmus- 
paper. The specific gravity is ascertained by adding a drop of blood to 
fluids of different specific gravity, such as benzol, chloroform, or mixtures 
of these, so as to note the one in which it neither sinks nor floats. The 
specific gravity of that fluid or mixture represents the specific gravity of 
the blood. The specific gravity of the blood of the horse, ox, and pig is 
1060; sheep, 1050 to 1058; dog, 1050. It appears to bear a direct 
relationship to the number of red blood-corpuscles. 


ANZEMIA. 


The term “ anemia ”’ ina wide sense signifies a reduction of the amount ° 
of blood as a whole, or of the red corpuscles, or a diminution of its 
constituents. Thus, it may depend on certain conditions, as follows: 
(a) Oligemia, in which all the constituents of the blood are more or less 
diminished. (6) Oligocythemia, in which there is a diminution of the 
red blood-corpuscles. (c) Oligochromemia, in which the hemoglobin is 
diminished, but the red corpuscles are in normal numbers. Olgemia 
and oligocythemia are generally associated in cases of anemia, and in 
some instances the water contents of the blood are greatly increased 
(hydreemia). 

Ansmia may be either Local or General. 


Local Anzemia. 


Local aneemia is confined to certain organs or regions of the body. 
The supply of blood to a partis controlled by the contraction or expansion 
of the arteries supplying it, and these actions are under the influence of 
the central and peripheral vasomotor ganglia. When there is an excess 
of blood in one region of the body, other parts become anemic, and the 
function of the latter are inhibited. Thus, when blood accumulates in 
the mesenteric vessels local anemia of the brain is produced. A similax 
result is produced by reflexes occurring in painful conditions, also from the 
sudden removal of pressure, such as takes place in cases of ascites when 


DISEASES OF THE BLOOD 1287 


the operation of paracentesis abdominis is carried out. We have little 
definite knowledge with reference to the occurrence of anaemia in the 
various organs of the body. 


General Anecemia. 


General anemia may be conveniently described under the following 

headings: (1) Secondary or Symptomatic; (2) Primary or Essential. 
Secondary or Symptomatic Anzeemia may occur in an acute form as 
the result of profuse hemorrhage. 

The chronic form may arise from a variety of causes, as follows: 

Repeated hemorrhages, insufficient nutrition, such as too little food, 
or a diet deficient in proteids and iron, as exemplified in anemia of sheep 
resulting from being grazed on marshy pastures, also in cattle fed on 
innutritious food. 

Animals kept in insanitary surroundings may also suffer from 
anemia. Anemia is also associated with chronic wasting affections, 
helminthiasis, and malignant disease; also in parasitic affections of the 
blood, such as piroplasmosis and trypanosomiasis. 

Morzsrp Anatomy.—lIn chronic secondary anemia the blood is pale 
and watery in appearance, and the free coagulum is small in amount, 
Fatty degeneration of the heart and kidneys may be observed, also 
ascites and hydrothorax. In acute anemia causing death from hemor- 
rhage, the internal organs, especially the lungs, are pale and bloodless, 
and the large bloodvessels contain only small amounts of free coagula. 

Symptoms.—In acute anemia depending on hemorrhage, the symp- 
toms vary in intensity according to the severity of the bleeding. The 
animal sweats, staggers, and sways from side to side; the visible mucose 
are pallid; the cardiac actionis tumultuous; the pulse is frequent and small, 
and later on becomes thready; the respirations are accelerated; the ex- 
tremities are cold; and muscular trembling occurs. When the hemorrhage 
is profuse and continuous, the animal soon assumes the recumbent post- 
tion, and death is preceded by convulsions. In chronic anemia the symp- 
toms develop in a gradual manner. The animal is dull in appearance, 
easily fatigued, and is unable to perform severe work. The visible mucose 
are pale, the action of the heart is accelerated, and palpitation occurs if the 
animal be excited from any cause. The cardiac sounds are indistinct or 
imperceptible, owing to the presence of false murmurs, and the pulse is 
weak, The appetite is diminished, the coat is staring, and if the anzemia 
depends on organic diseases or on insufficient feeding, emaciation occurs. 

The morbid alterations in the blood are important. The hemoglobin 


1288 SYSTEM OF VETERINARY MEDICINE 


content is diminished, under 70 per cent., and in very severe cases may 
be 30 to 40 per cent. The number of red blood-corpuscles may fall to 
23,000,000 or to 3,000,000 per cubic millimetre. In severe cases poikilo- 
cytosis may be present (see p. 1282). In a rapidly developed anemia 
nucleated red blood-corpuscles (erythroblasts) may be observed. Baso- 
philic granules, which are the remains of broken-down nuclei of erythro- 
blasts, can be detected in some of the red corpuscles. The number of 
leucocytes is usually increased. In the later stages of the affection 
cedematous swellings appear on the dependent parts of the body, and 
effusions may occur in the serous cavities. 

Coursk.—Chronic anemia may continue for a long period, especially 
when associated with chronic diseases. 

DIFFERENTIAL Di1aGNnosis.—This is carried out by an examination 
of the blood. The affection must be differentiated from pernicious 
anemia and from infectious anemia by the special characteristics in the 
blood in these diseases (see p. 1289; also Infectious Anemia, Vol. I., 
p. 927). 

ProGNnosis.—In acute anemia, depending on hemorrhage, recovery 
may result in a short time after the bleeding has been arrested, but it 
may take several weeks before the red corpuscles are replaced to the 
normal amount. In severe cases of hemorrhage several months may 
elapse before the blood returns to its normal condition. In chronic 
anemia the prognosis depends on the primary disease which is the 
cause of the condition, and on the morbid changes which are produced. 

TREATMENT.—In acute anemia the hemorrhage, when originating 
from an accessible vessel, must be arrested by surgical means. When 
internal hemorrhage is the cause, agents such as adrenalin or atropine 
should be prescribed by hypodermic injection. The subcutaneous in- 
jection of large amounts of normal saline solution often proves valuable. 

In chronic anemia attention to diet is necessary, and nutritious foods 
should be ordered. As regards medicinal agents, a combination of iron 
and arsenic is indicated. The primary disease on which the anemia 
depends must receive attention. 

Primary or Essential Aneemia.—In human medicine primary anemia 
is described as occurring in two forms—viz., chlorosis, and idiopathic or 
pernicious angemia. 

Chlorosis is defined by Osler as “an anemia of unknown cause 
occurring in young girls, and characterised by a marked relative diminu- 
tion of the hemoglobin. According to Friedberger and Frohner, and 
also Hutyra and Marek, the occurrence of chlorosis in animals has not 
yet been demonstrated. The anemia of sheep, which is sometimes 


DISEASES OF THE BLOOD 1289 


regarded as an independent affection, and termed “ chlorosis,” is not 
identical with the disease in the human subject designated by this name. 
Hutyra and Marek state that the so-called chlorosis of sheep and the 
hydremia of cattle should not be considered as independent forms of 
anemia, as they are only differentiated from the other types of the 
disease by special etiological factors, the morbid anatomy not showing 
any distinguishing features (see p. 1290). 

Progressive, Idiopathic, or Pernicioous Anemia.—This affection 1s 
described by Friedberger and Fréhner, but, according to Hutyra and 
Marek, the majority of the cases recorded were probably instances of 
infectious anemia of horses (see Vol. I., p. 927). These authors con- 
sider that further investigations are desirable to decide the frequency 
with which progressive pernicious anemia occurs in animals. 

Imminger described both a sporadic and an enzootic form of progres- 
Sive pernicious anemia in cattle in Bavaria. Walker and Baldrey met 
with a fatal form of anemia among sheep and goats in the Punjab. 

KirioLocy.—Hutyra and Marek state that nothing definite is known 
with reference to the causes of the affection, and that severe anemias 
are frequently included under the heading of pernicious aneemia, such as 
those due to strongylosis, piroplasmosis, and trypanosomiasis, etc. 

Morzsip ANatomy.—The lesions resemble those occurring in cases of 
severe secondary anemia. An examination of the bone-marrow shows 
that it is replaced by a red mass, or it may resemble this tissue in the 
embryo. Various kinds of red blood-corpuscles possessing one or two 
nuclei, and of various sizes, are found init. The alterations in the blood 
are described below. 

Symptoms.—These commence in an insidious manner. The animal 
is easily fatigued, the appetite is interfered with, and loss of condition 
results. The visible mucosz are pale, the respirations are accelerated 
even during slow walking, cardiac palpitation is easily induced, and the 
heart sounds are indistinct. Later on, cedematous swellings occur on 
the dependent parts of the body, and hemorrhages may be observed 
from the nasal and buccal mucose. The temperature may in some 
instances show variable elevations, and nervous phenomena may be 
present. Albuminuria is sometimes observed. 

The following changes occur in the blood: It is pale red, or sometimes 
of a yellowish tint. It coagulates slowly, the specific gravity is low, 
and the hemoglobin content is largely reduced. The red corpuscles are 
considerably diminished in number, and show various alterations in form. 
Thus, some may be larger than normal and pale in colour (macrocytes) ; 
others are very small and of a deep yellowish-red colour (mzcrocytes). 


1290 SYSTEM OF VETERINARY MEDICINE. 


Nucleated red corpuscles are also present (erythroblasts). Porkilocytosis 
is also observed—4.e., the red corpuscles are shrunken, angular, elongated, 
and contain one or more projections; they may be club-shaped, or 
biscuit-shaped, or in the form of drumsticks. 

CouRsE AND Proenosis.—Acute types are observed in which death 
may occur in from six to eight weeks from the first appearance of 
symptoms. 

In the chronic form the birerion may be several months; it is charac- 
terised by remissions and exacerbations. Death may occur from ex- 
haustion or from a sudden attack of hemorrhage. The prognosis is 
unfavourable. 

DIFFERENTIAL D1acNnosis.—This is based on an examination of the 
blood. As already remarked, considerable difficulty is experienced in 
differentiating the disease from infectious anemia when a number of 
horses are affected simultaneously. In infectious anzmia it is said that 
poikilocytosis is not present, but Carré and Vallée found changes in the 
form of the red corpuscles. 

TREATMENT.—Attention to hygiene and dietetics is necessary. Prep- 
arations of iron with arsenic are advised. Atoxyl is recommended by 
some authors. | 

Infectious Anemia of Horses.—See Vol. I., p. 927. 

H ydroemaa. —This form of anemia is described by Continental authors 
as occurring in cattle, sheep, and pigs. 

Cattle—The causes suggested are lonetanenen) feeding on dis- 
tiller’s wash and beetroot residue. These substances contain a large 
percentage of water, and only a small amount of albuminoids. The 
affection is more common in working oxen. On post-mortem, general 
dropsy is observed, the subcutaneous and intermuscular connective tissue 
is infiltrated with serous fluid, the muscles are pale and flaccid, rigor 
mortis is absent, and the serous cavities of the body are more or less 
filled with transudates. Chronic intestinal catarrh is usually present. 
(idematous swellings appear on the dependent parts of the body. 

CoursE.—Death occurs from exhaustion in from three to six months. 

Sheep.—In these animals the affection has been termed “ chlorosis ”’ 
and “‘ cachexia aquosa.” The causes brought forward are: insufficient 
and damaged food, swampy pastures, and insanitary surroundings. 
(idematous swellings appear on the dependent parts of the body, and the 
head is swollen. The wool is lustreless, brittle, and falls off in patches. 
All the other evidences of anemia are present. Ascites, emaciation, and 
diarrhoea occurs in the later stages, and the disease usually continues 
for several months. 


DISEASES OF THE BLOOD 1291 


As regards treatment, nutritious food is indicated, and, according to 
Friedberger and Frohner, a cure is always possible in the first stage of the 
disease if attention be paid to the diet. Preparations of iron, and common 
salt are advised, with vegetable tonics. 

Pigs.—Werner met with cases of hydremia and anemia in these 
animals, and the cause suggested was feeding on watery food. Braasch, 
in Schleswig-Holstein, observed cases of anemia in sucking-pigs and 
young hogs, which caused great losses in some localities. The cause of 
the affection was not definitely determined. 


LEU K2MIA. 


Synonyms.—Leukocythemia; Leucemia. 

In this condition there is a permanent increase in the leucocytes of 
the blood associated with hyperplasia of the leucoblastic (blood-forming) 
tissues—viz., the spleen, lymph glands, and bone-marrow. Normally, 
the proportion of leucocytes to red blood-corpuscles is about 1 to 
300 or 700, but in leukemia it may be altered to 1 to 50, or even 
1 to 10. 

History.—The disease was first described in man by Hughes Bennet 
in October, 1845, as “‘ suppuration of the blood with enlargement of the 
spleen and liver,’ and he afterwards termed the affection “ leukocy- 
themia.”’ Virchow, a month later, described the condition, and named 
it “leukemia,” signifying “‘ white blood ’’; he recognised the connection 
between the lesions of the spleen and lymph glands, and the increase of 
leucocytes in the blood. Neumann, in 1870, pointed out the morbid 
alterations in the bone-marrow in connection with the disease. The 
affection was first recognised in animals by Leisering in 1858, but it was 
not specially studied until about twenty years after, when Siedamgrotzky 
(1878), Johne (1879), Nocard (1880), Frohner (1885), Wolff (1892), de 
Jong (1903), and Hutyra and Marek recorded cases. 

OccuRRENcE.—According to Friedberger and Froéhner, leukemia 
occurs more frequently in animals than is generally supposed. The 
majority of cases have been observed in dogs. It occurs less frequently 
in horses, cattle, goats, pigs, and cats, and an infectious form is recog- 
nised in poultry. In 46 cases reported by Sommer, 22 occurred in dogs, 
10 in horses, 7 in cattle, 5 in pigs, and 2 in cats. In the horses of the 
Prussian army from 1890 to 1895, 26 cases were recorded. 

VARIETIES.—It is now recognised that the hyperplasia may commence 
in any part of the blood-glandular system—viz., the bone-marrow, 
lymph glands, and probably the spleen. The cases of the disease are now 


1292 SYSTEM OF VETERINARY MEDICINE 


usually divided into two groups as follows, according to the dominance 
of the myeloid or lymphoid process: 

1. The Myeloid or Myelocytic group, also known as the 
medullary,’’ in which the leucocytes are largely increased in number in» 
the blood, and are derived chiefly from the bone-marrow. Lesions occur 
in the latter, and also in the spleen, lymph glands, liver, and other 
organs. 

2. The Lymphoid group, in which the most striking features are the 
large number of lymphocytes in the blood, although the number of true 
leucocytes may be normal; also hyperplasia of the lymphadenoid tissue 
of lymph glands, spleen, liver, bone-marrow, and other organs, which 
normally contain very small amounts of this tissue. Large and small 
mononuclear lymphocytes are recognised, and the former are believed to 
come from the bone marrow. As regards the frequency of these forms 
in animals, nothing definite is known. According to Hutyra and Marek, 
the lymphatic form is probably met with more frequently than the 
myeloid form. In man the opposite is the case. A mixed type of leu- 
keemia is observed in the human subject, in part myeloid, and in part 
lymphoid; and, according to Osler, in nearly all cases of the ordinary 
spleno-medullary variety a certain percentage of lymphocytes are present, 
which towards the end may be materially increased. According to 
Hutyra and Marek, the leucocytes formed in the spleen do not appear 
to take any part in the cases of leukemia which have been observed in 
animals. 

ETroLtocy.—The causes of the disease are unknown. All attempts to 
transmit the affection experimentally have failed. The leukemia of 
poultry, on the other hand, is known to be an infectious disease (see 
Vol. L., p. 494). 

Morsip ANATOMY.—The macroscopical lesions in both forms of the 
disease resemble each other to a great extent. 

Spleen.—This organ is much enlarged and increased in weight, espe- 
cially in the myeloid type of the disease, and is in a condition of chronic 
hyperplasia. It cuts with resistance, but occasionally in the dog and pig 
it may be soft in consistence. The capsule may be thickened and the 
vessels at the hilus enlarged, and in exceptional cases the surface of the 
organ may be nodulated. On section, it is of a reddish-brown colour, 
and the cut surface may show a number of bluish-white areas of various 
sizes, also hemorrhages. Circumscribed growths resembling lympho- 
mata may in some cases occur throughout the organ. According to 
Hutyra and Marek, the cases recorded of enormous enlargement of the 
spleen were probably instances of pseudo-leukeemic origin (see p. 1295). 


¢ 


‘ spleno- 


DISEASES OF THE BLOOD 1293 


Lymph Glands.—These are enlarged, especially in the lymphoid form 
of the disease, and vary in size from a hazel-nut to a walnut. They 
may coalesce with other glands in the vicinity, and form nodular growths, 
and are symmetrical on both sides of the body. 

Bone-Marrow.—This may be altered to a greyish-red, jelly-like sub- 
stance, which completely fills the marrow cavity; or it may be of a pale 
grey tint and pus-like in appearance, or of a dark brown colour. Rare- 
faction of the bone-tissue and marked expansion of the shell of the bone 
may occur, and the spaces are filled with leucocytes. 

Liver.—This organ is not infrequently found enlarged, infiltrated with 
leucocytes, and growths resembling lymphomata may be observed 
between the lobules. 

Other Lesions —The kidneys may be enlarged and pale, infiltrated 
with leucocytes, and contain lymphoma-like growths. Similar growths 
to the latter may be found in the intestinal wall, especially in the posterior 
region of the small bowel, and may cause partial obstruction of the lumen 
of the viscus. Nodules may occur in the serous membranes and in the 
lungs. Cellular infiltrations and small nodules may be observed in the 
pericardium and endocardium. The cerebral meninges may also show 
cellular infiltrations. 

Symproms.—These develop in an insidious manner. In the horse 
evidences of fatigue are observed when the animal is at work, and sweating 
is easily induced. According to Hutyra and Marek, symptoms of pul- 
monary emphysema may be present. Amongst other symptoms observed 
are depression, a capricious appetite, thirst, paleness of the visible mucose, 
accelerated cardiac action, obliteration of the cardiac sounds by false 
murmurs, emaciation, and cedematous swellings on the dependent parts 
of the body. 

The lymph glands are generally swollen in a symmetrical manner on 
both sides of the body; they vary in size, and are not painful to palpation. 
The usual locations involved are the submaxillary space, the vicinity of 
the pharynx, the jugular furrow, the axillary, and inguinal regions. The 
enlargement of the lymph glands may bring about various results. They 
may, in a mechanical manner, or by pressing on nerve-trunks, cause inter- 
ference with locomotion. When the lymph glands of the thorax and 
abdominal cavity are involved, symptoms will be produced which vary 
according to the organs which suffer compression. Thus, roaring, 
dyspnoea, oedematous swellings, ascites, etc., may be present. 

The enlargement of the spleen may be detected by rectal exploration 
in the horse, and by palpation of the abdomen in the dogand cat. The 
increase in size of the liver can be recognised by percussion and palpation. 


1294 SYSTEM OF VETERINARY MEDICINE 


Wolff observed in a calf that the region of the lower ribs was sensitive 
to pressure, and attributed this to hyperplasia of the bone-marrow. 

The temperature may be slightly raised in some instances, but towards 
the termination of the affection a subnormal temperature may be ob-- 
served. At this stage hemorrhages may occur on the gums, conjunctive, 
and intestinal mucose, and occasionally in the brain. 

Changes in the Blood.—The blood is pale red in colour, but shows a 
chocolate-brown tint in some instances. It coagulates slowly, and on 
the upper surface of the coagulum a greyish-white layer, or an adherent 
deposit of the same colour, and composed of leucocytes, is observed. 

According to Hutyra and Marek, the following characteristics are 
present: In the horse affected with leukemia the blood separates on 
standing into three layers—viz.: (1) A lower layer, violet-coloured, 
composed of red blood-corpuscles; (2) a middle, greyish-white, con- 
sisting of leucocytes; (3) an upper, formed of transparent yellowish 
fibrin. : 

In other animals there are but two layers—viz.: (1) A lower, similar 
to that described as occurring in the horse; (2) an upper, greyish-white, 
and formed by fibrin and leucocytes. 

The leucocytes are always increased in number, and, according to 
Nocard, a diminution of the red blood-corpuscles can always be demon- 
strated. As already pointed out, in lymphoid leukemia the lymphocytes 
are increased in number, while the leucocytes occur in a comparatively 
normal proportion. The red blood-corpuscles show as a rule no alteration 
in form. 

In myeloid leukemia the leucocytes are greatly increased in number, 
and the red blood-corpuscles often show poikilocytosis. The hemo- 
globin content is always diminished. 

CoursE.—The disease usually runs a chronic course, vee may extend 
for several months, or even over a year. Nocard observed that in young 
animals an acute form may occur, and recorded a case which proved 
fatal in less than a week. Temporary improvement may occur in some 
instances. 

In most cases the animals are destroyed as incurable. Occasionally 
death occurs from exhaustion or internal hemorrhage. 

DIFFERENTIAL D1aGNnosis.—This is carried out by an examination of 
the blood. It must be remembered that leucocytosis (a temporary 
increase of the leucocytes) may occur in pregnancy, and after venesection. 
Leukemia may also be observed during the course of infectious diseases, 
in severe anemia, and in glanders. The chronic swelling of the lymph 
glands may be confused with tuberculosis, glanders, and malignant new 


DISEASES OF THE BLOOD 1295 


growths. For the differential diagnosis from pseudo-leukemia (Hodgkin’s 
disease) see p. 1296. 

ProGNosis.—This is distinctly unfavourable, as no case of recovery 
is on record. 

TREATMENT.—Therapeutical measures, up to the present, have failed 
to bring about recovery. Large doses of arsenic are advised by some 
authors. 7 

Leukeemia of Chickens.—See Vol. I., p. 494. 


PSEUDO-LEUKZEMIA. 


SynonyM.—Hodgkin’s disease. 

In this affection a general hyperplasia of the blood-forming organs 
occurs, with progressive anemia, but there is no increase in the leuco- 
cytes. Clinically, the disease resembles leukemia, as the symmetrical 
enlargement of the lymph glands is similar in both. Recent researches 
in the disease in man show that characteristic histological changes occur 
in the affected glands—viz., increase in the adenoid tissue, proliferation 
of the endothelial and reticular cells, with the formation of lymphoid 
cells of uniform size and shape, and characteristic giant cells—the so- 
called lymphadenoma cells, containing four or more nuclei. Hosinophiles 
are always present, and proliferation of the stroma leads to fibrosis of 
the gland.* 

The affection is often mistaken for leukemia, and, according to 
Hutyra and Marek, it occurs more frequently than the latter disease. 

OccURRENCE.—Cases have been recorded in the horse, ox, dog, and 
cat. It probably occurs more frequently in the dog than in other 
animals, 

Eit1oLoay.—The cause of the affection is unknown. Osler suggests 
that possibly the disease is a spirillosis. 

Symptoms.—The clinical picture resembles that of leukemia. The 
submaxillary lymphatic glands are first involved, then the cervical, 
axillary, and inguinal glands, and the spleen, liver, kidneys, bone-marrow, 
and internal lymph glands. According to Hutyra and Marek, poikilo- 
cytosis may sometimes be present, the number of red blood-corpuscles is 
diminished, while the lymphocytes are present in larger amounts than 
in normal blood. We observed an cedematous condition of the eyelids 
in one case in the dog, In some instances the subcutaneous connective 
tissue is infiltrated with small tumours, and the entire skin is covered with 
elevations due to these growths. The duration of the disease is variable, 


* QOsler’s ‘“‘ Practice of Medicine.”’ 


1296 SYSTEM OF VETERINARY MEDICINE 


but a fatal termination is inevitable. The enlarged glands are not tender 
to palpation, and there is no tendency to degenerative changes. 

DIFFERENTIAL DiaGnosis.—An examination of the blood will as a 
rule enable us to differentiate Hodgkin’s disease from leukeemia. 

Tuberculosis may be differentiated by the employment of tuberculin, 
but it is possible for both affections to be associated. 

Lympho-sarcoma resembles Hodgkin’s disease in its clinical aspects 
very closely. Some authors state that in Hodgkin’s disease the enlarged 
glands do not form adhesions with surrounding tissues, but remain freely 
mobile, while the opposite is the case with lympho-sarcoma; but, accord- 
ing to others, these conditions may also be present in Hodgkin’s disease. 
The differential diagnosis can only be definitely carried out by excising 
one of the affected glands, and conducting a microscopical examination 
ofit. The difference in structure between a gland affected by Hodgkin’s 
disease and lym pho-sarcoma is very marked. 

TREATMENT.—The course of the disease may be modified in some 
cases by the administration of full and continued doses of arsenic, but 
recovery is unknown. In the case of valuable dogs, treatment with 
Rontgen rays may be tried. 


SIMPLE HASMOGLOBINADMIA. 


Apart from azoturia (paralytic hemoglobinemia, see p. 1348), 
hemoglobinemia is occasionally observed in animals. It may be 
regarded as a condition in which the blood-plasma contains dissolved 
hemoglobin, and in severe cases is accompanied by hemoglobinuria. 
The red blood-corpuscles may break down, or the hemoglobin may be 
eliminated from them, or both processes may be combined. Portion of 
the hemoglobin is eliminated by the kidneys when the amount dissolved 
in the blood-plasma is extensive. 

KrroLocy.—Simple hemoglobineemia may be caused by the follow- 
ing conditions: Piroplasmosis, and occasionally in trypanosomiasis; 
certain chemical substances, such as potasstum chlorate, creolin, naphthol, 
naphthalin; occasionally in certain infectious diseases, such as influenza 
and canine distemper. It has also been observed in septiceemia, in intes- 
tinal hemorrhage due to the ingestion of mouldy clover; also in connec- 
tion with extensive burns of the skin. A few cases are recorded in which 
hemoglobinemia occurred without a hematozoal origin. 

Morsip ANATomy.—lIn severe cases at the outset the blood may be 
dark in colour, but later on it assumes a lighter tint. The blood-serum 
is of a reddish tint. The spleen is enlarged, owing to the deposition of 


DISEASES OF THE BLOOD 1297 


hemoglobin therein. The bone-marrow shows redness, and in some cases 
is dark red in colour. General icterus may be present in severe instances, 
owing to the liver forming large amounts of bile pigments from the 
hemoglobin; and as the fluid constituents of the bile are not present in 
proportionate amounts, it becomes thick, accumulates in the liver, and 
becomes partly absorbed into the system. 

Symproms.—Mild cases may not manifest any apparent symptoms. 
Severe cases show depression, icterus, hemoglobinuria, and a varying 
degree of fever, which may be due to the primary disease or to the action 
of products derived from the disintegrated blood-corpuscles. Accelerated 
respiration, nervous disturbances, convulsions, evidences of anzemia, and 
occasionally nephritis, may be present. In mild cases recovery may 
result, but in severe instances a fatal termination occurs. The diagnosis 
is based on an examination of the blood, and on the presence of hemo- 
globinuria. 

TREATMENT.—The therapeutical measures to be adopted will depend 
on the cause of the condition. 


HAEMOPHILIA. 


This is a peculiar condition in which there is a tendency to im- 
moderate hemorrhage after trifling external injuries, or it may occur in 
internal organs. Fatal results may follow, as the bleeding may resist all 
attempts to control it. Judging by the number of recorded cases in 
animals, the condition must be regarded as rare. According to Hutyra 
and Marek, the disease has been observed almost exclusively in horses, 
especially in thoroughbreds. It is as a rule congenital, and in-breeding 
appears to have an influence in the development of a hemorrhagic dia- 
thesis in the progeny. These authors state that the incidental causes of 
the hemorrhage are rapid galloping (giving rise to pulmonary hemor- 
rhage), castration, injuries to the skin or mucous membranes, or even 
parturition may be followed by profuse uterine hemorrhage. 

According to Zschokke, an affection identical with hemophilia in man 
has not yet been demonstrated in animals. 

It seems very probable that the cases recorded of uncontrollable 
hemorrhage following the extraction of teeth in aged dogs may be due 
to hemophilia. 

We have never met with a clearly defined instance of the disease, but 
have observed cases in the horse in which immoderate hemorrhage has 
followed even simple operations, and was only controlled with great 
difficulty. Occasionally in castration persistent hemorrhage may occur, 

VOL. II. 82 


1298 SYSTEM OF VETERINARY MEDICINE 


although so far as we are aware the surgical measures for hemostasis 
were properly carried out. We must admit this tendency to hemorrhage 
in some animals, but whether it should be attributed to hemophilia is a 
doubtful matter, because we are not aware whether trivial wounds in 
other regions of the body would be followed by a similar hemorrhage, or 
that repeated attacks would occur. ? 

In the human subject the disease is confined to the male sex, but the 
females alone transmit the tendency, although they are unaffected. 

Errotocy.—According to recent studies, it would appear as if dis- 
turbance in the fibrin-forming factors was the essential feature in the 
disease. Wright has demonstrated that the coagulation time in hzmo- 
philics was much delayed. Various theories have been brought forward 
in connection with the subject, which it is not necessary to discuss. 

Symptoms.—In most instances the hemorrhage is external, but occa- 
sionally it may take place into one of the cavities of the body. The 
bleeding is difficult to control, and in some cases it may prove fatal. 
Again, in cases that do not succumb, an acute anemia may result. Re- 
currences may be observed, and may ultimately prove fatal. 

DIFFERENTIAL Dracnosis.—In order to establish a diagnosis of 
hemophilia it must be shown that the animal has been more or less 
subject to hemorrhage from various parts of the body throughout his 
life. Debility and other conditions favouring hemorrhages must be 
excluded. 

TREATMENT.—The usual hemostatic methods must be employed. 
Ergot or adrenalin may be administered hypodermically, also normal 
‘saline solution. Some authors advise the administration of chloride of 
calcrum or phosphoric acid. In human medicine subcutaneous injections 
of serum, or of defibrinated blood, or direct transfusion, are advised. 


ANIMAL PARASITES IN THE BLOOD. 


See section on Parasites. 


DISEASES OF THE DUCTLESS GLANDS 
By E. WALLIS HOARE, F.RB.C.V.S. 


DISEASES OF THE SPLEEN. 


THESE are of more interest to the pathologist than to the clinician, 
owing to the fact that the symptoms presented are obscure, and the 
lesions are usually discovered as a surprise at post-mortem examinations. 
Moreover, it is not uncommon to find in some instances that no apparent 
symptoms are manifested. 

Very little attention has been devoted clinically to diseases of the 
spleen in animals, hence our remarks on the subject must of necessity be 
limited in extent. 

Acute Enlargement of the Spleen.—This condition is of comparatively 
frequent occurrence. Active hyperemia of the organ may be associated 
with a variety of affections, such as the initial stages of inflammatory 
processes, acute infectious diseases, etc. It may be followed by inflam- 
mation and hyperplasia of the spleen. In anthrax (see Vol. I.) the spleen 
is greatly enlarged, and in some instances rupture of the organ may take 
place. Acute enlargement of the spleen also occurs in connection with 
swine erysipelas, acute glanders, acute tuberculosis, pyemia, heemo- 
globineemia, infectious anemia of horses, etc. | 

Symproms.—These are not characteristic. In the horse the enlarged 
organ can sometimes be detected by rectal exploration, but, according 
to W. Williams, this is rarely possible except the enlargement is extreme. 
In the smaller animals the alteration in size may be revealed by careful 
abdominal palpation. In ruminants, fat pigs, and obese dogs, this 
means of diagnosis cannot be carried out. 

According to Hutyra and Marek, the enlarged spleen, if considerable, 
can be determined in the horse by the dulness elicited on percussion 
applied parallel to the costal arch on the left side. In the dog percus- 
sion should be applied in the direction of the last two intercostal spaces 
of the left side, passing downwards from the costal arch. 

Chronic Enlargement of the Spleen.—This may occur under the fol- 
lowing conditions: Venous stasis causing an increase in the connective 

1299 


1300 SYSTEM OF VETERINARY MEDICINE 


tissue of the organ, thrombosis of the splenic vein, chronic inter- 
stitial hepatitis, thrombosis of the portal vein, leukemia, Hodgkin’s 
disease, and occasionally in organic affections of the heart. A chronic 
indurative splenitis may be observed in chronic erysipelas of swine. 
Simple hyperplasia of the spleen has been recorded in the horse 
and in cattle. New growths in the organ also cause a chronic 
enlargement. 

The diagnosis is based on similar lines to those advised for the detec- 
tion of acute enlargement of the spleen. On palpation, the consistency 
of the organ is firmer than in the acute cases. 

Purulent Inflammation of the Spleen.—This lesion may result as an 
extension from affected organs in the vicinity of the spleen, also from 
emboli derived from a suppurative inflammation in other regions of the 
body. In ruminants a foreign body from the reticulum may reach the 
organ, and set up a splenic abscess. 

The abscess may be single, or a number of abscesses may be present. 
In some cases the entire organ may be converted into a large abscess. 
There is generally an increase in size of the spleen. 

Symptoms.—lIn some instances no symptoms are presented; in others 
disturbances of digestion, colicky pains, and emaciation may be observed, 
and the region of the spleen may be enlarged and sensitive to pressure. 
In the horse a rectal examination may reveal the increase in size of the 
organ and the presence of fluctuation. The abscess may rupture and | 
set up suppurative peritonitis. In the large majority of cases a diagnosis 
is not made. 

TREATMENT.—Even if a correct diagnosis were possible, nothing can 
be done in the way of treatment. 

Heemorrhage of the Spleen.—This may occur as the result of active 
or passive hyperemia, acute enlargement of the spleen, amyloid degenera- 
tion, also contusions of the splenic region when the organ is affected by 
the conditions mentioned. Cadéac states that, when the spleen is en- 
' gorged with blood, an attack of gastric or intestinal tympany may induce 
compression of the liver and the gastric arteries, followed by a reflux of 
blood into the cceliac axis and splenic arteries, and hemorrhage of the 
spleen may result. Thrombosis of the splenic vein is regarded by Wiart 
as a rare cause of this condition. The extent of the hemorrhage varies. 
Small hemorrhages may become absorbed, and sclerotic cicatrices may 
remain. In some instances the hemorrhage is abundant and diffuse, 
and the splenic substance at the seat of the lesion may be replaced by a 
large blood-clot. The capsule of the organ may rupture, and blood then 
enters the peritoneal cavity. 


DISEASES OF THE DUCTLESS GLANDS 1301 


Symproms.—There are no symptoms which would lead us to diagnose © 
the condition, unless rupture of the organ results (see below). 

Rupture of the Spleen.—This lesion may occur as the result of acute 
enlargement of the organ, or extensive hemorrhage, even in the absence 
of traumatic influences. It has been observed in cases of anthrax. 

Symptoms.—Evidences of internal hemorrhage are present, also 
colicky symptoms. According to Hutyra and Marek, an examination 
per rectum may reveal the presence of an enlarged spleen. 

Torsion of the Spleen.—This condition has been observed not infre- 
quently in pigs, and occasionally in dogs. When the spleen is enlarged 
or affected with neoplasms, it may rotate on the gastro-splenic ligament, 
the exciting cause being sudden violent movement of the body, or pres- 
sure exerted by an enlarged organ in the vicinity. The result is that the 
venous circulation of the spleen is impeded, and the organ becomes much 
enlarged. The circulation in the gastric veins may also suffer from stasis, 
and gastric catarrh may ensue. Necrosis of the spleen may follow torsion 
of the organ (see below). 

Symproms.—Beyond enlargement of ‘ihe spleen, and in some cases 
evidences of gastric catarrh, no symptoms of any importance may be 
manifested. 

Necrosis of the Spleen.—This lesion has been observed in the pig by 
various authors, and it was found to depend on torsion of the spleen. 
Zietschmann and Poetsch recorded a case in an apparently healthy 
heifer due to a complete thrombosis of the splenic vein. 

The spleen is transformed into a large fluctuating rounded sac, and on 
section the parenchyma gives the impression of a body floating in liquid. 
The organ shows evidences of a granulo-fatty degeneration (Cadéac). 

Tumours of the Spleen.—These include melano-sarcomata, sarcomata, 
carcinomata, angiomata, lymphadenomata, and, in rare instances, para- 
sitic cysts (ecchinococci and cysticerci). 

Tuberculosis of the spleen in the horse has frequently been mistaken 
for lymphadenomata (see Tuberculosis, Vol. I., p. 164). 

Symproms.—These are very indefinite. Ina case recorded by Barrier, 
beyond an increase in the circumference of the abdomen, no symptoms 
were observed until a few weeks prior to death. Loss of condition, inter- 
ference with appetite, progressive weakness, a staggering gait, and at 
times colicky pains were then manifested. Rectal examination revealed 
the presence of a large swelling in the left half of the abdominal cavity. 

W. Williams stated that there were no symptoms which would indi- 
cate the presence of these lesions. 


1302 SYSTEM OF VETERINARY MEDICINE 


DISEASES OF THE THYROID GLAND. 


Goitre—Synonyms.—Bronchocele; Struma. 

In this condition there is a chronic enlargement of the thyroid gland. 
It is not uncommon in the horse, and is manifested by an egg-shaped 
swelling usually of both lobes of the gland, which varies in size. In rare 
instances the enlargement may be extensive. In the dog it is of com- 
paratively frequent occurrence, especially in the young animal, and an 
entire litter of puppies may be affected. According to some authors it 
may be congenital. W. Williams met with flocks of lambs which suffered 
from the disease. 

ErioLogy.—Nothing definite is known with reference to the etiology 
of goitre. Water rich in lime and magnesia is believed to have some 
influence on the causation of the disease in man, as in “ goitrous dis- 
tricts ” the water is of this description. According to Osler, “ the disease 
was transmitted to goats who drank water contaminated by goitre 
patients.” Remarkable outbreaks of acute goitre in schools lasting for 
a few months and then disappearing have been recorded. A specific 
organism is suggested. 

According to Zschokke, it is rare to find dogs free from enlargement 
of the thyroid in some of the Cantons of Switzerland. 

Morsip Anatomy.—Various forms of the disease are met with. In 
parenchymatous goitre there is a uniform enlargement of the gland, and 
in the vascular form the bloodvessels are much increased in size. In 
both these types the colloid material of the follicles is increased. In 
cystic goitre a number of large and small cavities containing colloid 
contents are found in the gland. 

According to Cecil French, the commonest form met with in the dog 
is a diffuse parenchymatous hyperplasia of the gland, with or without a 
certain amount of proliferation of the stroma and an increase of the 
gelatinous contents. The same author recorded an osseous condition of 
one side of the thyroid in an aged collie. The affected region was much 
enlarged, and the glandular tissue in it had almost completely disap- 
peared. ) 

In some cases of cystic goitre the cysts may contain blood, and ex- 
tensive hemorrhages may be observed in the gland. | 

SYMPTOMS.—Goitre in the horse rarely causes any symptoms. A 
bilateral ege-shaped swelling close to the region of the larynx is observed, 
and on examination the swollen condition of the gland is easily detected. 
In exceptional cases the swelling may be very extensive, and may cause 
pressure on important structures in the vicinity. 


DISEASES OF THE DUCTLESS GLANDS 1303 


In the dog the enlargement of the gland may occur insidiously or in | 
a rapid manner. Woodrofie Hill* stated that a large swelling may 
develop within twenty-four hours. According to Sewell,+ goitre rarely 
causes any inconvenience unless the gland is very large; but in the young 
dog (six weeks old) serious symptoms due to compression of the trachea 
or of the recurrent nerves may occur. The same author states that the 
affection is very common in pointers at the age of a few weeks. We have 
observed a number of puppies of the same litter affected with the disease, 
and the mortality was very high. Cecil Frencht states that in some 
instances even a slight enlargement of the gland may cause well-marked 
respiratory disturbance. In some cases the swelling may extend as far 
as the lower region of the neck. The same author has found in some 
of the congenital cases an imperfect development of the body. 

DIFFERENTIAL Diacnosis.—Goitre must be differentiated from other 
swellings in the region of the neck, such as ranula, also malignant disease 
of the thyroid. In the former, the swelling is soft and extends to the 
submaxillary space; in the latter, the surface is uneven and irregular. 

TREATMENT.—In mild cases, an ointment composed of potassium 
iodide in lanoline (1 to 6) should be rubbed in daily. The same drug 
may be prescribed internally. In the parenchymatous form, injections 
of tincture of iodine are advised by some authors. Care should be taken 
so that the injection is not made into a bloodvessel, or a fatal result 
would occur. 

In the cystic form, operative measures are advised, such as a free 
incision, removal of the contents, the injection of tincture of iodine, and 
tamponing with antiseptic gauze. 

In the case of extensive goitre causing compression of structures in 
the vicinity, excision of the gland must be considered. The entire organ 
should not be removed, as otherwise a fatal termination would result. 

We may remark, however, that in the goat thyroidectomy can be 
carried out with impunity. For details of the operation the reader is 
referred to Cecil French’s work, ‘‘ Surgical Diseases of the Dog.” 

Tumours of the Thyroid.—Carcinomata and sarcomata have been 
observed, and are generally secondary in origin. Treatment is usually of 
no avail. 

Exophthalmic Goitre—Synonyms.—Graves’s, Basedow’s, or Parry’s 
disease; Hyperthyroidism. 

In this affection the functions of the thyroid are perverted or hyper- 

* “The Management and Diseases of the Dog.”’ 


tT ‘The Dogs’ Medical Dictionary.” 
+ “Surgical Diseases of the Dog.” 


1304 SYSTEM OF VETERINARY MEDICINE 


active, and the leading phenomena are goitre, protrusion of the eyeballs 
(exophthalmos), tachycardia, and tremors. 

The disease was first observed in man by Parry in 1786, and eight 
cases were described in the posthumous writings of this physician (1825). 
Graves described the affection in 1835, and Basedow in 1840. © 

Cases have been recorded in animals by Jewsejenko (1888), Roder 
(1890), Cadiot (1892), Albrecht (1896), and by other writers. According 
to Hutyra and Marek, all the cases do not exactly correspond with the 
disease in man, but there is sufficient evidence to show that the affection 
probably occurs in animals. Cases in the horse have been observed by 
Jewsejenko, Cadiot, Marek, and Ries; in the cow by Roder and Gorig; and 
in the dog by Jewsejenko, Sonnenberg, Albrecht, and Lelleman. 

EtrioLogy.—The disease was regarded by some authors as a pure 
neurosis, but recently the view is held that the condition depends on a 
primary affection of the thyroid gland (hyperthyroidism). Itis thus an 
opposite condition to myxcedema, in which athyroidism is present. 
According to Mobius, the symptoms in exophthalmic goitre are due to 
disturbed function of the thyroid gland, probably to hypersecretion of 
materials which induce a form of chronic intoxication. Thyroid extract, 
when given in excess, produces symptoms resembling those of Parry’s 
disease; while if this agent be given in the affection mentioned, it generally 
ageravates the symptoms. Complete removal of the thyroid gland 
causes diametrically opposite symptoms to those occurring in exoph- 
thalmic goitre. Partial removal of the enlarged thyroid proves the most 
successful treatment for exophthalmic goitre. These facts tend to support 
the views of Mobius. 

Morsrp ANatomy.—The thyroid gland is enlarged—this depends on 
hyperplasia—the follicles are increased in size, and new ones are formed. 
The lymphoid tissue of the gland stroma is increased. The colloid 
material may be absorbed and replaced by a more mucinous fluid. In 
some instances the hyperplasia may cease, and the gland returns to the 
colloid state. According to Cadéac, the heart is generally hypertrophied, 
and the arteries increased in volume, owing to a well-marked attenuation 
of their walls. 

Symptoms.—The onset of the disease is usually gradual, and the 
course chronic. Occasionally it may develop rapidly in an acute form. 
The characteristic symptoms are tachycardia, exophthalmos, and enlarge- 
ment of the thyroid. Tremors are sometimes observed. According to 
Cadéac, tachycardia is the first symptom manifested; but Hutyra and 
Marek state that the enlargement of the thyroid appears first. Accord- 
ing to Cadiot, well-marked palpitation of the heart is a prominent symp- 


DISEASES OF THE DUCTLESS GLANDS 1305 


tom in some cases, the cardiac impulse being so violent that the left side — 
of the chest is distinctly shaken. Occasionally a visible pulsation of the 
superficial arteries is observed. Cadéac states that this symptom is by 
no means constant. The area of cardiac dulness is increased, and evi- 
dences of hypertrophy of the heart are always present, according to 
Albrecht. The pulse is full, strong, and frequent. Vertigo and a 
cyanotic condition of the visible mucosee may be present. 

Kxophthalmos gives a characteristic aspect to the disease. The eye- 
balls are protruded, and the expression is staring; the eyelids are re- 
tracted, exposing the sclere above and below the cornesee. When the 
eyeball is moved downwards, the upper eyelid does not follow it, as in 
health. Tremor of the eyelids may be observed, also lachrymation, and 
in some instances convergent strabismus. 

Enlargement of the thyroid is generally present. Both lobes may be 
involved, and the swelling is smooth, firm, and tense. 

In some cases the exophthalmos and the tachycardia may disappear 
temporarily. Digestive disturbances, such as loss of appetite, diarrhea, 
and, in the dog, vomiting, may be present. Some authors have observed 
albuminuria. Albrecht recorded a case in the dog in which frequent 
cramps of the muscles of the limbs were present, and a tendency to walk 
in a circular direction. Cerebral complications may occur in some 
instances. ) 

CouRSsE AND TERMINATION.—It is difficult to trace the development 
of the disease. Although apparent recoveries may occur as the result of 
treatment, there is a tendency to recurrence. As a rule the course is 
chronic, but there are exceptions. In the case recorded by Jewsejenko 
of a four-year-old mare, the symptoms were manifested after a race— 
viz., palpitation, accelerated pulse, progressive weakness, and enlarge- 
ment of the thyroid gland. In sixteen days later severe exophthalmos 
of both eyes occurred, and death took place after a course of four weeks. 
In the case recorded by Réder in a cow the disease lasted for four years. 

DIFFERENTIAL D1aGnosits.—When the cardinal symptoms are present, 
the disease presents no difficulty in diagnosis; but cases occur in which 
the exophthalmos or the tachycardia may be absent. 

Proenosis.—Except in severe cases, the prognosis is said to be 
favourable. 

TREATMENT.—Perfect rest should be ordered. For the relief of the 
cardiac palpitation, strophanthus may be prescribed. Partial thyroidec- 
tomy is admitted by all writers to offer the best chance of success. 

Hypothyroidism—Synonyms.—Cretinism; Myxcedema. 

In this condition in man there is atrophy and a loss of function of 


1306 SYSTEM OF VETERINARY MEDICINE 


the thyroid gland, and a myxcedematous condition of the subcutaneous 
tissues. The clinical forms recognised are cretinism, myxcedema, and 
operative myxcedema (due to extirpation of the thyroid gland). 

In regions where endemic cretinism is common in man cases of a 
similar disease have been observed in dogs, and were studied. by Cerletti 
and Perusini, Wagner, and Dexler. The symptoms recorded were a 
moderate enlargement of the thyroid gland, anomalies in the growth of 
the bony system and the soft parts, and also in the development of the 
brain. The spinal column was reduced in length, and was compact, the 
skull large and short, the extremities short and clumsy, and the neck 
thick and shorter than normal. The anterior region of the body seemed 
out of proportion to the hind part. Digestive troubles, apathy, and a 
sleepy appearance were present. Similar symptoms follow complete 
extirpation of the thyroid in the dog. 

The treatment with dried thyroid gland has proved eminently suc- 
cessful in cretinism and myxcedema in man, and similar results have 
been observed in the dog. 


DISEASES OF THE THYMUS GLAND. 


Judging by the fact that no mention is made by any author with 
reference to diseases of the thymus gland in animals, it seems probable 
that such affections have not been observed. 

One condition, however, merits attention—viz., Lymphatism—as 
further investigation may show that it may account for some at least 
of the cases of sudden deaths from trivial causes, or from anesthetics, 
which occasionally occur in young dogs. 

Lymphatism, also known as Status Thymico-Lymphaticus, is defined 
by Osler as “a condition in children of hyperplasia of the lymphatic 
tissues and of the thymus in association with a flabby, fat overgrowth 
of the body, and hypoplasia of the heart and bloodvessels.” 

“The subjects of lymphatism have a lowered resistance, and are 
liable to sudden death from trifling and apparently inadequate causes.” 
The condition is held to be responsible for the sudden deaths which occur 
in children during the administration of chloroform. It is also observed 
in young adults. The cause of the sudden death is said to be a toxemia 
from an overproduction of the internal secretion of the thymus and of 
the lymph glands. 

Careful autopsies are necessary in order to ascertain if this condition 
occurs in animals. 


DISEASES OF THE DUCTLESS GLANDS 1307 


DISEASES OF THE SUPRARENAL BODIES. 


Nothing appears to be known clinically with reference to diseases of 
the suprarenal bodies. We have not succeeded in finding any recorded 
case of Addison’s disease in animals. This disease in man is characterised 
by muscular and vascular asthenia, gastric irritation, and pigmentation 
of the skin, and the lesions found were tuberculosis (the most common); 
also atrophy of the suprarenals, or malignant disease of these bodies. 
Experimentally, removal of the suprarenal glands in animals causes 
death by progressive weakness and toxemia. 

Cadéac states that the following lesions of the suprarenal bodies have 
been recorded in the horse: Hematomata of various sizes; colloid cysts* 
containing a viscid brownish liquid; carcinomatat either primary or 
secondary, and sometimes attaining a large size; inflammation of the 
glands{ associated with hypertrophy; their surface was irregular, and 
they appeared to be composed of several distinct lobes of various sizes 
full of coagulated blood. 

In ruminants, according to Cadéac, tumours of the suprarenal bodies 
are not very rare. Carcinomata have been met with in cattle by Horne, 
Gorig, Detroye, and others. Horne observed twelve cases in ten years.§ 
Pellotier recorded a case in the sheep. The tumours in such instances 
_ were very voluminous. 

Cadéac makes no mention of any symptoms in connection with lesions 
of the suprarenal bodies in either horses or ruminants. 


* Forgeot, Journal de Lyon, 1906. + Césari et Paninet, Soc. Centrale, 1906. 
t Detroye, Soc. Centrale, 1906. § Revue Gén., 1905. 


DISEASES OF METABOLISM 


I. DIABETES INSIPIDUS. 
By E. Waits Hoare, F.R.C.V.S. 


Tuts is an affection chiefly met with in the horse, and usually occurring 
as the result of feeding on damaged fodder, but is occasionally observed 
in the absence of any assignable causes. It is characterised by well- 
marked thirst, profuse urination, rapid loss of condition, and unfitness 
for exertion. The urine is pale in colour, of low specific gravity, but 
contains neither albumin nor sugar. Cases have also been recorded in 
the sheep and in the dog. This affection must be distinguished from 
the profuse diuresis or polyuria, which is a symptom occurring in certain 
forms of chronic nephritis, also in glycosuria, tuberculosis, glanders, after 
the administration of large doses of diuretics, and during recovery from 
pneumonia or pleurisy when exudates are absorbed and excreted by the 
kidneys. It is also distinct from the diabetes insipidus of human beings, 
which is a chronic affection occurring either idiopathically or associated 
with injury or disease of the nervous system, or in connection with the 
presence of abdominal tumours. According to Hutyra and Marek, cases 
of diabetes insipidus in animals depending on affections of the central 
nervous system have not been definitely recognised. Cadéac, however, 
describes instances in the dog due to lesions of the cerebrum and medulla 
oblongata. 

Eriotocy.—The disease may occur in isolated cases, or a large 
number of horses may be attacked in one establishment. It can generally 
be traced to the purchase of a new supply of food of inferior quality. 
Musty oats, or oats badly saved, kept without being properly turned over, 
are well known to be a fertile cause of the disease. The specific action 
‘of such deteriorated food is not definitely known, some authorities 
ascribing the effects as being due to the action of mould fungi. It is 
generally believed that kiln-dried oats are capable of producing the 
disease, but W. Williams believed that if the oats were of fair quality 
when put into the kiln, they are not so injurious as is usually imagined. 


Hay which is badly saved, mow-burnt, or musty, is also a frequent cause 
1808 


DISEASES OF METABOLISM: DIABETES INSIPIDUS — 1309 


of the disease, and probably contains some substance which produces . 
renal irritation. According to W. Williams, bran. of inferior quality, 
and possessing a greasy odour, can produce the affection, and the same 
authority has also observed that feeding on warm boiled food may cause 
the disease in some horses. 

Cases are met with in which the etiology cannot be traced to the 
food-supply, and is obscure in its nature. Various theories have been 
advanced to account for these cases, such as the presence of indigestion 
or defective powers of assimilation. Robertson believed that in these 
instances some unknown influence in the system produced dilatation of 
the renal vessels, owing to paralysis of their walls depending on disturbed 
innervation, the result being the manifestation of the prominent symp- 
toms of the affection. The disease is also met with during convalescence 
from debilitating affections, and occasionally as the result of long-con- 
tinued or exhausting work. In one outbreak of influenza we observed 
that the premonitory symptoms in every case were excessive thirst, 
profuse urination, and emaciation. 

Continental authors state that the disease is more commonly met 
with in stallions than in geldings. According to Cadéac, it is only 
exceptionally observed in mares, but this is not our experience. 

Morsip ANATOMY.—Opportunities for post-mortem examinations are 
rarely offered in this disease, as it seldom proves fatal per se. The cases 
that succumb are usually due to intercurrent affections, or to complica- 
tions. According to Robertson, the following lesions may be met with, 
although he did not regard them as either well marked or diagnostic: A 
pale, soft, flabby condition of the muscles, and similar changes in the 
mesenteric glands. Occasionally lesions in the nervous system may be 
found, such as serous effusion in the subarachnoid spaces and an infiltra- 
tion of the meninges, with a slightly coloured serous or gelatinous effusion. 
Hutyra and Marek state that no lesions are found in some instances. 
In others, the kidneys may show unimportant morbid changes, such as 
hyperemia, cloudy swelling, etc. 

Symptoms.—The leading symptoms are profuse urination, marked 
thirst, and rapid loss of condition. The appetite is not affected in some 
cases, but in others it becomes depraved, the animal having a tendency 
to eat his excrement, or to ingest clay if it be within reach. He also 
shows evidence of gastric acidity by constantly licking the walls and the 
manger. Other symptoms are pallidity of the visible mucous membranes 
(in some instances they may be of a rusty yellow colour), a sour condi- 
tion of the mouth, the skin dry and scurfy. In some cases the animal is 
in that condition known as “ hide-bound,” the feeces may be dry and 


1310 SYSTEM OF VETERINARY MEDICINE 


hard. The pulse may show a want of vigour and tone, or, in severe and 
neglected cases, it may be weak or infrequent. The animal manifests 
inaptitude for exertion, and sweats easily. Occasionally the loss of 
condition and general unfitness may be the first symptoms observed by. 
the attendant. The urine is largely increased in amount, very pale in 
colour, and of low specific gravity. 

The specific gravity of normal urine in the horse is from 1030 to 1035, 
while in diabetes insipidus it varies from 1002 to 1005. It is deficient 
in earthy carbonates, or these may be entirely absent. It is said to 
contain free acetic acid, and may show an acid reaction. Neither albumin 
nor sugar is present. Some authorities have observed evidences of in- 
digestion and the presence of colicky pains as preliminary symptoms of 
the affection, these occurring in a few days after the ingestion of deterior- 
ated food. 

Robertson described a form of the disease which occurred in the 
absence of any known cause. The urine was of higher specific gravity, 
less watery and less pale in colour than in ordinary cases, but contained 
a peculiar form of albumin. In such cases the general debility was more 
marked, and a fatal termination not uncommon. We should imagine 
that such symptoms pointed to the presence of a form of albuminuria 
rather than to diabetes insipidus. 

CoursE AND Proenosis.—If proper attention be paid to diet, and if 
suitable treatment be adopted, the animal usually recovers in from one 
to two weeks. 

On the other hand, if the case be neglected, debility becomes marked, 
digestion and assimilation are interfered with, cardiac weakness and 
anemia appear, dropsical swellings are formed on the dependent parts 
of the body, and occasionally effusions may occur in the serous cavities, 
the result being a fatal termination. 

DIFFERENTIAL Diacnosis.—The history of the case and the presence 
of the prominent symptoms of the affection renders diagnosis compara- 
tively easy. 

In prolonged or obstinate cases the urine should be examined for 
evidences of a renal affection. 

Diabetes mellitus, which is a very rare disease in the horse, is differ- 
entiated from diabetes insipidus by an examination of the urine. 

TREATMENT.—The first essential in treatment is to make a careful 
examination of the food, and if this is of inferior quality it should be 
immediately changed. In the case of a large establishment, where an 
extensive quantity of oats has been purchased, and this is found deterior- 
ated, some difficulty is likely to arise as to its disposal. Some prac- 


DISEASES OF METABOLISM: DIABETES INSIPIDUS 1311 


titioners have found that badly saved oats, or oats that have not been 
properly turned in the lofts, if subjected to the process of kiln-drying, 
will cease to prove injurious. 

In our experience, it is always necessary to discard food of this nature 
in order that the cases may recover promptly and completely, and also 
to prevent further animals from becoming affected. 

With reference to medicinal treatment, it is advisable to commence 
by administering an aperient, such as a pint of raw linseed oil, or as 
much Epsom salt as the animal will take in the food and drinking-water. 
After this, the most effectual agents to check the inordinate thirst and 
profuse urination are iodine or its preparations. Jodine may be given in 
the form of bolus in doses of 31. to Zii. twice daily. Or Lugol’s solution 
in doses of 38s. can be given in the drinking-water three times daily. 
Or iodide of potassium may be administered in doses of 31. to Ziss. 
either alone, or combined with sulphate of iron, in the food twice or 
three timesaday. The doses of these agents should be reduced as the 
symptoms of the disease abate. Bicarbonate of soda in doses of 3ss. to 
31., given in the drinking-water twice daily, also proves of service, in 
addition to the above treatment. Indeed, in some cases we have found 
the treatment with bicarbonate of soda to succeed better than with 
iodine, but usually we find it of advantage to combine these agents. 
The supply of water should not be curtailed in any way. Oatmeal 
gruel and linseed tea are useful adjuncts, while in the case of valuable 
animals, milk may be added with advantage. 

In tedious cases, the addition of arsenic in the form of Fowler’s solu- 
tion sometimes proves useful. When the prominent symptoms have 
disappeared, a course of tonics, such as sulphate of iron with nux vomica, 
should be prescribed. 

Diabetes Insipidus in the Dog.—According to Cadéac, this affection is 
not rare in the dog, and results chiefly from diseases of the nervous 
system, such as lesions of the medulla oblongata, cerebrum, or cerebellum, 
injuries to the lumbar region, and compression of the spinal cord by 
tumours. Such lesions are believed to act by causing irritation of the 
vaso-dilator nerves of the kidney. This author recognises two types of 
cases—viz. (1) those in which the urine does not contain albumin or 
other abnormal substances, and the affection disappears in a few weeks; 
(2) those depending on organic diseases, and showing exaggerated symp- 
toms, the urine often contains traces of albumin. The thirst is excessive, 
the secretion of urine very abundant, and emaciation is well marked. A 
fatal termination results unless treatment be adopted. In order to dis- 
tinguish true diabetes insipidus from a temporary polyuria, it is advised 


1312 SYSTEM OF VETERINARY MEDICINE 


to administer a few grammes of sea-salt for a few days. If this agent 
causes a rapid exaggeration in the amount of urine secreted, the case is 
one of true diabetes insipidus. On the other hand, if the amount of 
urine is not increased, a diagnosis of temporary polyuria may be made. 
If, however, chronic interstitial nephritis be present, the agent men- 
tioned will cause an increase in the amount of urine, but an examination 
of the latter will decide the question. 

Sewell* states that old dogs are particularly liable to suffer from 
- diabetes insipidus, and if the disease be not checked marked emaciation 
occurs. 

TREATMENT.—The dog should be fed on a milk and raw meat diet. 
Barley water and an infusion of triticum repens may be allowed ad lib. 
Bromide of soda is advised as a sedative to the nervous system, and is 
said to act favourably in recent cases of the disease. Sewell advises 
small doses of liquor arsenicalis three times daily before feeding, and if 
this fails, powdered opium in pill form should be given twice a day. 


* “The Dog’s Medical Dictionary.” 


DISHASES OF METABOLISM: DIABETES MELLITUS = 1313 


II. DIABETES MELLITUS. 
By E. WALLIS Hoare, F.R.C.V.S. 


This is a condition due to disturbance in the carbohydrate metabolism 
from various causes, and characterised by the presence of grape-sugar in 
the urine, marked thirst, polyuria, and emaciation. A temporary form 
of the disease is recognised, and termed “ glycosuria,” and is distin- 
guished from true diabetes mellitus. According to Hutyra and Marek, 
the blood of healthy animals contains about 0:1 per cent. of grape-sugar, 
and it is always possible to find traces in the urine, especially in cattle 
and sheep. This is known as “ physiological glycosuria.” Glycosuria 
may also result from the action of certain drugs, such as morphine, 
chloroform, ether, adrenalin, etc., and from injuries or diseases of certain 
parts of the nervous system. The occurrence of glycosuria as the result 
of the ingestion of sugar (alimentary glycosuria) has not been demon- 
strated in animals. Sugar has been detected in the urine of nursing 
animals, following a sudden suppression of the milk secretion, also in 
cases of milk fever in cattle, but it has been shown that milk sugar is 
present in such cases, and the term “ lactosuria’’ has been applied to 
the condition. On the other hand, true diabetes mellitus is a chronic 
affection. Glycosuria has also been observed in cases of azoturia (see 
p. 1359). 

OccuURRENCE.—The disease is regarded by all authors as being of 
rare occurrence in animals, but a number of cases have been recorded 
in recent years. Probably, if more attention were devoted to analysis 
of the urine by clinicians, the affection would be recognised more fre; 
quently. The majority of cases were recorded in the dog, generally in 
aged animals, and only a few were observed in horses and cattle. Robert- 
son* met with only one case in the horse, and Nunnf also recorded one 
instance of the affection. Darbas (1890) and Hillerbrand (1910) met 
with cases of true diabetes mellitus in cattle. 

Er1oLoGy.—Post-mortem examinations and experimental investiga- 
tion show that diabetes mellitus may depend on a variety of morbid 
conditions, while in some instances no lesions may be found to account 
for the occurrence of the disease. 

The following conditions have been found in association with the 


disease: 
* “Practice of Equine Medicine.”’ 
{t Veterinary Journal, 1891, p. 405. 


VOL. Il, 83 


1314 SYSTEM OF VETERINARY MEDICINE 


1. Disturbances in the Nervous System.—These include tumours’ 
especially in the vicinity of the medulla oblongata, also injuries to the 
brain and upper part of the spinal cord. This is sometimes called 
“neurogenic diabetes.’’ Such conditions may cause disturbance of the 
“diabetic centre,’ or may irritate the posterior lobe of the pituitary 
gland, and thus induce glycosuria. 

2. Disturbance of the Internal Secretions.—These include diseases of 
the pancreas, as demonstrated by the cases recorded by Liénaux, Sendrall 
and Cuille, Eber, and other observers. It is not yet definitely deter- 
mined whether morbid changes in the islands of Langerhans are the only 
lesions of the pancreas which induce diabetes mellitus, or whether diffuse 
alterations in the pancreas can cause the condition. In human medicine, 
diseases of the thyroid, adrenal, or pituitary glands, are believed to be 
causes of diabetes mellitus. 

3. Lesions of the Liver—Although often observed in cases of diabetes 
mellitus, are not now regarded as causes per se of the latter, as they 
are generally found to be associated with coincident lesions of the 
pancreas. | 

Metabolism in Diabetes Mellitus——There is much to be learned with 
reference to this subject. Various views are held as to the explana- 
tion of the lack of oxidation of the carbohydrates and the failure to 
transform them into glycogen. Certain points are recognised—viz., that 
hyperglycemia (sugar in the blood) is present, associated with loss of 
energy due to the constant excretion of sugar in the urine, and this 
energy must be provided from the proteins and the fats. There is no 
serious disturbance of the metabolism of the proteins, and the carbo- 
hydrate portion of the latter partly takes the place of the sugar which 
is lost to the body. The metabolism of the fats, however, is interfered 
with, and incomplete combustion results. Acidosis (acid toxeemia) is 
produced, owing to the formation of 8-oxybutyric acid, which is the 
source of diacetic acid and acetone. 

Morspip AnatomMy.—There are no constant lesions, and, as already 
remarked, in some instances no special morbid alterations are observed, 
but secondary changes may be present. Lesions may be found in the 
central nervous system, such as hemorrhages, new growths, etc., in the 
medulla oblongata or in the vicinity of the latter. Fatty liver or cirrhosis 
is not uncommon in cases of diabetes in the dog. Various lesions may 
be found in the pancreas. Cataract or ulceration of the cornea has been 
observed in the horse and in the dog. 

Symptoms.—In all animals the cardinal symptoms are polyuria, 
excessive thirst, a voracious appetite, and emaciation. The disease 


DISEASES OF METABOLISM: DIABETES MELLITUS 13815 


develops in an insidious manner, and in the early stages the animal 
appears dull, is easily fatigued, and shows gradual emaciation. The 
urine is pale in colour, has a sweetish odour, and in cases where marked 
polyuria is present it resembles water. The specific gravity is increased 
and varies between 1050 and 1060. The amount of grape-sugar present 
varies in the horse from 3 to 7 per cent., and in the dog from 4 to 10 per 
cent. It is increased by the ingestion of sugar or starchy foods, and 
lessened on a nitrogenous diet. In the early stages the sugar may tem- 
porarily disappear from the urine, but when the disease is advanced the 
glycosuria is permanent. 

According to Cadéac, the prominent symptoms in the horse are a 
capricious appetite, rapid emaciation, intense thirst, the animal drinks 
three to five times more water than in the normal condition, excessive 
polyuria, the urine is neutral in reaction, and the amount of sugar present 
varies from 3°62 to 3°75 per cent. In a case recorded by Heiss, high 
fever was observed; but in an instance reported by Dieckerhoff the 
temperature was normal. In some of the recorded cases in the horse a 
subnormal temperature was present. Ocular lesions may be manifested 
in from thirty to forty days after the first appearance of the symptoms of 
diabetes. These include cataract, commencing from the centre of the 
lens, and usually involving both eyes; opacity or ulceration of the cornea, 
conjunctivitis, iritis, and sub-retinal hemorrhages. In the case recorded 
by Nunn, the animal, an aged cob gelding, showed emaciation and 
weakness, but had a good appetite. The urine was dark in colour, its 
specific gravity was 1060, and it was found to contain a considerable 
quantity of sugar. He was under observation for about two months, 
and improved under treatment, so that in a few months later he was in 
fairly good condition, and was regularly worked by the owner. No 
further history of the case was given, so that it is impossible to ascertain 
if the sugar had permanently disappeared from the urine; hence we 
would be inclined to regard the case as one of glycosuria from some 
obscure cause, rather than as an instance of true diabetes mellitus. 

In the dog the symptoms are similar to those mentioned, but in 
addition eczematous affections of the skin are common, and in some 
cases catarrh of the external urinary passages may be observed. The 
tongue is dry and parched, and may be of a red-brick colour. 

CouRSE AND TERMINATION.—The course is always chronic, and the 
duration varies from one to twelve months. In the later stages respira- 
tory affections may occur as complications, such as laryngeal or bronchial 
catarrh, which may be succeeded by pneumonia. In the dog enlarge- 
ment of the liver may sometimes be detected by palpation. Cases are 


1316 SYSTEM OF VETERINARY MEDICINE 


recorded in which lesions of the skin and subcutaneous tissues occurred, 
such as necrosis of the tip of the tail in the dog, and ulceration of the 
skin of the coronet in the horse. 

In the later stages debility is extreme, and, according to some authors, 
the excretion of sugar gradually diminishes, or may cease. Death may 
occur in convulsions, or a comatose condition may develop. Diabetic 
coma (due to acidosis) has been observed in the horse by Hutyra and 
Marek, and in the dog by Froéhner, Hichhorn, and Liénaux. 

ProeNnosis.—All true cases of diabetes mellitus usually prove fatal, 
and, as pointed out by Hutyra and Marek, those recorded as cured are 
probably instances of transitory glycosuria, or they represent intermis- 
sions of the disease. 

DIFFERENTIAL D1AaGNosis.—It must be remembered that the disease 
may be in existence for a considerable time before it is recognised. The 
diagnosis must be based on an examination of the urine. It is difficult 
to distinguish transitory glycosuria from true diabetes mellitus, unless a 
series of examinations of the urine are carried out. Moreover, the 
transitory form may be succeeded by true diabetes. 

The following are some of the tests employed for the detection of 
sugar in the urine: 

Fehling’s Test.—The following solution is employed: Sulphate of 
copper, 904 grains; neutral tartrate of potassium, 364 grains; solution 
of caustic soda; 4 ounces; distilled water to make 6 ounces. One drachm 
of this solution is placed in a test-tube and boiled, and to this is added 
1 drachm of the suspected urine. The mixture is boiled again. If sugar 
be present, the yellow suboxide of copper is thrown down as a precipitate. 
The solution should be freshly prepared, as it is apt to decompose. 

Trommer’s Test—One drachm of the suspected urine is placed in a 
test-tube, and a few drops of a dilute solution of sulphate of copper are 
added, also 1 drachm of lig. potasse. The resulting mixture is then 
boiled, and if sugar be present, the copper is reduced, forming a yellow 
or orange-red precipitate of suboxide of copper. 

It must be remembered that in the dog traces of glycuronic acid are 
normally present, and after the administration of drugs, such as chloral 
hydrate, morphine, phenacetin, chloroform, camphor, this substance 
occurs in well-marked quantities, and has the power of reducing salts 
of copper, hence Fehling’s and Trommer’s tests may prove fallacious 
in the examination of the urine in this animal. 

Fermentation Test.—This is recognised as the most accurate and 
reliable test. A small fragment of yeast is placed in a test-tube full of 
the suspected urine. The test-tube is then inverted over a glass vessel 


DISEASES OF METABOLISM: DIABETES MELLITUS 1317 


also containing urine. If sugar be present, fermentation occurs, and | 
carbon dioxide is formed, which accumulates in the upper part of the 
tube, and expels the urine therefrom. Specially devised fermentation- 
tubes can be obtained for carrying out this test. 

Polariscope Test.—This is adopted for quantitative determination of 
glucose. Glucose being dextro-rotatory, the percentage of suyar if 
estimated by the degree of rotation. 

Nylander’s Bismuth Test.—Nylander’s solution is prepared as follows: 

Rochelle salts, 4 grammes 


Solution of caustic soda, 10 per cent. 
Dissolve. 


a }100 C.C. 


Next add 2 grammes of bismuth subnitrate, and digest in a hot-water 
bath until as much as possible of the bismuth salt is dissolved. 

To Apply the Test.—Add 1 c.c. of this solution to 10 ¢.c. of the sus- 
pected urine, and boil for five minutes. If sugar be present, a black 
deposit of bismuth occurs, this being due to the reduction of the sub- 
nitrate to the metallic bismuth. 

TREATMENT.—The first essential is to limit the amount of carbo- 
hydrates in the diet, and to substitute food rich in fats and proteids. 
Obviously, in the case of the horse this procedure would be difficult to 
carry out. Hutyra and Marek advise oats, hay, bran, and oil-cake. 
Owing to the fatal nature of the disease, it is seldom that treatment will 
be desirable. 

In the dog some authors advise a raw meat diet. Hutyra and Marek 
point out that if acetone bodies appear in the urine in large amounts, 
the supply of albumin and fat should be limited, and that it is advisable 
for a time to put the animal on a carbohydrate diet. 

As regards treatment with drugs, various agents have been tried, 
but all have proved unsatisfactory. Codeine appears to have the effect 
of temporarily diminishing the glycosuria, and is preferable to opium. 
In severe acidosis or diabetic coma, large doses of bicarbonate of soda 
are advised. The latter condition may be regarded as hopeless. 


1318 SYSTEM OF VETERINARY MEDICINE 


III. OSTEOPOROSIS. 


By H. B. Extiot, M.R.C.V.S., 
Deputy Territorial Veterinarian, Hilo, Hawaii. 


Synonyms.—Rarefying osteitis; Osteomalacia of the horse; Fragilitas 
ossium; Osteoclastia; Bighead; Swelled head. 

This is an equine disease characterised by enlargement, softening, 
relative decrease of weight, and increased fragility of the osseous tissues 
due to processes of absorption and rarefaction in the bone canals and 
“spaces. 

History AND GEoGRAPHICAL DistripuTion.—The first description 
of osteoporosis in English veterinary literature is that contributed by 
Varnell to the Veterinarian in 1860, in which an outbreak is most care- 
fully and elaborately reported. Since then the disease has been the 
subject of occasional reference in Great Britain and European countries, 
and has been noted in various and widely distributed parts of the world: 
in North America, South Africa, Australia, India, Burma, Tonquin, 
Hong-Kong, Madagascar, the Philippine Islands, and the Hawaiian 
Archipelago. It shows a well-marked local preference, at times rages 
enzootically in circumscribed areas for periods of years, and by reason 
of its mysterious origin and incurable nature is the source of serious 
economic loss to stock-owners. 

OccURRENCE.—Osteoporosis is considered by some writers, notably 
Friedberger and Fréhner, who decline to recognise it as a distinct clinical 
form of disease, to be closely related to, if not identical with, the osteo- 
malacia of cattle, sheep, pigs, and goats. This view has not met with 
general acceptance from those who have had more extended oppor- 
tunities of observation in other than European countries; and, apart 
from some confusion in nomenclature, it is doubtful if there is a disease 
in equines identical with bovine osteomalacia, and it is certain that the 
pathological and clinical phenomena currently recognised under the 
designation of “ osteoporosis ”’ differ in many respects from those which 
characterise the bovine disease. Mohler very correctly points out that 
the latter disease is frequently seen on old, worn-out soils, on lands de- 
ficient in lime salts, or among cattle fed upon food lacking in bone- 
forming constituents; that the appropriate hygienic and medicinal treat- 
ment is well known, and almost always effective; and that in those 
localities where osteomalacia is common among range cattle the disease 
does not affect horses using the same range. Osteoporosis, on the other 


DISEASES OF METABOLISM: OSTEOPOROSIS 1319 


hand, appears independently of these etiological circumstances; it is — 
always very refractory to therapeutic measures, and even during the 
prevalence of severe enzootics in local areas we do not find its occurrence 
among cattle and sheep, although they may be stabled and pastured 
with diseased horses and mules. 

In the present state of our knowledge no definite classification can be 
extended to the bone diseases of the lower animals. The rachitis of the 
young, and osteomalacia or osteoporosis of the adult, may all have the 
same etiological origin, and owe their modifications to factors of species, 
age, and varying environment; or each species may be subject to diseases 
having a close resemblance in clinical manifestation to those of other 
species, but arising from entirely different causes. We can only say 
that the balance of evidence is in favour of regarding osteoporosis as a 
pathological and clinical entity, peculiar to the equine race, and distinct 
from those diseases of a similar nature affecting cattle and sheep. 

The statement of Law that asses and mules habitually escape this 
disease is not justified by experience. Ball reports the occurrence of 
numerous cases amongst imported mules in Tonquin, and our observa- 
tions in Hawaii do not reveal any immunity on the part of hybrids, 
although the percentage of animals affected may be somewhat lower. 

Breed does not confer immunity, and exerts very little appreciable 
influence either as a predisposing cause or in the development of the 
symptoms. Thoroughbred horses are supposed to be more susceptible 
than those of coarser breeds, and numerous cases have been reported from 
breeding-farms and training-stables. The Shetland pony has acquired a 
notorious reputation in the United States, but this is probably due to 
pampered conditions of environment and irregular mode of life. We 
notice in the smaller breeds a tendency to a more prolonged and chronic 
course, with greater probability of recovery. 

The period of growth is undoubtedly the most dangerous, sesh 
larly from the third to the sixth years, and the heaviest toll is exacted 
from young animals; nevertheless, maturity creates no exemption, and 
the disease may appear up to twenty years of age or more. 

The geographical distribution indicates that occurrence is not con- 
trolled by climatic factors, although, after development of the symp- 
toms, remarkable curative results are often affected by a simple change 
of locality. These recoveries seem to be independent of dietetic changes, 
but are neither invariable nor certain. City life has been blamed as a 
most potent cause, and Berns and Meyer, who have met with many cases 
in Brooklyn and Cincinnati respectively, say that affected animals sent 
into the country recover, but contract the disease anew if returned to 


1320 SYSTEM OF VETERINARY MEDICINE 


their previous stables. But in most cities osteoporosis is a rare disease, 
and it is more probable that those named are merely localised areas such 
as are known to exist even in rural districts. 

The suspicion which is attached to insanitary and defective habita- 
tions, stables in basements, or with earthen floors, is more verifiable, 
and, where the disease is common, a very large percentage of the cases 
may be found to be living under these conditions. The earlier stables on 
the Hawaiian sugar estates were dry and well ventilated, but were con- 
structed with wooden flooring, slightly raised above the ground suriace, 
through which the excreta soaked for years, forming a bed of abominable 
filth underneath. This has been remedied in most places, and some of 
the improvement, so far as osteoporosis is concerned, may be attributable 
to this circumstance. But at the most this is not more than an accessory 
cause, because the disease has been known to exert very destructive 
effects in stables of the most modern and approved type. 

Habit of life influences susceptibility in the case of the horse of 
luxury—+.e., the saddle or driving animal only occasionally used, and 
which stands idly in the stable most of the time; but, again, no exemp- 
tion can be claimed for the harder-worked classes, whose life is an un- 
ceasing round of daily toil. 

Er1otocy.—Age, habit of life, and insanitary housing, are, therefore, 
predisposing factors, but not essential ones, in the production of osteo- 
porosis, which often occurs where these conditions are most favourable 
for the animal. When we are compelled to search further for the actual 
cause of the disease, we become involved in a maze of conflicting and 
mutually contradictory hypotheses, which, apart from those that are 
concerned with supposed aberrations of glandular structure and function, 
fall naturally into two classes: Firstly, we find a large number of theories 
based upon presumptive metabolic changes due to qualitative or quanti- 
tative defects in the food-supply; and, secondly, tentative suggestions, 
founded purely upon clinical analogy, that the disease will be discovered 
ultimately to be of microbial origin. 

The fact that the processes of bone nutrition, particularly in im- 
mature animals, may be profoundly disturbed by the presence, or pro- 
portion, of certain mineral salts and acids in the system kas given rise 
to the theories of lime-inanition and acid formation. That a deficiency 
of lime salts in the food is the actual cause of equine osteoporosis was 
first advanced by Varnell, and appears to be to some extent confirmed 
by the investigations of Roloff, Voit, Milne-Edwards, and others, who 
claim to have caused osteomalacic symptoms in certain animals by 
supplying a dietary free from these salts. Né6rgaard has called attention 


DISEASES OF METABOLISM: OSTEOPOROSIS 1321 
in a very exhaustive report to the paucity of lime salts in the water and . 
herbage of the Hawaiian Islands, and has shown that the lack of size of 
range cattle, and the presence of osteomalacia among them, is caused by 
this deficiency. When we come, however, to apply this argument to 
the enzodétic phase of osteoporosis which was prevalent in the Hilo dis- 
tricts of the island of Hawaii during the closing years of the last century, 
we are confronted by many difficulties. A large proportion of the 
animals aflected were fed almost entirely upon imported American hay 
and grain; others received varying amounts of native forage, with or 
without the addition of molasses. If the variation in diet created any 
predisposition, it showed itself most markedly in stables where the 
question of expense in feed-bills was least considered. The subsidence 
of the endemic wave, followed by almost complete quiescence for several 
years, suggests that the unchanged water-supplies were faultless. It is 
remarkable, also, that one large stable, engaged in the business of trans- 
portation, completely escaped the ravages of this disease, although most 
of the animals employed in their work were horses at a susceptible age, 
and subject to an apparently most provocative environment. Again, we 
have never seen any appearance of bone disease in the milch-cows of this 
district, which are often fed almost entirely upon native fodder, and their 
ofispring grow to a healthy and full-sized maturity with very little care 
or attention. This remark does not apply to foals. They may do fairly 
well up to the time of weaning, but after then development is partially 
arrested, and even if the period of colthood is successfully overpassed, the 
mature animal is usually dwarfed and of small value. We suspect, how- 
ever, that the difference between the young animals of these species is 
caused by the great susceptibility of the young horse to the entozoic 
infestation which is also prevalent in that district, and is not due to lime 
deficiency. This view is corroborated by Mohler, who states that the 
idea that feeding horses upon fodder and cereals poor in lime salts, or 
grazing them upon pastures where the soil is below the average in lime 
or phosphates, will cause osteoporosis has been disproved, and that the 
disease is seen on limestone formations and among animals fed generously 
upon grain. It is undoubted that in many instances this cause is in- 
operative, and it is known that the liberal addition of lime salts to the 
food ration has very little therapeutic value for the individual, and does 
not check the course of the disease in a stable. 

The theory of acid formation implicates several acids as possible 
agents in the processes inducing bone softening, and especial attention 
has been attracted to the action of lactic and phosphoric acids in this 
respect. Apart from the deleterious effects of an excess of free phos- 


1322 SYSTEM OF VETERINARY MEDICINE 


phorus upon osseous tissues, we have no definite proof that either of 
these acids play an important part in the etiology of osteoporosis. It 
may be suggested, also, as a practical consideration that the source of 
origin of these acids would have to vary very considerably to fit in. 
with all the conditions under which this disease appears among adult 
animals, 

Friedberger and Froéhner attribute the occurrence of the disease 
described by them as osteomalacia of the horse to continued poor feeding 
and deprivation of oats, combined with damp, chilly stables. M. H. 
Hayes, a competent observer with much experience in many countries, 
believes that mere insufficiency of fodder cannot be the cause, and con- 
jectures the presence of a specific poison in it. We have said that very 
many of the cases encountered in the Hawaiian Islands were found 
among stock exceptionally well supplied with hay and grain, and this 
experience has been confirmed in other parts of the world. This circum- 
stance has suggested superfluity of proteid or carbohydrate constituents 
of the food as a possible factor. Special foodstufis, bran and millet, used 
in disproportionate quantity, have been blamed. Bran rachitis, or 
miller’s disease, has been described by Piitz, who is of the opinion that 
it is a chronic phosphorus-poisoning due to the large amount of phos- 
phoric acid in bran. Law remarks that phosphorus is only found in 
bran in the form of phosphates, and the supposition that the acid is 
produced during digestive processes remains unproved. A serious and 
long-continued outbreak of osteoporosis on a Hawaiian sugar-plantation 
disappeared after orders were issued to discontinue the supplies of this 
food. Here, however, the possibility of coincidence must not be over- 
looked, because sudden cessation, without apparent reason, of the en- 
demic phase is a feature of the disease that has been noticed elsewhere; 
also, many cases of osteoporosis have been noted among stock which 
have not been accustomed to bran as a, part of their daily ration. An 
acute osteitis with bone softening is mentioned by Hinebauch, who con- 
siders it to be caused by feeding millet. It is improbable that either of 
these foods are more than occasional accessory causes acting in con- 
junction with some other factor of which we have no knowledge, but it 
is good practice to advise their discontinuance if they are being used in 
stables in which the disease has appeared. 

The theory of microbial origin has received increasing attention in 
recent years, but so far all efforts to demonstrate the presence ofa patho- 
genic organism, or to artificially transmit the disease from animal to 
animal by blood transfusion or implantation of diseased tissue, have 
failed, and the evidence in favour of this theory is founded entirely upon 


DISEASES OF METABOLISM: OSTEOPOROSIS 1323 


clinical observation. The mysterious occurrence of osteoporosis, its local | 
preference and occasionally endemicity, and its evident independence of 
circumstances of environment, diet, labour, and individual peculiarity, 
constitute striking analogies with the class of infective diseases which 
cannot be overlooked, and are difficult to explain by any other line of 
argument. W. Williams remarked a relationship between punctured 
wounds of the foot and the development of this disease—an observation 
which has frequently been confirmed in our experience. We have seen 
a large number of cases in which wounds of the feet, or of other parts 
of the body, in hitherto apparently healthy and vigorous animals have 
been followed by osteoporotic symptoms. It cannot be conceded that 
this is simply due to the effects of wound irritation, enforced idleness, or 
change in diet, but it is possible that these factors aggravate a pre- 
existing latent condition. 

‘Evidence as to infection from one living animal to another is con- 
flicting and unsatisfactory, and, in the light of the failure of experimental 
efforts along this line, it seems safe to say that the danger of such trans- 
mission is small, if not actually non-existent. This view is borne out by 
the fact that it is by no means unusual to see an osteoporotic wreck 
ending its weary days in the midst of a crowded stable, using the same 
mangers and watering-troughs with the other animals, but without 
further spread of the disease. Berns and Hoskins have remarked that 
animals placed in particular stalls in stables under their charge invariably 
fell victims to the disease, and similar experiences have been encountered 
in Hawaii. Some of these cases may be explained by the theory of 
coincidence; in others, the animal introduced into the stall is frequently 
one recently purchased from the outside, and may be supposed to possess 
a higher degree of susceptibility than those which have been in the 
stable for some length of time. Certainly, if transmission does take 
place under natural circumstances, it is a most insidious process, requiring 
a special susceptibility on the part of the victim, and passes slowly and 
irregularly from animal to animal through some such medium as the 
soil of the pasture, the dust of the stable, manure, or forage. 

Morsip ANatoMy.—The macroscopical appearance of the articula- 
tions and bones from an acute case of osteoporosis are described by 
Varnell as follows: ‘‘. . . The appearance of each joint was remark- 
able. In most instances, although not in all, the articular cartilage was 
of a dark slate colour, much thinner than is natural, and in many places 
it was entirely lost. This was especially the case around the margin of 
the articulations, leaving the bone at that point quite exposed. The 
synovial membrane was considerably thickened, especially in those parts 


1324 SYSTEM OF VETERINARY MEDICINE 


where it is most vascular. The quantity of synovia in each joint was 
small, of a dark colour, and in some cases mixed with blood. The char-— 
acter of some of the articular surfaces, however, was quite different. 
In such, the articular cartilage was pale-coloured, and in some places of 
a palish yellow, velvety to the feel, and evidently containing fat, thereby 
indicating that the cartilage cells had disappeared, and fat had become 
deposited in their place. The ends of the bones were so much softened 
that, by applying a slight degree of force to the capsular or articular 
ligaments, small portions of the bone could be easily detached. The 
periosteal covering of the flat and irregular, and also some parts of the 
long bones, was very vascular, and could be easily stripped off. The 
bones generally were likewise so very soft that they could be cut with 
a knife in any direction with the greatest ease, and, if pressure were 
applied to the cut surfaces, or where the periosteum had been removed, 
blood would ooze from innumerable points. In the interior of the bones 
the cancelli were filled with a red gelatinous substance. The ribs, the 
vertebre, and, indeed, all the irregular and flat bones, were in the same 
condition. The shafts of the long bones of the extremities were not 
visibly increased in size, nor was the shell or compact structure much 
altered. The ends of these bones, however, were enlarged and soft, and 
on making a section through them in their long diameter, the medullary 
canal, and especially the cancelli near the extremities, had a singular, 
though not a uniform, appearance. In some of them the whole of the 
interior was of a dark red colour, from congestion of the vessels and 
effusion of blood into the areolar interspaces; in others, one-half only 
of the interior was in this state, the other part being filled with a peculiar 
fat, and consequently very pale in colour. It was at the end of the 
bone affected in this way that the articular cartilage was of a palish 
colour, velvety to the feel, and also slightly greasy. Even the teeth did 
not escape the malady, the crusta petrosa being much thicker and more 
spongy than usual.. The bones, after being dried and macerated, ex- 
hibited many peculiarities, which were not apparent in their fresh state. 
For instance, the ulceration of the articular cartilages, which seemed to 
be altogether confined to the cartilages of incrustation, was found on 
their removal to affect the bone underneath, and the loss of structure, 
however small it might be in the cartilage, extended more or less deeply 
into the bone, the size of the cavity increasing with its depth. Scarcely 
an articulation of the whole body was found free from this ‘ worm- 
eaten ’ condition of both bone and cartilage. It was found, likewise, in 
cleaning the bones after maceration, that from their extreme softness 
great care was necessary to prevent their processes (epiphyses) from 


DISEASES OF METABOLISM: OSTEOPOROSIS 1325 


being detached, and the application of the slightest force to a portion of 
ligament or tendon that was not sufficiently disintegrated by decom- 
position would be certain to effect their removal. The external surfaces 
also of the bones, as contrasted with those of a normal condition, had a 
very singular aspect, especially in the flat and irregular bones. The 
ends of the long bones were similarly affected, but the shafts of most of 
them deviated but little in external appearance from a healthy state. 
A transverse section, however, of the middle of the shaft. showed very 
distinctly that the osseous lamine surrounding the Haversian canals 
were much thinner than is natural, thus necessarily leading to a con- 
siderable enlargement of the latter. In the first-named, and in the flat 
bones, instead of the surface being smooth and dense, it had a character 
not very unlike a fine sponge. The foramina for the passage of the 
bloodvessels, and especially those belonging to the periosteal membrane, 
were much dilated, thus giving the bone a kind of honeycomb appearance.” 

In the foregoing paragraphs we have an excellent picture of the 
naked-eye lesions found in the very acute type of osteoporosis, but such 
violent alterations of structure must not be expected in milder and 
more chronic cases of this disease. The general characteristics are the 
same in both instances, but exist in the mild and chronic types in a more 
modified form. Articular disease, bone softening, and the changes in 
the bone channels, are less strikingly evident, and even where the skeleton 
is the subject of widely spread disease, here and there the action of 
reparative processes may be discovered. Osteoporotic bone, in the 
active stages, is lighter than normal, crumbles under pressure, and the 
dilated foramina give to it somewhat of a ‘“‘ pumice-stone ”’ appearance. 
The results of chemical analysis reveal that it contains more organic 
matter and silicic acid, and less fat, phosphoric acid, and salts of calcium 
and sodium. After recovery it is hard and dense, and weighs con- 
siderably more, bulk for bulk, than normal bone. 

Under the microscope the morbid changes are seen to consist essen- 
tially of rarefaction and softening, the absorption apparently being 
effected by osteoclasts grouped around the large bloodvessels. In the 
Haversian canals and bone spaces we note an active proliferation of 
cells, with increased vascularity and a gradual absorption of the earthy 
salts and fibrous matrix. The absorptive processes follow the course of 
the Haversian system, the canals become increasingly enlarged, their walls 
attenuated, and they are filled with gelatinous substance and globules 
of fat. The bone tissue loses its homogeneous structure; areas of erosion 
and hollow spaces, some of which commence in the lacunz and others 
by the breaking down of Haversian walls, appear in its substance. 


1326 SYSTEM OF VETERINARY MEDICINE 


These cavities are of irregular shape, vary in size from a pin’s point to a 
millet-seed, they may become confluent, thus creating the typical honey- 
comb appearance, and contain globules of fat. The presence of the latter 
results chiefly from changes in the bone cells, which are enlarged and 
transparent, assume a round or oval shape, losing at the same time their 
prolongations, and gradually become transformed into fat globules. 
Section of a long bone reveals dilatation of the medullary cavity, and 
changes in the marrow, which is hyperemic and tinged with extravasated 
blood. 

In advanced cases the morbid alterations in the internal organs are 
those which are usually associated with diseases of a chronic and de- 
bilitating nature. We find signs of anemia, poverty of fat, muscular 
atrophy, and sometimes gastric catarrh, resulting from imperfect mastica- 
tion. | 

Symproms.—For convenience of description, it is permissible to speak 
of an acute and a chronic type of osteoporosis, and although a certain 
degree of chronicity is the rule in most cases, this classification is desir- 
able, because there is considerable variation in the development and 
succession of the symptoms in different animals. 

In acute osteoporosis the onset of the disease is sudden, and may be 
accompanied trom the beginning with marked constitutional disturb- 
ance. The pathological processes invade the tissues rapidly, bone 
enlargement and pronounced facial deformity are soon established, and 
in a comparatively short space of time the patient is reduced to a physical 
wreck, dragging itself stiffly and laboriously from one place to another, 
lying recumbent upon the ground for lengthy periods, and only rising 
to its feet with groaning effort and difficulty. Extension to the cranial 
cavity is very unusual, but exceptional cases have been seen where very 
curious and remarkable evidences of nervous derangement were present. 
Implication of the alveoli resulting in loosening and evulsion of the 
molar teeth is a common condition, and occasionally snuffling and im- 
peded respiration may be caused by spread to the turbinated bones. 
Fracture is a frequent complication in this type of the disease, and may 
be induced by the most trivial circumstances, such as a false step whilst . 
walking, or from the effort of rising in the stall; or, instead of fracture, 
detachment of ligaments or tendons from diseased surfaces may occur. 
In rare instances these accidents are the first intimation of the presence 
of the disease, the nature of which is only revealed by a post-mortem 
examination, and the extent to which single bones may be affected 
without noticeable external manifestation is sometimes astonishing. 

Chronic osteoporosis is preceded by an indeterminate stage, which 


DISEASES OF METABOLISM: OSTEOPOROSIS 1327 


may be very prolonged, in some cases for many months, and during this — 
period diagnosis is to some extent a matter of guesswork. The external 
aspect of the animal, its desire for food, and general behaviour in the 
stable, are unchanged, and it is only when called upon for unusual exer- 
tion that any impairment of the physical powers is noticed. Gradually 
this impairment becomes more evident in ordinary work, fatigue is 
easily induced, and a moderate drive may be followed by soreness, 
which is only relieved after several days of rest. The gait of the animal 
changes for the worse, it walks and trots stiffly, with shortening of the 
step, and sooner or later acquires the trick of stumbling without visible 
cause—a symptom which must always be viewed with suspicion in 
young and hitherto normal horses. As the disease progresses, the signs 
of ill-health become more pronounced, the animal is languid, masticates 
its food imperfectly, loses flesh, is decidedly lame in one or more legs, 
shows a tendency towards exostoses or bursal enlargements, lies for 
lengthened periods of time, rises with difficulty, and sooner or later the 
pathognomonic symptoms of bone swelling makes its appearance. Osteo- 
porotic lameness cannot be differentiated from that seen in the course 
of rheumatic affections. It may be intermittent or metastatic in nature, 
and although the superior jomts—the shoulder and hip—are supposed 
to be the most common seat, an exact location is rarely possible. The 
bone swelling may occur at any stage in the course of osteoporosis, may 
be detected in the long bones of the limbs, and is almost always found 
in those of the face and lower jaw. The characteristic changes in the 
aspect of the facial bones are bilateral and more or less symmetrical, and 
affect chiefly the superior maxillary and nasal bones, which present 
themselves as a bulging, rounded swelling between the zygomatic ridge 
and alveolar margin. A somewhat similar conformation is sometimes 
seen in colts and fillies, and care must be exercised in discriminating 
between this normal condition and osteoporosis, particularly if lameness 
is present, or if the animal is in poor flesh. The inferior maxille are fre- 
quently enlarged, and the swollen rami and diminishment of the inter- 
maxillary space are easily recognisable by the eye or sense of touch. 
When the vertebre participate in these alterations of structure, the 
patient grazes awkwardly, has difficulty in depressing or extending the 
neck, and may be unable to rise after prolonged recumbency without 
assistance. Towards the end this inability becomes permanent, and 
death from decubitus is a frequent termination.* 

* Gray points out that an osteoporotic condition of bones is frequently observed 
in aged horses, and such bones are very liable to spontaneous fracture, an example 
of which occurs in some cases of ‘split pastern.” 


1328 SYSTEM OF VETERINARY MEDICINE 


PRoGNosis.—The opinion given as to the probable termination of a 
case under treatment should be guarded, and the possibility of recovery, 
even in advanced cases with pronounced facial deformity and generalisa- 
tion of the disease throughout the system, must not be forgotten. We 
have very little knowledge of the conditions that govern these recoveries, 
and whilst they are rare, they are certainly less exceptional than is 
usually supposed. Change of location is an important factor in obtain- 
ing this result, but statements attributing recoveries to medicinal treat- 
ments or dietetic changes should not receive ready acceptance. Recovery 
is liable to occur at two stages of the disease: in the earlier stages, when 
the symptoms have not progressed so far as actual bone enlargement; 
and at a later date, when all attempts at treatment have been abandoned. 
On a Hawaiian sugar-plantation which had suffered severely from this 
disease, Norgaard saw a number of horses recover completely after 
medicinal measures had been discontinued in view of the apparent hope- 
lessness of the cases. The writer has a large work-mare under daily 
observation, which developed the disease with all the classical symptoms 
at four years of age, and which now, after the lapse of three years, is 
perfectly sound, and shows no perceptible trace of the former facial 
enlargement. This, again, is exceptional, and the alteration of shape 
is usually permanent, and persists after all other symptoms have dis- 
appeared. 

Partial recovery is frequently met with in practice. The initial 
violence of the symptoms subsides, the general health of the animal 
improves, and capability for light work may be restored. This condi- 
tion may exist for several months, ending gradually in complete recovery, 
or there may be recrudescence of the more acute phase, and death. 

Law finds a reasonable basis for prognosis in repeated examinations 
of the urine, and says that excess of phosphates indicates an active 
pathological process with uncertain outcome, whilst their decrease or 
absence reveals arrest of rarefaction, and holds out good hope for 
recovery. 

In conclusion, we may say that, in spite of the instances cited, the 
prognosis of osteoporosis is distinctly unfavourable, and that, where 
change of location is not obtainable, or the animal is of small value, the 
practitioner is justified in advising slaughter on humane and economical 
grounds. 

DIFFERENTIAL D1acNnosts.—The cardinal indication of osteoporosis is 
bone swelling, and after this is once established in the region of the face, 
there should be no possibility of mistake in recognising the identity of 
the disease. The changes in facial conformation produced by bilateral 


DISEASES OF METABOLISM: OSTEOPOROSIS 1329 


alveolar periostitis resemble those seen in osteoporosis, and if not attended | 
with suppuration or evident disease of the molar teeth, might cause con- 
fusion; but although this has been noted by Paine in South Africa, it 
is a sufficiently rare pathological condition to be safely disregarded. 

Correct diagnosis in the earlier stages depends largely upon the 
practitioner’s previous experience of the disease and knowledge of the 
history of his district. When loss of flesh is the predominant symptom, 
the suggestion of parasitic anemia may compel recourse to microscopical 
examination of the feces. The intermittent and shifting lameness of 
osteoporosis simulates that seen in rheumatism so very closely that a 
distinction cannot always be made, and in this event it 1s wise to adopt 
the routine treatment for the latter disease, at the same time keeping 
a careful watch for possible development of osteoporotic symptoms at 
a later date. The latent period may be complicated by attacks of 
laminitis—in fact, Moussu claims to have discovered some relationship 
between the two diseases. As a rule, however, the acute stifiness which 
sometimes occurs in the course of work at this time is not accompanied 
with fever, and is of a transient nature, passing off after a few days’ 
rest. : 

PROPHYLAXIS AND TREATMENT.—In stables where many horses are 
congregated together certain general precautions should be adopted, 
although it should be premised that in the majority of instances all 
efforts fail to check the disease. Buildings should be thoroughly dis- 
infected, and the floors saturated with a liquid antiseptic. It is desirable 
to rectify bad or deficient sanitary conditions in the housing and arrange- 
ment of the animals, and especial attention should be paid to the flooring 
and drainage. The system of feeding the animals must be changed, 
either in part by the discontinuance of foodstuffs that are presumably 
provocative, or completely by the substitution of a new ration. We 
advise a liberal addition of crude molasses, or molasses mixture, to each 
meal; and Mohler recommends the use of foods containing a high per- 
centage of mineral salts, such as oats, cowpeas, beans, and cotton-seed 
meal. Where the animals are pastured, it is good policy to remove them 
to other fields at some distance from their original location. In serious 
outbreaks it must be remembered that the drain upon the system before 
and after parturition is a heavy handicap to brood-mares, and it may 
be found necessary to suspend breeding operations for a time. Isolation 
of diseased animals, if convenient and inexpensive, may be advised, and 
is certainly preferable in outbreaks which assume large proportions. 
Those which evidently will not repay prolonged treatment should be 
destroyed, and the carcasses rendered innocuous by cremation. 

VOL. II. 84 


1330 SYSTEM OF VETERINARY MEDICINE 

Good surroundings, abundant and properly selected food, rest from 
work, and, above all, change of location, are the only curative measures 
which have stood the test of time. The standard remedies of the older 
pharmacopeceia have been tried for years, with little success, and it seems 
probable that if a specific is eventually discovered it will be found among 
the newer combination of more modern therapy. The drugs most com- 
monly used have been sodium salicylate, potassium iodide, calcium 
phosphate, pure phosphorus, bone meal, and lime slaked in water. 
Theoretically, the use of molasses and bone meal in the food, and free 
access to a cask of lime-water, has much to commend them, and we 
suggest, In addition to these measures, free experimentation with those 
more recent remedies which the chemist is placing at the disposal of the 
practitioner. 


NOTE BY EDITOR. 


Osteomalacia.—According to some authors, general osteoporosis 
should not be classified as an independent affection apart from osteoma- 
lacia. H. B. Elhot, the author of the article on Osteoporosis, holds a 
different view, and in this he is supported by Mina and Stoltzner, Theiler 
and others. 

In cattle, the following symptoms are prominent, according to Hutyra 
and Marek: Digestive disturbances frequently precede the character- 
istic phenomena of the disease, and also occur later after changes in the 
bones are manifested. The animals persistently lick the manger and 
the walls, and later on gnaw at surrounding objects, and tend to swallow 
foreign bodies within reach. As the disease progresses, they develop a 
perverted appetite, refuse ordinary food, and eat all kinds of dirt, and 
have been known to drink urine. Emaciation is manifested, and the 
skin is harsh and dry. Nervous phenomena are also recorded, such as 
staggering, a sleepy appearance, a tendency to fall down, and occasionally 
convulsions develop. 

Owing to the pain caused by the disease of the bones, the animal 
assumes the recumbent position for long periods. When standing, the 
back is arched, the feet are spread apart, and progression is difficult. 
The pains may be intermittent and metastatic, resembling those of 
rheumatism. On walking and also on rising a peculiar cracking sound 
is heard, and probably originates from loosening of the articular capsules. 
Changes in the pelvic bones are common, such as a bent condition of the 
pubis and ischium, distortion of the obturator foramen, and lowering of 
the internal angle of the ilium. Bulging of the cranial bones is only 
observed exceptionally in cattle, frequently in goats and pigs, and occa- 


DISEASES OF METABOLISM: OSTEOPOROSIS 1331 


sionally in dogs. In goats, the skull bones may become so pliable that 
the anterior portion of the inferior maxilla may be bent or turned in an 
angle of 90 degrees (Richter). 

Osteomalacia, according to the above authors, is most frequently 
found in cattle, especially milch-cows, less often in goats and swine, and 
still more infrequently in horses, mules, sheep, and buffaloes. It is 
exceptional in dogs and birds. 

In the Dog.—H. Gray informs us that in his experience osteomalacia 
is not rare in the dog. The nasal, maxillary, and mandibular bones are 
chiefly affected, and the bony tissue is altered to a rubber-like condition. 
The etiology is unknown. The above writer has observed the develop- 
ment of the disease after the extraction of teeth, but he points out that 
it may also occur when the teeth are in a normal condition. Age has no 
influence, as the disease is observed in young as well as in old animals. 
The following symptoms may occur: A snuffling sound during respiration, 
inability to eat large lumps of food owing to a difficulty in moving the 
jaws. Sometimes the animal may keep the mouth open. The limbs in 
some instances may be curved, as in rickets. 

The treatment advised, in addition to good feeding, is the addition 
of lime salts to the food. If there is coexisting phosphoric acid defici- 
ency, bone meal should be given, alternated with chalk. When persis- 
tent licking is present, Lemke advises apomorphine hydrochlorate (0-10 
to 0:20 gramme subcutaneously), and claims that after three doses the 
licking disease will be arrested for three to four months. Roloff recom- 
mends not to milk affected cows dry, and also to exclude them from 
breeding during the duration of the disease. Klimmer and Schmidt 
advise a diminution in the supply of nitrogenous food in order to reduce 
the secretion of milk. They also recommend to cease milking pregnant 
cows about six to eight weeks prior to parturition. 


1332 SYSTEM OF VETERINARY MEDICINE 


IV. RICKETS. 
By Henry Gray, M.R.C.V.S., Kenstneton, W. 


Synonyms.—Rachitis; Rhachitis; Leg weakness; Deformity of the 
sternum. 3 

Derinition.—Rickets is a disease of young animals and also of young 
children, characterised by arrest of natural growth and development, 
delay in calcification of the osseous framework, softening and bending 
of the bones, enlargement of the joints, wasting of the muscles and liga- 
ments, and, in fact, a disturbance of general nutrition. Not infrequently 
there are histological and anatomical changes in the brain, liver, spleen, 
and lymphatic glands. 

GENERAL RemarkKs.—Rickets (a term derived from the Old English 
word wrikken, signifying to twist) is a disease that has long occupied the 
attention of physicians. The first systematic account of it was given in 
a work published in Latin by Francis Glissin, George Bate, and Aha- 
seurus Regmorter, and since then, up to modern times, almost every 
author seems to have considered it as an affection of young children and 
young animals. During the latter half of the last century certain authori- 
ties have, however, included other bone diseases of adult animals re- 
sembling rickets to a certain extent by their pathological anatomy. 
Included in this category have been osteoporosis, osteomalacia, foetal 
cretinism, and imperfect osteogenesis. A strong supporter of this view 
has been J. Bland-Sutton, who has divided the diseases into three sections 
—viz.: (1) The rickets of infancy; (2) the rickets of puberty; and (8) the 
rickets of adult life. 

Other authorities have also included “ snuffles in pigs” under this 
denomination. 

But this view of including all these affections under the term “ rickets ” 
is not supported by clinical experience. Whereas rickets occurs in the 
earlier months of life, osteomalacia and osteoporosis are essentially 
diseases of adults; we shall, therefore, confine our attention to the gener- 
ally accepted meaning of rickets. 

GrocRAPHIcAL Distripution.—Although rickets is generally ob- 
served in temperate climates, and in Great Britain in particular, it has 
occasionally been witnessed in tropical and subtropical countries. There 
is no evidence of its occurrence in Arctic and Subarctic regions, where 
young children and possibly certain young domesticated animals, such 


DISEASES OF METABOLISM: RICKETS 1333 


as puppies and probably reindeer calves, must necessarily be confined 
indoors for the greater portion of the year. In children it is met with 
chiefly in towns, especially in Great Britain; hence it has received on the 
Continent the term “ English disease.” 

EtroLocy.—Various theories have been enunciated as to the causa- 
tion of this infantile malady, but on close examination of the evidence 
in their favour, most of them fail to solve the problem in a logical manner. 

It is beyond question that infancy plays the preponderating réle in 
the production of the malady, but there is not yet any satisfactory chain 
of facts set forth to establish the real nature of the exciting cause. 

Many authorities have endeavoured to show that the disease was set 
up by an insufficiency of lime salts in the food, but this theory is at the 
best merely supposition, based on the fact that there is a lack of earthy 
salts in the osseous framework, and an imaginary absence of calcium salts 
in the diet. This view is overbalanced by the fact that in this disease a 
quantity of lime salts passes out of the system, notably with the urine, 
and that the food may contain all those elements necessary to build up 
the bony framework. 

Others have brought forward the absence of fat in the food, as the 
disease has been observed in children and young animals fed on skim 
milk and other foods lacking a sensible proportion of fat, and that, by 
administering cream, bone-marrow, or cod-liver oil, the malady has dis- 
appeared, or, at least, the patient has improved. 

A few observers have invoked the aid of infectious and parasitical 
diseases as an existing cause, because they have seen this condition arise 
during the course of an attack of strangles, distemper, or strongylosis, 
indeed, Moussu and others consider it to be an infectious disease per se. 
Moussu has certainly brought forward some very strong evidence in favour 
of this theory. He has shown that young animals kept in sheds or pens 
with affected cases, or even placed in surroundings which diseased animals 
have occupied, contracted the malady. Again, by taking the marrow 
from the bones in the early or acute stage of the affection he has been 
able, by inoculation, to produce it in sound animals. Furthermore, 
that by sprinkling the same material on the ground of the shed or pen 
the disease has been reproduced. 

Want of sunlight, lack of fresh air, too early weaning, and rearing 
animals on boarded floors, have also been invoked as causes of the 
malady; but such conditions only play a secondary part, because they are 
generally accompanied by other influences—viz., confinement with lack 
of free movement—which seems to have a larger share in the etiogenesis 
than has been universally admitted. 


1334 SYSTEM OF VETERINARY MEDICINE 


Rickets is generally seen in those animals kept in confinement, and 
has therefore been considered by many practical observers to be a disease 
due to lack of free exercise in the open during the early period of life, 
when the osseous framework and the system generally is developing 
rapidly. Stock-breeders of every description, especially those who have 
gone in for the heavier types of animals, have for a very long period 
recognised that unless young animals were allowed their liberty as soon 
after birth as conditions permitted, there was a great liability to the 
young stock “ going wrong in the limbs.”’ This was noticed, in spite of 
other good hygienic conditions, such as daylight, fresh air, dry sur- 
roundings, cleanliness, and good food. 

Everybody has observed that the young of all species, when well fed 
and allowed their liberty, jump, skip, and frolic, play and gallop, and get 
into all kinds of mischief; this is not a purposeless action, but a beneficent 
and instinctive function necessary for the general nutrition and develop- 
ment of the system. Prevent this full scope of activity, especially in the 
heavier breeds of all species, limit their movements by slippery floors, 
low buildings, or low cages or kennels, keep them on the chain, etc., 
and rickets (especially in the dog) will almost certainly set in. 

In days gone by, when there'was a craze for bulldogs with low, out- 
curved or bowed limbs, breeders well knew how to induce this condition 
by keeping the young animal continuously on the chain, and in a box or 
kennel too low in the roof for him to stand up to his full height. These 
dog-breeders also knew that if their animals were allowed too much exer- 
cise the limbs would grow straight and the object in view would be de- 
feated. ‘ 

For many years the writer has bred budgerigars (the Australian grass 
parrakeet). These birds frequently breed during winter, when the days 
are short and the nights long; in consequence, the young birds, not being 
fed so often by their parents as is necessary, do not develop so rapidly 
as they should, and in consequence of remaining in the nest for a longer 
period than is natural for their well-bemg, they become rickety and 
helpless cripples. It is often the same when they have one of their wings 
clipped as soon as they leave the nest; the lack of free movement prevents 
proper development of the bony framework. Young canaries and 

pigeons suffering from diarrhoea do not in the nest develop in the normal 
period, and therefore are confined to this location longer than usual, 
and in consequence become rickety. | 

The lack of exercise is often associated with damp, musty, dark build- 
ings, which are not rarely filthy and ill-ventilated, the giving of food, 
innutritious in quality or deficient in quantity, and the occurrence of 


DISEASES OF METABOLISM: RICKETS 1335 


infectious diseases; hence these accompanying conditions are often put 
down as prime causal factors. However, any condition that is likely 
to depress the system so that the young, rapidly-growing animal has not 
the spirit to take that exercise which is necessary for its well-being, are 
not in reality negligible factors in the etiogenesis of this malady. 

Against the confinement theory there is the important fact that 
thousands of calves reared for veal, which are confined in small pens and 
do not get any exercise beyond going twice a day a few yards to and 
fro to suck the cow, do not become rickety. 

Lambs often suffer from rickets, or from a disease closely resembling 
it. Itis said that they are most subject to the affection when maintained 
on soils lacking a sufficiency of lime; but this theory seems to be built 
up on assumption, and it would be well if further inquiry were made into 
the question, so as to ascertain whether lack of exercise, or conditions 
influencing the spirit of the young so as to prevent them taking exercise, 
exert any influence in the etiology of the disease. 

Heredity has been invoked as an etiological factor, and cases of stal- 
lions begetting rickety foals are on record; but when the mares were put 
to other stallions the offspring no longer became affected. The disease 
is not rarely encountered in offspring whose parents were rickety in early 
life. This may, however, be explained by the fact that the breed was of 
the heavy type, and that the conditions of rearing were the same in the 
parent as in the offspring; this is well exemplified in the case of Great 
Danes and collies bred in town, and in highly-bred heavy fowls for show- 
ing purposes bred and maintained in pens. The English breed of pigs 
on the Continent, in consequence of being of great value as stock animals, 
are maintained in styes, whereas the native breeds are allowed more 
liberty, explains this so-called “ hereditary predisposition.” 

Species AFFECTED.—Rickets proper occurs in every species of the 
domestic animals, the frequency of its occurrence being in the order 
given as follows: Dog, pig, fowl, turkey, goose, pigeon, goat, calf, camel- 
calf, lamb, foal, and cat. It also occurs in those wild animals usually 
bred and kept in confinement in zoological gardens or in cages, and is 
frequently observed in carnivorous animals, such as lions, tigers, bears, 
wolves, etc. It has also been witnessed in stags, the porcupine, hyena, 
rat, budgerigar and other parrakeets, parrots, canaries, etc. 

Young monkeys are as readily affected as children. 

BreEeps.—Although the disease may be seen in any breed, it more 
generally attacks the heavier or lymphatic types, especially in such 
breeds of dogs as the Great Dane, St. Bernard, wolfhound, bull-dog, 
bloodhound, and foxhound; it is, however, not rare in the borzoi, grey- 


1336 SYSTEM OF VETERINARY MEDICINE 


hound, collie, bull-terrier, and pug. In the pig it is more frequently seen 
in English than in Continental breeds, and in the large white Yorkshire 
more than in any other. In poultry the heavier types are also affected. 

Morsrp ANatomy.—The long bones, such as the humerus, radius, 
femur, and tibia, are usually swollen two or three times their normal size, 
softened, very vascular, and generally curved in their shaft. The epiphyses 
are enlarged, nodulated, or tuberose. The periosteum is thick, succulent, - 
and generally easily separated from the bony tissue. 

The bony tissue is soft, in many cases to such an extent that it can 
easily be cut with a knife or bent or broken under the finger. The 
cancellated tissue is In many instances so attenuated that it is hardly 
thicker than a sheet of notepaper. The medullary cavity is filled with 
intensely red and very vascular medulla. At the epiphyseal junctions, 
instead of a narrow strip of hyaline cartilage, as is found in health, a 
spongy, soft, red band of tissue of a few millimetres in breadth, and 
named by Guérin the “ spongoid tissue,” takes the place of it in rickets. 
This spongoid tissue may be found most abundant at the lower ends of 
the femur, tibia, fibula, radius, and ulna. 

Between the periosteum and bone a succulent vascular layer (osteoid 
layer) is in part found to be attached to the bone tissue when the perios- 
teum is stripped; this layer is much thicker at the tendinous and mus- 
cular insertions, where exostosic enlargements may sometimes be found. 
The adhesion between the epiphysis and diaphysis seems to be loosened, 
so that they can, not infrequently, be torn apart on the least exertion. 
The joints in advanced cases may show some traces of inflammatory 
changes in the cartilages, even to destruction of this tissue. 

The small round bones may show similar changes. The flat bones, 
such as the scapula, skull, and pelvic bones, are thickened, occasionally 
bulging, and composed of a greyish to a dark red tissue, which can some- 
times be cut like india-rubber. 

Histological examination of the diseased bone shows three zones: 
(1) There is normal hyaline cartilage, which exceeds many times its 
healthy thickness; (2) the layer of cells in vertical columns, which in 
rickets may reach as many as fifty to sixty in each single column against 
the ten or twelve superimposed cells found in the normal bone; (3) a 
layer of irregular calcareous trabecule enclosing isolated foci of spongoid 
tissue and tracts of hyaline cartilage. 

The proliferation of the second layer gives rise to spongoid tissue. 
The earthy matter is sprinkled irregularly throughout the terminal 
cartilage, so that thirty or forty separate nuclei are found for each of the 
condyles of the femur, 


DISEASES OF METABOLISM: RICKETS 1337 


Sir William Jenner asserted that in “ rickets there is increased prepa- 
ration for ossification, with an imperfect performance of that process.”’ 

Symproms.—Although the disease may appear before the weaning 
period, its symptoms are not generally noticed until the young animal 
has been separated from its dam for some time, when it may be observed 
not to be thriving, is less lively than usual, disinclined to move, and 
progresses with some difficulty. As the disease advances there seems 
in a great number of instances to be a distended tympanitic appearance 
of the abdomen, often accompanied by a persistent foul-smelling diar- 
rhoea; there may be a dull, staring, open coat, the skin loses its lustre, 
and is dry, and not rarely is covered with scales of epithelium or even an 
eruption. In the herbivora there may be a licking or nibbling of the 
walls, or a desire for filth or foul water. The second dentition usually 
becomes delayed, and the newly erupted teeth in the carnivora may show 
a vertically notched or grooved appearance of the enamel of the apices, 
especially of the incisors. 

The general condition of the animal, its tired but restless movements, 
which are often stiff, and the persistent recumbent position from which 
it does not seem inclined to be disturbed, seem to indicate that the limbs 
ache or are painful. Some animals utter a cry when made to change 
their position, or if their limbs are manipulated. Not rarely they seem 
disinclined to use their hind-limbs or any of their limbs; they often 
kneel or have a stooping attitude during feeding, or in attempting to get 
about. In many instances the hind-limbs are paraplegic, or the back is 
arched, showing a well-marked kyphotic curve. 

Some animals, especially heavy-bodied dogs, confined in a small space, 
or in a kennel too low, so that they have to assume a crouching attitude 
when standing, soon begin to show curvature in the limbs. The ex- 
tremities of the long bones, especially the humeri, radii, femora, and 
tibia, become enlarged, tuberose, or knotty, giving the joints an en- 
larged or swollen appearance. The shafts of these bones become curved, 
sometimes in a lateral direction, and other times bent backwards. In 
the first case the bones may be bent outwards or inwards. In dogs this 
bending gives the limbs either a bandy or bow-legged appearance, and in 
the case of the bones being bent backwards, as is frequently the case in 
collie pups, the posterior surface of the metacarpal or metatarsal region 
rests on the ground, so that the patient assumes the attitude of a planti- 
grade animal, such as the bear. In some of the larger breeds, such as 
the Great Dane, whose body is very heavy, the humeri and femora become 
so bent that they fracture under the weight of the animal, whilst in the 
greyhound class of dog the radii and ulne and tibie are liable to become 


1338 SYSTEM OF VETERINARY MEDICINE 


fractured. This fracturing of bones may be seen in several dogs at the 
same time in the same kennel. In the calf, young camel, goat, and foal, 
the radii become bent, giving the animal a bandy-legged or knock-kneed 
appearance. 

The ribs at the sterno-costal region are frequently beaded or knotted. 
The middle portions of the ribs are turned inwards, and then give rise to 
a longitudinal shallow furrow on either side and a transverse constriction 
of the chest, the walls of which approach ‘one another and form a promi- 
nent and sharp sternum, commonly known as “ pigeon-breasted.”’ In 
fowls the sternum often forms one or more curves. 

The pelvis becomes narrowed and depressed, so that the pelvic outlet 
remains constricted. The vertebral column often becomes curved later- 
ally (scoliosis) to the right or left or in an S-shaped curve, especially in 
foals purchased by small farmers, and then too long confined to the stable, 
and fed improperly; or the curve may be in the downward direction 
(lordosis, or hollow back), or it may be arched (kyphosis, or roach-back), 
as is often the case in affected pigs. Not infrequently, as in the case of 
lambs, the vertebral canal, especially in the lumbar region, becomes 
constricted by muscular pressure on the softened vertebre and sets up 
spinal pressure and consequent paraplegia. A similar condition is found 
in the monkey and in the fowl. 

In the dog and pig the skull, especially in the zygomatic, nasal, and 
upper maxillary regions, becomes swollen, giving rise to a snuffling sound 
during inspiration and expiration. The lower jaw as well as the upper 
jaw, in consequence of pressure of one against the other during feeding, 
may be spread outwards, as may the teeth. The bones on pressure are 
soft and yield like india-rubber. The fontanelles may remain open. 

The stature of the body is low, often giving the animal a dull and 
clumsy appearance, resembling that of the dachshund or basset hound. 
The movements are not sprightly. In the colt the musculature of the 
neck, loin, and other parts is thin and soft. 

In the fowl the epiphyses of the long bones of the legs and wings 
become thickened, and often the tarso-metatarsal region rests on the 
ground, the bird being unable to stand erect. 

DIFFERENTIAL DiaGnosis.—The early age of the animal and _ its 
general appearance, coupled with enlargement of epiphyses of the long 
bones, which generally become curved, should offer no difficulty in dis- 
tinguishing rickets from osteomalacia and osteoporosis. 

These latter complaints, however, according to the observations of 
the writer, have all the same clinical and pathological characters, but they 
attack adult or mature animals. 


DISEASES OF METABOLISM: RICKETS 1339 


From septic arthritis (omphalophlebitis) it is distinguished by the 
fact that the disease named attacks the joints in very early life, follows 
navel infection, and does not give rise to curvature of the bones. It is, 
in fact, a septic articular disease, appearing soon after birth, whereas 
rickets is not a joint disease, and rarely appears before weaning. 

From rheumatism it is distinguished by the history of the case and 
the absence of curvature and softening of the bones in the affection 
named. 

TREATMENT—Prophylaxis.—As this disease appears from the evidence 
observed by veterinary surgeons, farmers, dog and other stock-breeders, 
to be chiefly due to lack of exercise and other good hygienic conditions, 
prophylaxis should be aimed at, and with this object in view young 
animals should be allowed free exercise as soon after birth as possible. 
Again, every care should be taken that the dietary is suitable for the 
demands of the system in building up the osseous framework, and thus 
enabling the young animal to become vigorous, and instinctively to frolic, 
skip, and jump about, which play such an important part in its develop- 
ment. Furthermore, dark, musty, and badly ventilated buildings should 
be avoided. During pregnancy the dam should have a mixed diet of 
highly nutritious food necessary to build up the constitution of the footus 
wm utero. Chickens, especially those of the heavier breeds, should be given 
ample opportunities for scratching. Young canaries should be put in 
large flight-cages, so that they can get as much exercise as possible. 

In the case of young lambs, too close penning on innutritious herbage 
grown on poor soils should be avoided. Again, the breeding of animals 
should be arranged with the view of affording the most suitable food and 
conditions of exercise to both the mother and her offspring. In a tem- 
perate climate, such as that of the British Isles, experience has proved 
that this period should correspond to the earlier months of the year, 
when the warm weather is approaching, the young herbage and longer 
days are coming on, and when young animals can be allowed their free- 
dom in the open. Animals bred in autumn and winter require greater 
attention, cost more to maintain, and, in spite of this, often fail to develop 
as satisfactorily as a spring-bred animal. 

In some cases, such as dairy cattle and poultry, this is, however, com- 
pensated by the increased value of their products, such as milk, butter, 
eggs, and early spring chickens. 

Curative Treatment.—Before undertaking treatment of the disease 
the veterinary surgeon should take into consideration three conditions: 
(1) Will the necessary expense of keep and treatment of the animal be 
justified ? (2) Is there a sentimental value placed upon the animal ? 


1340 SYSTEM OF VETERINARY MEDICINE 


(3) What are the prospects of recovery, and the time it will take to 
effect the same ? 

1. In the case of pedigree stock, provided the disease is not too far 
advanced, recovery, under appropriate treatment, is relatively certain, 
and therefore there should be no hesitation in adopting such treatment. 
On the contrary, in the case of animals of prospectively low commercial 
value, it would be more economical to destroy them than to undertake 
a prolonged treatment. 

2. In the case of dogs, foals, and sometimes of poultry, where a senti- 
mental value is placed on the animal’s life, treatment should be adopted 
and rigidly carried out, irrespective of the commercial value of the 
animal. 

3. Where the animal is seen in the early stage and is still growing, 
complete recovery under treatment may be anticipated in a few weeks; 
but when the disease is far advanced and extends until the -osseous 
framework has become unyielding, no prospects of improving the dis- 
torted limbs or low stature can reasonably be entertained; and unless 
the animal is valuable from a stock-selling point of view, it would be more 
economical to destroy its life than to expend much on its keep and treat- 
ment. 

The animal to be submitted to treatment should be allowed free 
exercise in the open air, and its limbs massaged in a well-regulated 
manner. The individual limb should not only be well hand-rubbed, but 
also extended and flexed, adducted, and abducted rhythmically, and an 
attempt made to straighten the curved bone by manipulation; this should. 
be daily repeated until the limbs have regained their normal shape. 
While this treatment is being continued good nutritious food should be 
given. In the case of dogs, meat with fat, raw in preference to cooked, 
milk with cream, boiled tripe and wheaten bread, are indicated. In 
colts, calves, and young pigs, boiled grain, such as peas, beans, oats, 
barley, and linseed, new milk, succulent green food, should be allowed. 
In poultry, wheat, barley, meat with fat, wheaten meal, etc., should be 
supplied. . 

Cod-liver oil, mixed with milk or with the food, should also be given. 
Bone-meal, the hypophosphites of lime, compound syrup of iron phos- 
phate, Haston’s syrup, or other mild hematinic compounds, should. be 
tried. 

Lambs should have their pasture changed, and have an allowance 
of linseed cake, oats, etc. 

It should be pointed out that unless phosphates, lime, and iron are 
given in a complex organic form, such as occurs in flesh, grain, and food- 


DISEASES OF METABOLISM: RICKETS 1341 


stuffs, they do not assist in the building up of the system, but are, if of 
synthetic chemical composition, merely decomposed, or even not split 
up at all, and passed out of the system with the faces or urine. 


Osteogenesis Imperfecta. 


This is characterised by an imperfect development of osseous material, 
whereby in the adult animal the cranium is not properly protected with 
bone, and so-called fontanelles remain open all through life. 

It is a very common condition in the dog, and is hereditary. Its 
frequency isincreased by inbreeding. Itis very common in the Pekingese, 
Japanese, and British toy spaniels; it is occasionally seen in inbred 
miniature Pomeranians. 

Symptoms.—The bony skull is found to have one or more soft spots, 
where there is an absence of bone. Not rarely the top of the cranium 
is entirely deficient in bony protection. The bones of the cranium are 
often very thin—in fact, not thicker than a thin sheet of notepaper, and 
yield to digital pressure. The sagittal crest is not developed; the teeth 
are fewer in number than the normal, rarely exceeding thirty-five. The 
incisors are generally only inserted in cartilage, and are therefore 
movable, and have no bony alveolus for their lodgment. 

It may be of interest to note here that there is a relationship between 
the number of the teeth and development of the sagittal crest; the 
number increases with its development. 

Occasionally hydrocephalus, epilepsy, nervous disorders, and other 
congenital imperfections, may be associated with this anomaly. 


Achondroplasia. 


SynonymMs.—Bulldogism; Bassetism; Foetal rickets; Chondrodys- 
trophia foetalis; Gnathism. 

This is a disease of foetal life, whereby a dwarfish condition remains 
during adult life. 

It is seen in the dog, notably the bulldog, dachshund, bassethound, 
and in cattle, especially the Kerry-Dexter breed. Inthe Aberdeen terrier, 
basset, and dachshund, it is hereditary. 

The limbs are very short, but the body is of the normal length. The 
long bones are curved; the gait is waddling; abortions are frequent. 


1342 SYSTEM OF VETERINARY MEDICINE 


V. OTHER DISEASES OF METABOLISM. 
By E. Watxis Hoare, F.R.C.V.S. 


OBESITY. 


This term signifies an excessive deposit of fat in the body. In some 
instances it is difficult to draw the border-line between obesity and a 
normal fat condition, such as occurs in stall-fed cattle, or in pigs which 
are specially fattened for market. The commonest examples of obesity 
in animals are aged, overfed dogs, which get no exercise. The condition 
is also observed in ponies which are highly fed and do little work. Horses 
or ponies suffering from pulmonary emphysema often suffer from obesity, 
the explanation being, according to some authors, that the respiratory 
capacity of the lung is diminished. To this we would add that such 
cases possess an inordinate appetite are unfit for active exertion. 

Morzgip Anatomy.—The fat is deposited chiefly in the subcutaneous 
connective tissue. It may be found between the muscles and between 
the muscle fibres. Other locations are the mediastinal folds, under the 
visceral layer of the pericardium, the omentum, and the region of the 
kidneys. In well-marked cases fatty degeneration of the heart and 
fatty liver may be present. : 

Symproms.—The shape of the body is altered, the outlines are rounded, 
and the skin forms thick, soft, elastic folds. The condition is seen most 
typically in the dog, and the regions chiefly affected are the trunk, 
abdomen, shoulders, and throat. The enlarged abdomen simulates 
ascites, and the diagnosis must be based on the evidences obtained from 
palpation and percussion. The animal is disinclined for exertion, easily 
fatigued, the cardiac action may be weak, and the respirations acceler- 
ated. Digestive disturbances are common, and constipation is often 
observed. 

The course varies. In some cases the animal lives an indolent life 
for a number of years; in others, complications occur, such as bronchial 
catarrh, bronchial asthma, cardiac weakness, anemia, etc. Sudden 
paraplegia 1s not an uncommon occurrence in cases of obesity in 
the dog. 

In the horse pulmonary emphysema is frequently associated with 
obesity, and the “ pot-bellied ’’ condition of such cases is very charac- 
teristic. Obesity tends to bring about pulmonary emphysema, and the 
latter, as already remarked, favours obesity. 


DISEASES OF METABOLISM: SCURVY 1343 


TREATMENT.—Attention to diet and to exercise is essential. In the 
dog the carbohydrates and fats should be limited as much as possible. 
When the obesity is extreme, these measures fail, as proper exercise 
cannot be carried out, owing to the animal being unfit for such. Prepara- 
tions of the thyroid gland are indicated for these cases. These stimulate 
the oxidation of fat, but as they also bring about increased disintegration 
of proteids, plenty of flesh food should be allowed. 


SCURVY. 
SyNoNyM.—Scorbutus. 


This is a disorder of metabolism characterised by debility, anzemia, 
a spongy condition of the gums which may lead to ulceration, and a 
tendency to hemorrhages in various organs. Nothing is definitely 
known with reference to the etiology of the disease, although various 
theories have been advanced in this direction. Up to the present time 
the affection has only been recognised in pigs and dogs. Friedberger and 
Frohner point out that the disease is rare in dogs, and that the majority 
of the cases recorded in this species were in reality due to ulcerative 
stomatitis. The same authors state that the instances of scurvy reported 
in horses were cases of purpura hemorrhagica, and those in sheep and 
goats depended on anemia or rhachitis. Scurvy of sheep and lambs 
was described by Lowak, but other observers considered that the affec- 
tion was in reality an ulcerative stomatitis associated with anemia. A 
case resembling infantile scurvy (Barlow’s disease) in the human subject 
was observed in a young dog by Stoltzner, but he did not feel justified in 
identifying the affection with Barlow’s disease. Some authorities con- 
sider that the scurvy of pigs does not correspond with the disease in 
man, but should be regarded as a form of purpura hemorrhagica. 
Schneidemiikl observed scurvy in the monkeys of a menagerie which 
had been recently landed from a sea voyage. 

Er1oLoGy.—The causes of scurvy in pigs are not definitely known. 
Weber, Cornevin, Hess, and others, consider that the affection may have 
some connection with swine erysipelas. The cases observed by Weber 
occurred in pigs, three to six months old, that had previously passed 
through a mild attack (urticarial form) of swine erysipelas. The follow- 
ing are recognised as predisposing causes: Damp, unhygienic surround- | 
ings, mouldy, decomposing food, and insufficient exercise. 

According to Hutyra and Marek, scurvy in the dog may occasionally 
develop as the result of ingesting tainted meat. These authors are of 
opinion that the disease described as scurvy in animals may probably 
have a toxi-infectious origin. 


1344 SYSTEM OF VETERINARY MEDICINE 


Morsip ANAatomy.—Hemorrhages of various extent are observed in 
the skin, subcutaneous and intramuscular connective tissue, mucous and 
serous membranes, and joints. Deep-seated ulceration of the gums is 
present. Fatty degeneration of parenchymatous organs, and enlargement 
and softening of the spleen may be observed, also swelling and hyper- 
emia of the mesenteric lymph glands. The blood is often pale red in 
colour, thin, and deficient in the fibrin-forming elements. 

Symproms.—The early symptoms in the pig in some cases are debility, 
a capricious appetite, thirst, and gradual emaciation. In other instances, 
according to Weber, hemorrhages occur in the absence of preliminary 
symptoms. Hemorrhagic spots of a bluish-red colour, and of various 
sizes, occur in the skin, and gradually increase in number. Ifthe animal 
be caught by the ears, extensive hemorrhages are observed in the skin 
and subcutis of these organs. The bristles in coarse-haired pigs become 
loose, are easily removed, and at the root-ends dark-coloured drops of 
blood are observed. The skin has a bloated appearance, and it pits on 
pressure. The hemorrhagic spots may be altered to vesicles or ulcers. 
Morbid alterations in the mucose are associated with the lesions in the 
skin. The gums are swollen, of a bluish-red colour, and bleed easily on 
the slightest pressure. Later on ulcers form, the teeth become loose, 
and finally fall out. Salivation is present, and the mouth exhales a verv 
foetid odour. Heemorrhages have been observed in the orbital cavity, 
causing protrusion of the eye. Hpistaxis, pulmonary and intestinal 
hemorrhage, and hematuria, also occur. Occasionally, in severe cases, 
swelling of the joints is observed. Increased emaciation and debility are 
followed by death. Severe pulmonary or intestinal hemorrhage may 
occur earlier in the disease, and cause a fatal termination. 

In the dog, anemia, debility, and similar alterations in the gums to 
those already mentioned, are observed, and evidences of ulcerative 
stomatitis occur. Heemorrhages in the conjunctive and anterior chamber 
of the eye, and skin, and sometimes epistaxis, intestinal hemorrhage, 
hematemesis, and hematuria, may be observed. In rare instances 
retinal hemorrhages may be detected by ophthalmoscopic examination. 
Death occurs from exhaustion, internal hemorrhage, or from various 
complications (pneumonia, general septic infection, etc.). 

DIFFERENTIAL D1aGnosis.—The disease in the dog may be mistaken 
for ulcerative stomatitis. In the latter the lesions are localised in the 
oral cavity, and the hemorrhages characteristic of scurvy are absent. 

In the cases of purpura hemorrhagica recorded in the dog the symp- 
toms simulated those of scurvy, and the differential diagnosis is said to 
be based on the absence of lesions in the gums, especially necrotic and 


DISEASES OF METABOLISM: GOUT 1345 


ulcerative changes. But in one instance reported of purpura hemor- 
rhagica in the dog by Raitsits, swellings of the gums were present. 

Proanosis.—In the early stages, and if prompt treatment be adopted, 
the prognosis is said to be tolerably favourable; but when evidences of 
ulcerative stomatitis and hemorrhages are present, the outlook is 
serious. 

TREATMENT.—Attention to diet and to hygienic surroundings is 
essential. In the pig, corn food should be allowed, to which acorns and 
horse-chestnuts may be added. Some authors advise the internal ad- 
ministration of alum, others advise mild preparations of iron, with 
vegetable tonics. | 

In the dog a meat diet should be ordered. The stomatitis requires 
suitable treatment (see p. 459). In human medicine lemon-juice in 
gradually increasing doses is advised for the treatment of scurvy. 


GOUT. 
SyNnonyM.—Podagra. 


Gout is defined by Osler as “a disorder of metabolism associated 
with retention of uric acid and of other purin bodies in the body, charac- 
terised clinically by attacks of acute arthritis, the deposition of sodium 
biurate in and about the joints, and by the occurrence of irregular con- 
stitutional symptoms.” The affection is common in the human subject, 
but is of rare occurrence in animals, while in birds it is frequently met 
with. 

OccURRENCE.—Cases of gout were recorded in the horse by Vogt. 
The symptoms observed were painful swellings on the bones of the hind 
extremities, in the vicinity of joints, such as the hock, fetlock, pastern, 
and coronet. Marked lameness was present, also an abundant sediment 
_of uric acid was observed in the urine. Recovery resulted after twelve 
months. 

According to Cadéac, recurrences are common, and attacks may be 
prevented by subjecting the animal to regular work. This author also 
states that the affection may occur in cattle in the form of articular 
gout. j | 

The disease has been observed in the pig by Virchow, Mendelsohn, 
Pflug, and Péricaud, in the form of guanin deposits in the joints and 
muscles (guanin is a decomposition product of nuclein). Gouty pigs 
often show lameness in all four limbs. 

Spinola, Bruckmiiller, and Chazeau, met with cases of gout in aged 
dogs. Nodes were observed on several of the lower articulations of the 
limbs, and also on the inferior extremity of the ribs, These nodes, on 

VOR Iie 85 


1346 SYSTEM OF VETERINARY MEDICINE 


examination, were found to consist of urate of soda. Anchylosis of the 
affected joints occurred in some cases. 

Avian gout is a common affection in birds, and has been specially 
studied by various observers. It occurs most frequently in birds of 
prey kept in zoological gardens, and is also common in parrakeets and 
in fowl. According to Klee, chickens are specially subject to the disease. 
Hartenstein observed an enzodtic of acute visceral gout in geese. The 
disease is said not to occur in birds at liberty, and is rare in the ostrich. 
Male birds are affected more frequently than females, and amongst 
domestic fowl the highly-bred large breeds (Brahma and Cochin China) 
are more likely to be attacked. _ 

EtroLocy.—A generous diet rich in nucleo-proteids is believed to be 
the chief etiologicalfactor. The disease has been produced experimentally 
by feeding fowl exclusively on horse-flesh for variable periods of time. 
Amongst other causes put forward, we may mention the ingestion of 
smut fungi (Ustelago mardis), renal affections, obstruction of a ureter by 
a calculus, hereditary influences, etc. The predisposing causes recog- 
nised are want of exercise, confinement of the birds, and old age. 

Symptoms.—Two types of the disease are observed—viz., (1) Articular, 
(2) Vesceral. 

Articular Gout is less frequently met with than the visceral form. 
The seats of predilection are the articulations of the feet, and less often 
those of the wings. These joints are swollen, and deposits of a chalky 
nature (tophi) occur in the articular cartilages and around the articula- 
tions. Lameness is well marked, and the birds move about as little as 
possible. When the wings are involved, flying may be impossible. 
When several joints in the foot are affected, deformity is well marked, 
and finally complete anchylosis may occur. In some instances the skin 
over the tophi becomes thin, necrosis results, and a greyish-yellow: 
crumbling substance is discharged. Ulcers are formed, which may 
extend to the articular cartilage or even to the ends of the bones forming 
the joint. Tophi of a smaller size may sometimes be observed in the 
tendons, skin, and subcutaneous tissue, and may surround the base of 
the quills. As the disease advances, other joints are involved, emacia- 
tion sets in, and death occurs from exhaustion. 

Visceral Gout.—The chalky deposits occur in the pleura, peritoneum, 
the membranes of the air sacs, the pericardium, the surface of the heart, 
the liver, and the kidneys. It causes disturbances of nutrition, but, 
unless associated with articular lesions, a diagnosis is not possible. 

In both forms of gout the course is nearly always chronic. Tuber- 
culosis may produce similar changes in the joints, and the differential 


DISEASES OF METABOLISM: OCHRONOSIS 1347 


diagnosis must be based on a bacteriological examination of the discharge, 
when present, or by the employment of avian tuberculin. 

The prognosis is unfavourable. 

TREATMENT.—The amount of nitrogenous food must be limited. 
Sodium bicarbonate or Carlsbad salt may be given in the drinking-water. 
Piperazine is advised by Continental authors, also tincture of colchicum. 
When evidences of acute inflammation of the joints are present, the 
affected parts should be covered with cotton-wool soaked in a solution 
of salicylic acid. Later on, when acute symptoms have disappeared, 
excision of circumscribed tophi in the skin and subcutaneous tissues 
may be attempted. When softening of the tophi has occurred, the parts 
should be opened, curetted, and irrigated with antiseptic solutions. - 

Except in the case of valuable birds, the most economical course to 
adopt is to kill the birds, if they are in fit condition for table, and this 
should be carried out on the first appearance of well-marked symptoms. 


OCHRONOSIS. 
SynonyM.—Melanosis. 


This is a rare disorder of metabolism in man, characterised by black- 
ening of the cartilages and fibrous tissues, pigmentation of the skin, and 
the presence of dark-coloured urine. Mettam* drew attention to the 
affection in animals, and recorded the following cases: (1) Ochronosis of 
the lungs and liver of an ox that had been slaughtered for food; (2) ochro- 
nosis of the skeleton in the pig, in which the cartilages were not coloured. 

Nothing is known with reference to the clinical phenomena of the 
affection in animals, so that it is of more interest to the pathologist than 
to the clinician. } 

According to Osler, the condition may depend on a failure to com- 
plete the catabolism of certain aromatic compounds, with the result that 
peculiar bodies, homogenistic acid, and uroleucic acid, are excreted in 
the urine, which blackens on exposure to air (alcaptonuria). It may 
also depend on the prolonged use of carbolic acid, and there may possibly 
be other causes. 

Other authorities consider that ochronosis is a form of melanotic 
pigmentation. 

Gray informs us that pigmentation of the bones and muscles is a 
normal condition in the silkie fowl. 


* Veterinary Journal, 1909, p. 601; also ibid., January, 1910, p. 8. 


DISEASES OF DOUBTFUL ETIOLOGY 


I. AZOTURIA. 
By E. Watiis Hoare, F.R.C.V.S. 


Synonyms.—Hemoglobinuria; Hemoglobinuria toxeemica; Paralytic 
hemoglobinemia; Paroxysmal muscular hemoglobinuria. 

GENERAL RemARKS.—Although this affection is of comparatively 
common occurrence in horses, and the symptoms in typical cases are 
perfectly familiar to clinicians, yet little definite is known with reference 
to its etiology and pathology, and much has yet to be learned in con- 
nection with its successful treatment. It is difficult to offer a definition 
of the malady, considering the diverse views which are held as to the 
etiological factors, and to the manner in which they act on the various 
organs in which lesions are produced. From a clinical point of view the 
disease may be regarded as one depending on idleness plus high feeding, 
to which must be added some unknown element, as we are well aware 
that many horses may be kept in the stable for variable periods, and fed 
as usual, without developing the affection. 

Similar remarks will apply to the disease known as “ lymphangitis,”’ 
which is also associated with idleness and high feeding; but there is a 
striking difference—viz., lymphangitis develops while the animal is at 
rest in the stable, whereas a certain amount of exercise is generally 
necessary, following a period of idleness, before symptoms of azoturia 
are manifested. In typical cases we find that after a period of enforced 
idleness the horse leaves the stable in good spirits, and after proceeding 
a short distance shows stiffness in progression, especially in the hind- 
limbs, comes to a standstill, sweats profusely, and may show colicky 
symptoms. If removed to the nearest stable, the symptoms may dis- 
appear, and a variable amount: of dark-coloured urine may be passed. 
On the other hand, if the animal be forced to move, he soon becomes 
unable to maintain the standing posture, and goes down, the muscles of 
the hind-quarters especially become rigid and swollen, and nervous symp- ~ 
toms are manifested. The disease is characterised by renal, muscular, 
and nervous phenomena, and considerable differences of opinion exist as 

1348 


© 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1349 


to the manner in which these are produced, and also with reference to 
the organs which are primarily attacked. Thus, we find a variety of 
terms applied to the affection, according to the views held from time to 
time as toits nature. Again, various authors described the disease under 
different headings, as follows: W. Williams included it under dietetic 
diseases; Robertson did not place it under any section, but devoted a 
special chapter to its consideration; Friedberger and Fréhner describe it 
in an appendix to diseases of the kidneys, but admit that it ought to be 
classified with muscular diseases; and Hutyra and Marek consider it 
under diseases of the blood. 

History.—The affection was recognised by various writers in the 
early part of the nineteenth century. Gohier (1813) drew attention to 
the muscular lesions, while Coulboux (1824), Charlot, Prévot, and Bouley 
junior, described under the term of “ spinal apoplexy ” a disease which 
appears to correspond with azoturia. Hofer (1852) showed that a 
number of affections known under various terms were in reality identical 
with azoturia. 

According to Friedberger and Frohner, the disease has been recog- 
nised from ancient times, and is probably one of the oldest equine affec- 
tions known. It was first clinically described by authorities in Bavaria 
and the Palatinate, and later in Wiirtemberg, North Germany, France, 
and Holland. W. Williams states that attention was first directed to 
the disease in Great Britain by Haycock, who named it, at the suggestion 
of Moore of London, “‘ hysteria,’ believing that it occurred only in mares. 
Robertson drew attention to the fact that Percivall, in his “ Hippo- 
pathology,”’ quoted a typical case of azoturia which was reported by 
Clayworth in the Veterinarian for 1836. 

W. Williams termed the disease “ azoturia,”’ believing that the urine 
contained a large amount of urea, but this view is challenged by several 
authorities who have studied the subject. It is apparent that the term 
‘* azoturia ’’ is by no means an ideal one for the affection, but as it has 
now, owing to custom, been adopted for a long time, we retain it, espe- 
clally as the other terms also only signify one of the phenomena in 
connection with the disease. 

OccuRRENCE.—It was formerly held by some authors that mares were 
more liable to the disease than geldings, but the accuracy of this state- 
ment is challenged by Williams and others. We have observed more 
cases in mares than in geldings, but this may be a coincidence. Robert- 
son stated that neither sex, breed, nor age, provided the animals have 
reached maturity and are stalled, seems to grant immunity from an 
attack; but the most susceptible animals are good thrivers, and the 


1350 SYSTEM OF VETERINARY MEDICINE 


affection does not (or very rarely) attack horses, whether young or old, 
roaming at large in the fields. This author, however, remarked that his 
personal experience tended to corroborate the view that more cases 
occur in mares than in geldings. Hutyra and Marek, and also Cadeéae, 
hold that heavy draught-horses are more subject to the disease than 
animals of the finer breeds, but this is not our experience. As regards 
age, these authors state that the affection is more likely to occur in 
animals between the ages of five and eight years. Hutyra and Marek 
observed the disease in a colt one and a half years of age, and Kleinpaul 
held that even sucking-foals may be susceptible. It is said that the 
affection does not occur in the mule or in the donkey. 

Brun met with eight cases of the disease in the space of three days 
in a large stable of horses, where the animals were idle for sixteen days. 
W. Williams recorded five cases in the spring of 1870 which occurred on 
a farm, where, in consequence of the prevalence of frost, the animals 
had not been worked or exercised for some time. Johne (1879) met with 
the disease in a zebra. 

The following figures taken from the Reports of the Army Veterinary 
Service are interesting, as the comparative rarity of the disease must 
be attributed to regular exercise and careful dieting: 


No. of Cases. Indian Service. 
1911-1912 .. as cs ae 6 5 
1912-1913... 5S ate oe 4 4 


Kit1oLoGy.—There are certain important etiological factors which are 
recognised by clinicians in connection with the disease, but at the same 
time we must point out that occasionally cases may occur in the absence 
of such factors. These may be considered most conveniently under the 
following headings: — 

Rest and High Feeding succeeded by Exercise—These are the usual 
conditions associated with an attack of azoturia; hence the affection is 
of comparatively common occurrence after Christmas holidays, or during 
a spell of hard frost, when horses are kept from work. It is also met 
with in horses that are necessarily kept idle when under treatment for 
surgical conditions, or during convalescence from affections such as influ- 
enza. In such instances high feeding is generally an essential etiological] 
factor as well as a period of rest, but there are exceptions to this rule, 
as we sometimes meet with cases in farmers’ horses which are fed on 
a low diet. Still, the effect of nitrogenous food must be regarded as 
important, as we are aware that an effectual preventive of the disease, 
when horses are necessarily kept without exercise, is to put them on a 
low diet. Robertson found that in nearly all the cases of the disease 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1351 


he encountered in the Border districts over a number of years the | 
animals had been fed on vetches, tares, and leguminous foods generally. 

Occasionally cases of azoturia occur in horses that are regularly worked, 
and at times the disease may be manifested in the stable without any 
exercise following the period of rest. Some practitioners attempt to 
explain the origin of the latter cases by suggesting that the horse has 
suffered from an attack of colic, and the movements due to the pain 
have the same effect in producing the disease as ordinary exercise; but 
it must be remembered that some cases of the disease evince colicky 
pains as premonitory symptoms while the animal is at work. 

The period of rest essential for the disease to develop varies from one 
day upwards. Cadéac states that two or three days’ rest is more likely 
to be followed by the affection than a period of two or three months. 
It would appear as if some horses were specially predisposed to the 
disease, as we are well aware that in many instances animals may be 
kept in the stable for long periods with impunity, while others become 
attacked by azoturia after being idle for two or three days, or even for 
a shorter period. Up to the present we cannot explain why this is so, 
as the various views held with reference to the etiology and pathogenesis 
of the malady do not assist us in this respect. 

Influence of Cold.—The majority of authors regard cold as an im- 
portant contributory etiological factor in conjunction with a period of 
rest and high feeding succeeded by exercise. Cold per se cannot cause 
the disease. All clinicians are aware that more cases are met with 
during autumn, winter, and spring, and especially in frosty weather; 
but to this there are exceptions, as we meet with cases in the summer 
months. According to the statistics of the Prussian Army, more cases 
occurred in those months where less opportunity existed for the action 
of cold. Some practitioners explain the greater frequency of cases in 
time of frost by the fact that horses are more likely to be kept idle during 
such weather. Warm, damp stables are said to favour the occurrence 
of the disease. 

Excessive Exertion.—According to Hutyra and Marek, excessive exer- 
tion may produce the disease without a previous rest, and these authors 
cite cases in which the affection developed after parturition in mares, or 
occurred in horses which had struggled considerably during surgica] 
operations. 

In ordinary cases excessive exertion does not appear to be necessary 
in order to bring about the affection, as the symptoms usually develop 
within a short time after the horse leaves the stable. The animal is 
fresh and in good spirits just previous to the attack. We have known 


1352 SYSTEM OF VETERINARY MEDICINE 


cases occurring in hunters where the meet was quite close to their stables, 
and after some delay at the cover, the symptoms developed when they had 
galloped the length of a field. We have also met with a case in a colt, 
in which the animal, after a long sojourn in a stable, was left out in a 
field, and after galloping a short distance showed typical symptoms of 
the affection. Exceptional instances are observed in which the attack 
does not occur until the horse has worked for.several hours. Hasse met 
with cases in the stable, where the horse got his foot entangled in the 
halter rope, and it was believed that, owing to the straining of the 
muscles, the disease developed. 

PATHOGENESIS.—The etiological factors we have mentioned are those 
which appeal to the clinician, but they do not offer an explanation of 
the manner in which the symptoms and lesions are brought about. Up 
to the present the various views advanced are purely theoretical, hence 
we do not intend to discuss them at length. 

The Microbial Theory is held by some observers. Ligniéres found 
Gram-positive streptococci in the subarachnoid fluid of the medulla, and 
sometimes also in the kidneys, and 300 c.c. of the culture injected intraven- 
ously into a horse produced paraplegia and albuminuria on the sixth day. 
Other investigators also found similar streptococci, but the results of 
inoculations proved negative. Cadéac states that all the facts known 
with reference to the disease tend to show that it is not of an infectious 
nature. Moreover, one attack does not confer any immunity, but, on 
the contrary, is likely to be followed by a recurrence. 

Auto-Intoxication Theory.—This is now held by the majority of 
modern observers, but there is not a consensus of opinion as to the 
manner in which the auto-intoxication is brought about. Hutyra and 
Marek believe that during the working of previously rested muscles, or 
in muscles subjected to excessive exertion, a toxic substance is formed 
which produces a degeneration of the muscle fibres and an elimination 
of hemoglobin from the red blood-corpuscles. This process may occur 
either while the blood is passing through the muscles involved, or at a 
later stage, when it circulates in other organs. Rest and high feeding 
are believed to increase the formation of toxins in the muscles. Cold is 
said to increase the metabolism of the muscles by the irritation it pro- 
duces. Nothing is definitely known with reference to the nature of this 
toxic substance. As against this myogenic auto-intoxication theory it 
may be mentioned that the same authors found on examination of the 
blood that the hemoglobin content was somewhat diminished; they also 
ascertained that the specific gravity of the blood was not increased, and 
the number of red blood-corpuscles was diminished. These results were 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1353 


at variance with the investigations of other authorities, who found an ~ 
increase in the hemoglobin content, and also in the number of red blood- 
corpuscles; but Hutyra and Marek point out that, according to the 
experimental findings of Wetzl, the hemoglobin content of the blood is 
subject to great variation, while a considerable loss of water by the 
body produces a marked increase of the relative percentage of red cor- 
puscles and of the hemoglobin content, owing to thickening of the 
blood. In azoturia the loss of water due to profuse sweating, and 
neglect of supplying the animal with fluids when he is in the recumbent 
position, will account for the increase in the hemoglobin content and the 
number of red blood-corpuscles found by various observers. 

W. Williams held that an excess of urea could be detected in the 
blood. Siedamgrotzky and Hofmeister found that the blood was very 
rich in urea and extractive matters, the products of increased muscular 
metabolism. 

Dieckerhoff held that the substances inducing auto-intoxication 
develop from the proteids which are not utilised during rest, and which 
are broken up under the influence of a supposed ferment. Bollinger 
_ Investigated the disease in Egypt, and arrived at the conclusion that a 
hemolytic toxin developed from the proteids under the influence of 
muscular work or cold. Ohler regarded the cause of the disease as an 
excessive and rapid breaking down of the glycogen in the muscles, so 
that the sugar formed from the glycogen produces a myositis, and, secon- 
darily, a nephritis. According to Siedamgrotzky and Hofmeister, urea 
and extractive matters accompanying it are formed in large quantities 
in the muscles, and cause breaking down of the red blood-corpuscles. 
Frohner holds that, owing to the intense irritation produced by the 
action of cold on the sensory nerves of the skin, the metabolism of the 
muscles is increased to such an extent that the muscle substance breaks 
down, and the muscle colouring matter, which is identical with heemo- 
globin, passes into the blood and is eliminated by the kidneys. 

Cadéac* has devoted special attention to the disease, and concludes 
that it depends on auto-intoxication, and that the hemoglobin which 
occurs in the urine is derived exclusively from the muscles in the form 
of methhemoglobin. According to this author, the attack results from 
an auto-intoxication originating in the digestive organs, favoured by a 
temporary renal insufficiency and aggravated by cold. Owing to these 
influences the oxidation of muscular glycogen is imperfect, the ferment 
which usually brings about this action is inhibited, and organic acids 
(formic, acetic, lactic, and butyric) are formed. 


* “ Pathologie Interne.” 


1354 SYSTEM OF VETERINARY MEDICINE 


McFadyean* contended that no evidence was in existence to prove a 
constant or notable increase of urea in either the blood or the urine. 
He demonstrated that both the blood and the urine contained an exces- 
sive amount of hemoglobin, or some allied pigment. This pigment 
existed in solution in the blood-plasma, and after death it there fre- 
quently assumed the crystalline form, while during life it is excreted by 
the kidneys, and colours the urine. The serum is of a different tint to 
that yielded by the blood of a healthy horse. When examined in a 
4-inch test-tube, it has a deep ruby tint, while the serum of normal 
blood has an amber tint. The same author pointed out that there may 
be two possible sources of the pigment in the liquor sanguinis during the 
acute stage of an attack—viz., (1) hemoglobin set free by destruction of 
red blood-corpuscles; or (2) the colouring-matter (believed to be identical 
with, or nearly related to, hamoglobin) liberated from the degenerated 
muscular fibres. 

With regard to the alterations in the blood, McFadyean did not 
accept the theory that the hemoglobin which is dissolved in the blood- 
plasma and excreted by the kidneys results from destruction of red 
blood-corpuscles. He argued that if such were the case, a microscopic 
examination of the blood would show evidences in the shape of red cor- 
puscles in various stages of destruction. Again, such extensive blood 
disintegration as would be necessary to furnish the large amount of free 
heemoglobin found in some cases would lead to profound anemia. But, 
even in cases that have survived for several days a sensible diminution 
in the number of red corpuscles cannot be demonstrated. Again, 
McFadyean examined the blood taken from three cases of azoturia during 
life, and found by the use of the hemocytometer that there was a large 
increase in the number of red corpuscles. In one case the number of 
red corpuscles was found to be 14,000,000 per cubic millimetre (normal 
7,000,000 to 8,000,000), and in another 10,750,000. In the third case 
the number was 11,000,000. The first case recovered, and it was found 
during the course of the disease that when the number of red corpuscles 
declined from 14,000,000 to 7,750,000, there was a marked improvement 
in the condition of the animal. The other cases proved fatal, and during 
their entire course the increase in the number of red corpuscles was 
demonstrated. The conclusion arrived at was that “if the above 
observations were confirmed, the muscular lesions should be regarded as 
secondary in point of time and importance, and it must be assumed that 
the starting-point of the disease is an overproduction of red corpuscles, 
uncompensated by a steady destruction of them, such as goes on in health, 


* Journal of Comp. Path. and Therap., vol. vi., p. 245. 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1355 


and that this overproduction is somehow determined by the period of . 
rest and the liberal diet of which there is a history in nearly every case 
of hemoglobinuria.” 

It is interesting to note that Robertson on two separate occasions 
administered to healthy horses between 2 and 3 pints of the cofiee- 
coloured urine taken from an animal suffering from azoturia. In each 
case a comatose condition was induced, with inability to rise for three 
days. 

Morsip ANatomy.—The chief morbid changes occur in the muscles, 
the blood, the kidneys, and the nervous system. 

Muscular Lesions—The muscles usually involved are the lumbar, 
the gluteal, the psoas, the triceps cruralis, and the abductors of the 
thigh. In some cases the muscles of the fore extremity are affected— 
viz., the scapular and the triceps extensor brachii. The cervical muscles 
are occasionally involved. The lesions consist of an alteration in colour 
to a greyish or yellowish tint, or the muscles may give the appearance of 
having been boiled. In some cases they are friable, in others firm. On 
section they show light grey or yellowish stripes between the normal 
bundles of muscle fibres. They may be swollen and cedematous, or dry 
and anemic. On histological examination the cross striation is effaced, 
and the sarcolemma seems to be occupied by a mixture of fine albuminous 
granules, fat globules, and coarse flakes—parenchymatous and fatty 
degeneration (Hutyra and Marek). Fatty degeneration is best marked 
when the muscles are friable and of a yellowish tint. 

Cadéac states that the lesions are sometimes very pronounced in the 
psoas muscles. These are swollen and of a bluish tint; the morbid changes 
are visible through the peritoneum, and are due to ecchymoses. Sub- 
lumbar hemorrhages may be present surrounding these muscles, and 
may extend to the pillars of the diaphragm. They are due to the struggles 
of the animal, which induce small ruptures of the muscular structure. 
The lesions in the muscles are rapidly produced, and may be observed in 
cases which have succumbed on the fourth, third, or even on the second 
day of the attack. In cases where the anterior crural nerves suffer from 
neuritis and paralysis, atrophy of the triceps cruralis results. 

Renal Lesions.—According to Cadéac the kidneys always show morbid 
alterations. In cases which run a short course these organs are dark 
coloured, congested, friable, and cedematous. On histological examina- 
tion the capillaries are found dilated, and the epithelial cells of the 
convoluted tubules are swollen and granular. Johne observed cloudy 
swelling, and in some cases well-marked parenchymatous or fatty 
degeneration; also diffuse necrosis of the epithelia. 


1356 SYSTEM OF VETERINARY MEDICINE 


According to McFadyean, “in the most typical cases of the disease 
the kidneys may be quite free from nephritic changes. Congestion and 
cedema of the kidneys, with extensive shedding of renal epithelium, are 
not rarely found in animals that have succumbed after some days; but 
these changes are perfectly accounted for by the hemoglobinemia, and, 
indeed, are the exact parallel of those met with in experimentally pro- 
duced hemocytolysis.” 

Alterations in the Blood.—¥riedberger and Frohner found the blood 
dark coloured, and only slightly coagulable. Hutyra and Marek state 
that no macroscopical changes are present. According to Cadéac, the 
post-mortem alterations found in the blood are secondary. It is altered 
in appearance, being thick and oily in consistence; the red corpuscles 
are broken down and discoloured; the serum is reddish, but this latter 
change results from cadaveric decomposition. Pigmentary granules, 
crystals of hematoidin, and micro-organisms of putrefaction are also 
present. The alterations in the blood during life are described on 
p. 1854. 

Lesions in the Nervous System.—These are inconstant, and, when 
present, are confined to the spinal cord and to certain nerves. They are 
otten limited to the lumbar enlargement of the cord, but may extend to 
the cervical enlargement. 

Cadéac states that the most common lesion is a simple congestion of 
the cord and spinal meninges. The arachnoid fluid is increased in 
amount, and is of a reddish tint, and in some cases numerous adhesions 
may be observed between the visceral and parietal layers of the arachnoid. 
On section of the cord, ecchymoses can be detected in the grey substance, 
especially in the cornua. Dilatation, or even rupture of the capillary 
vessels, or fusiform dilatations, may be present. In some cases a veritable 
apoplexy of the cord is observed, with extravasation of blood either on 
the surface or in the substance of the organ, and compression may be 
produced. When extravasation into the substance of the cord occurs, 
the grey matter may be softened and disintegrated. Occasionally the 
blood may gain entrance to the ependyma. These lesions may be found 
in the lumbar portion of the cord, or sometimes in the dorsal or brachial 
regions, and but rarely in the medulla oblongata. When they do not 
prove rapidly fatal, a varying degree of medullary softening and thick- 
ening of the dura mater and pia mater results. Dexler observed in the 
dorsal, lumbar, and sacral regions of the cord perinuclear chromatolysis 
of the motor and to a lesser degree of the other nerve cells, also degenera- 
tion of certain nerve sheaths in the lateral and inferior columns of the 
cord. 3 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1357 


Lesions of the nerves occur at their origin from the spinal cord, 
especially at the lumbo-sacral plexus. The morbid alterations consist of 
an increase in volume, and infiltration with a yellowish serosity, which 
may sometimes be gelatiniform in character. The anterior crural nerves 
are often involved, and show degeneration and rupture of several of the 
nerve tubules. ; 

Other Lesions.—The liver may be of a yellowish tint, infiltrated with 
fat, and hemorrhagic. The spleen is enlarged in areas, its surface may 
be irregular in some cases, and on section its tissue is soft and diffluent. 
Hutyra and Marek state that the heart muscle sometimes shows similar 
lesions to those described as occurring in the affected muscles of the hind- 
quarters, but in a lesser degree, and probably result from a subsequent 
septic infection. These authors describe lesions in the bone-marrow, 
especially in the femur and in the lumbar vertebra, consisting of hyper- 
emia, ecchymoses, and in some instances a blackish-brown discoloration. 

Lesions in the larger bones (femur, humerus, radius, etc.) are de- 
scribed by Friedberger and Frohner, consisting of swelling and infiltra- 
tion and a dark red coloration of the bone-marrow. 

Symproms.—These vary according to the severity of the case. Early 
treatment and rest have a marked effect on the progress of the disease. 
The first symptoms usually observed by the rider or driver are a weak- 
ness or stifiness of the hind-limbs, also sweating, trembling, and a ten- 
dency to “ knuckle over” at the fetlock joints. These phenomena may 
appear in five to ten minutes after the horse has left the stable, but 
occasionally they are not observed until after several hours’ work. A 
hard, tense, swollen condition of the gluteal muscles is also present. 
According to McFadyean, “‘ the statement that the muscles of the hips, 
loins, or other parts are swollen during an attack is erroneous. The - 
appearance of swelling, when present, is due to the muscles being in a 
state of rigid contraction, and it is this rigidity that is the cause of the 
wooden hardness of certain muscles at the onset of the attack.” In 
some cases colicky symptoms are observed, which tend to disappear 
spontaneously. Whether these are to be attributed to digestive disturb- 
ance or to pain originating in the muscles is doubtful, but we must point 
out that the affected muscles are not painful to palpation. If at this 
stage the horse is pulled up, placed in a stable, and treated, the symptoms 
may disappear; but if he is forced to move (and this practice is not un- 
common, owing to the driver mistaking the case for colic, and thinking 
that walking the animal is beneficial), he collapses in the hind-quarters, 
goes down, and is unable to rise. There may be marked variations in the 
premonitory symptoms. We have observed a case in which one hind- 


1358 SYSTEM OF VETERINARY MEDICINE 


limb was unable to bear weight. The horse kept continually stamping 
with the foot of this leg, and after a short time went down, struggled 
violently, and was unable to rise. We have also met with instances In | 
which the horse was under treatment for sand-crack, etc., and was 
brought to the infirmary every few days (a short distance from his stable) 
for treatment. The symptoms developed suddenly in one hind-limb, and 
were evidenced by lameness, a hardening and swelling of the gluteal 
muscles of the same side, profuse sweating, and a “‘ dropping” of the 
quarter, similar to that observed in cases of paralysis of the anterior 
crural nerve. Cases are also met with in which the symptoms occur 
with such suddenness and severity that the animal goes down before the 
driver observes the premonitory symptoms. The horse, when down, 
makes frequent attempts to rise, but only succeeds in raising the fore-part 
of the body. The hind-quarters are powerless, the hocks and fetlocks 
are strongly flexed, and the weight of the posterior portion of the body 
is borne by the toes of the hind-feet and the points of the hocks during 
the attempts to rise. He soon lies flat on his side, and in severe cases 
may struggle in a convulsive manner with the fore- and hind-limbs. In 
less severe cases struggling is absent, and evidences of paraplegia only 
are present, which may continue for a few days, and be followed by 
recovery. When convulsions occur the symptoms resemble those of 
meningitis, and, according to Hutyra and Marek, these are indicative of 
uremia. 

According to Cadéac, true paraplegia is not present in all cases. 
Although the horse is unable to rise or to walk, motor power and sensa- 
tion are not abolished; no cerebro-medullary lesions are present. The 
inability to rise is due to muscular lesions. But this author also states 
_ that cases are observed in which the auto-intoxication involves either 
the cerebro-medullary system or the muscles, and such types depend on 
whether the toxins possess an affinity for the nervous system or for the 
muscles. In some instances both types are combined. 

In the rare cases in which the disease develops in the stable the horse 
is found unable to rise, and presenting similar symptoms to those already 
mentioned. 

Cases are sometimes observed in which one or both fore-limbs only 
are involved, and the triceps extensor brachii is especially implicated. 
The symptoms in such instances, when the lesions are unilateral, resemble 
those of paralysis of the radial nerve. We shall now proceed to discuss 
the principal symptoms serzatim. : 

Urinary and Renal Symptoms.—In the majority of cases there is 
retention of urine, and the catheter has to be employed not only to give 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1359 


relief, but also for diagnostic purposes. When convulsions occur in the 
mare, however, the urine may be ejected with considerable force at 
intervals. 

The urine varies in colour. It may resemble Burgundy, port wine, 
porter, or coffee, and in some cases may be almost black. This altera- 
tion in colour is a fairly constant symptom. Cadéac states that it may 
be absent or overlooked in mild cases or in abortive attacks, but, accord- 
ing to Mayer, hemoglobin is always present, as demonstrated by the 
benzidine test of Schlesinger, or the gujac oil of turpentine test of Schumm, 
which are more suitable than the spectral-analytic method or Heller’s 
test. The urine first drawn off after the development of symptoms 
usually shows the characteristic colour. In some instances the colora- 
tion of the urine precedes the muscular symptoms. It is also found that 
the coloration may in mild cases disappear after subsequent micturition; 
or, on the other hand, it may persist until death occurs, or may progres- 
sively diminish from one micturition to another. We have generally 
observed that the coloration disappears towards the later stages, and the 
urine is then of a yellow tint, and resembles linseed oil—a fact which 
may give rise to difficulty in diagnosis in the absence of a correct history 
of the case (see p. 1362). 

Albuminuria is practically always present, and, according to some 
authors, the amount of albumin is in proportion to the severity of the 
attack, but does not always coincide with the intensity of the coloration 
of the urine. According to Lucet, the amount of albumin present varies 
from 1 to 25 grammes per litre, and is increased when a renal affection 
is associated with the attack. Hutyra and Marek state that the specific 
gravity of the urine 1s increased, but Cadéac found that in the majority 
of cases it was lower than normal. The reaction is generally alkaline, 
and, according to some observers, it 1s always so. The amount of urea 
is said by some authors to be diminished, although W. Williams held 
that it was largely increased. According to McFadyean, the urine passed 
during an attack always contains albumin and pigment. The pigment 
exists partly in solution, and often in greater proportion in the form of 
very minute, dusky, opaque granules. The urinary pigment is derived 
from the hemoglobin circulating in solution in the blood-plasma, and is 
excreted by the kidneys. The hemoglobin is not excreted as such, but 
is—at least, for the most part—split up, and this is probably the source 
of both the albumin and the granular pigment. 

Glycosuria is occasionally present. It-was observed by Mouquet and 
Lucet, and also in examinations of urine carried out by I. Macadam. 
It is a temporary condition. The urine contains a large amount of 


1360 SYSTEM OF VETERINARY MEDICINE 


phosphates, and generally uric acid salts, but less hippuric acid than 
normal. When allowed to remain at rest in a vessel, an abundant sedi- 
ment is observed of a pale grey or yellowish colour. When azoturia is 
complicated with nephritis, this sediment contains hyaline or granular 
casts, hemoglobin casts, renal epithelial cells, and sometimes red and 
white blood-corpuscles in small numbers. The amount of urine is not 
diminished except when renal lesions occur, although retention is often 
present. A free passage of urine is regarded asa favourable sign. Cadéac 
states that the renal lesions are due to the irritating effect of the meth- 
hemoglobin, albumin, and various toxic principles present in the urine 
He also observes that a favourable termination of the case depends on 
the relative integrity of the kidneys, as, if renal disease be present, auto- 
intoxication is greatly aggravated, and the paraplegia is complicated 
with a form of uremia. When anuria occurs, the gravity of the case is 
greatly increased, owing to failure of the eliminating function of the 
kidneys. 

MuscuLaR PHENOMENA.—These are very characteristic. The affected 
muscles are tense and hard to the touch, and those which are superficial 
-——e.g., the gluteal muscles—are swollen to a marked extent (see p. 1357), 
and this alteration may be seen as well as felt, but sensation is not altered. 
This swelling depends on tonic contraction as well as on morbid altera- 
tions, and the muscles of the hind-quarters are usually the first to become 
affected, and show the most marked changes. According to Cadéac, the 
action of cold on the muscles is to cause irritation of the sensory nerves 
and muscular contraction, and this factor is superadded to the effects of 
auto-intoxication. The condition may thus be regarded as a toxic 
myositis depending on auto-intoxication plus the action of cold and the 
effect of exercise. In some instances the muscular changes are unilateral 
and not extensive, and the animal may remain in the standing posture. 
Lucet observed rare cases in which the muscles of the trunk only were 
involved, and in such instances the horse was able to stand up. In the 
later stages of the disease the muscles usually regain their normal con- 
sistency, or may become softer. Cases are sometimes observed in which 
the gluteal muscles are so extensively tumefied that they form large hard 
masses on each side of the croup, separated by a deep indenture in the 
middle line. The muscles of the anterior region of the body present 
similar alterations in some cases. As already remarked, true paralysis 
is not present, as the animal is able to move the limbs, and in cases where 
the toxins exert their action on the central nervous system violent con- 
vulsive movements of both fore- and hind-limbs occur. 

Symptoms in connection with the respiratory and circulatory organs 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1361 


are present, also cutaneous phenomena and a variable degree of 
fever. 

The respirations may not show much alterations in the early stages, 
but later on they become accelerated. When the animal goes down, 
struggles, and is unable to rise, the respirations become greatly accelerated 
and even dyspneeic in some cases. 

The pulse in mild attacks is only slightly accelerated, but in severe 
cases, although strong and full at first, it gradually becomes soft, and 
finally thready in character, and the action of the heart is tumultuous. 
Sweating occurs in all cases at the commencement, and is very profuse 
in severe attacks. It may commence in the region of the hind-quarters, 
and soon becomes generalised. In mild cases, although it may be pro- 
fuse at the start, it disappears rather rapidly; but in severe attacks it 
continues for a long period, and may persist until death occurs, being 
accentuated by the struggling of the animal. We have seen cases in 
cold weather in which the sweating was so extensive that the animal was 
enveloped in a cloud of steam. 

The temperature may be slightly raised in mild cases and in the early 
stages of severe attacks. In the advanced stages of the latter a high 
temperature is observed, especially when cerebral complications are 
present. According to Friedberger and Frohner, there is usually no 
rise of temperature even in very severe cases. (Out of twenty-five cases, 
only one was above 104° F., and in twenty the temperature was normal.) 

CouRSE AND Duration.—In mild cases, if the animal is at once 
withdrawn from work and placed in a stable, recovery may take place 
in a short time. In well-marked instances subjected to rational treat- 
ment a favourable termination may occur in two or three days. When 
the animal goes down early, and manifests convulsive struggling, death 
may take place on the third or fourth day, or even earlier. It is not 
uncommon to find paralysis of the triceps cruralis muscle either on one 
or both sides of the body, which persists, and is generally incurable. 
Friedberger and Froéhner state that this condition should be regarded as 
of myogenic origin, and not as paralysis of the anterior crural nerves. 
Paralysis, either partial or complete, of one limb is not uncommon, and 
may persist for an indefinite period. Atrophy of the gluteal or triceps 
cruralis muscles is frequently observed. Occasionally the triceps ex- 
tensor cubiti muscle may be involved. Owing to the inability to rise, 
complications occur, such as bedsores, and the animal has to be destroyed. 
Pneumonia may also set in. The convulsions, which are not uncommon 
in the later stages of the disease, are regarded by some authors as de- 


pending on uremia. Recurrences, either at short or long intervals, are 
VOL, I. 86 


1362 SYSTEM OF VETERINARY MEDICINE 


sometimes observed. It is well recognised that a horse which has once 
suffered from an attack is liable to a recurrence at indefinite periods if 
kept idle and fed as usual. | 

Proenosis.—In mild cases the prognosis is favourable, provided early 
treatment is adopted. Unfavourable symptoms are the occurrence ofa 
paralysis in the early stages, a scanty secretion and a deep coloration of 
the urine, well-marked albuminuria, the presence of elements in the 
urine suggestive of nephritis, high fever, and convulsive struggling. 
Inability to rise or to maintain the standing posture, even with the aid 
of slings, after a period of three or four days, is also an unfavourable 
symptom. Cases are recorded in which recovery resulted, although 
evidences of paralysis of the triceps cruralis muscles continued for long 
periods; but usually this condition is not amenable to treatment, as 
complications occur which render destruction the most economical course 
to adopt. We must point out, however, that a guarded prognosis is 
always desirable at the outset, because cases presenting severe symp- 
toms may recover under rational treatment. The mortality varies 
greatly, as judged by the percentage of fatal cases given by various 
authors, and our own experience leads us to the conclusion that the 
disease is far more fatal in some years than in others. 

DIFFERENTIAL Dr1aGnosis.—The history of the case and the presence 
of the symptoms we have mentioned renders the diagnosis free from 
difficulty; but atypical cases are by no means uncommon, and their real 
nature may be overlooked. Inability to rise and the presence of con- 
vulsions are symptoms common to various conditions, and we know that 
the coloration of the urine may disappear in some instances towards the 
later stages, while the history of the case may not be available or may 
not be typical of the disease. As pointed out by Hutyra and Marek, 
hemoglobin may be present in the urine in acute infectious diseases or 
intoxications, while muscular disturbances, similar to those occurring in 
azoturia, may be observed in muscular rheumatism; but in the affections 
mentioned evidences of paralysis are absent. | 

Cases of uremia depending on renal lesions present many points of 
resemblance to azoturia in the later stages, and the differentiation may 
present considerable difficulty when the coloration of the urine is absent. 
It must be remembered that azoturia may be complicated with nephritis 
and uremia. 

Surgical conditions, such as fractures of the pelvis or femur, or rup- 
ture of the tendo Achillis, may give rise to locomotor symptoms resembling 
those of azoturia, and a physical examination must be carried out in 
order to arrive at a correct diagnosis. But in certain pelvic fractures a 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1363 


red coloration of the urine may be produced owing to the presence of 
hematuria, and it is necessary to examine the urine microscopically. 
Again, such fractures may induce a tumefaction of the muscles which 
might be mistaken for the muscular phenomena of azoturia. 

Thrombosis of the posterior aorta or of its branches may be mistaken 
for azoturia, especially in a case where the horse has been kept idle for 
some time, and suddenly develops nervo-muscular symptoms; but in 
this condition there is no coloration of the urine, and after a short rest 
the animal is able to stand on the limb and to walk. A rectal examina- 
tion will detect the absence of pulsation in the affected vessel (see p. 1087). 
Cadéac states that thrombosis of these vessels predisposes to attacks of 
azoturia, and also that tumefaction of the muscles may occur in the 
former condition (see p. 1088). 

The colicky symptoms present in the early stages of azoturia may 
not be ascribed to their true origin unless a careful examination of the 
case be made. 

Infectious paraplegia (see Vol. I., p. 900), according to Cadéac, presents 
many features common to azoturia. It occurs either in the stable or at 
the commencement of work, but its enzo6tic character, the more or less 
pronounced swelling of the vulva in mares and inflammation of the 
genital organs, and the absence of coloration of the urine, enable the 
differential diagnosis to be carried out. 

Finally, we may remark that itis very probable many cases of azoturia 
in the later stages are overlooked, and the symptoms ascribed to other 
afiections, especially when the coloration of the urine and the muscular 
phenomena are absent, and a typical history is not in evidence. Menin- 
gitis, uremia, and allied conditions often present similar symptoms to 
those met with in the later stages of azoturia, and unless the history of 
the case points to the latter affection, an erroneous diagnosis may be 
made by even the most experienced practitioner. 

TREATMENT.—As nothing definite is known with reference to the 
pathology of azoturia, the treatment of the affection is largely empirical. 
Hence, as might be expected, a number of therapeutical agents have 
been advocated from time to time, but no line of treatment has as yet 
been found generally successful once convulsions or paralysis have set in. 
It is quite true that we not infrequently meet with a case presenting 
serlous symptoms, and find certain medicinal agents successful; but on 
the next case this treatment may fail completely. 

All clinicians are aware that mild cases, if immediately kept at rest 
on the first appearance of symptoms, tend to recover with simple measures. 
If, on the other hand, they are forced to work, or walked about with a 


1364 SYSTEM OF VETERINARY MEDICINE 


view to “ relieve the colicky pains,” serious phenomena develop. Hence 
the first essential in treatment is to get the animal into the nearest stable 
before he goes down, clothe him warmly, administer a full dose of sweet 
spirit of nitre, and draw off the urine by means of a catheter. Not in- 

frequently such cases tend to recover spontaneously. a 

When the symptoms are more severe, an active cathartic 1s indicated 
in order to insure elimination of toxic material. The old-time treatment 
adopted was to administer a full dose of aloes and calomel in the form 
of bolus. As, however, such measures require a long period to produce 
purgation in a horse not prepared for physic, many practitioners in the 
present day employ either eserine or arecoline in order to insure a free 
action of the bowels. We have observed very good results from the 
early administration of 1 ounce of chloral hydrate and from 5 to 7 drachms 
of aloes (according to the size of the horse). The manner in which chloral 
hydrate acts in this disease is not easy of explanation, but at any rate 
it often seems to cut short an attack. In plethoric animals venesection 
is advised by some practitioners, and in France is said to give excellent 
results; but according to Hutyra and Marek, it has been found ineffective 
by various authors. 

Local applications to the affected muscles prove useful. The most 
convenient and effective is a large cataplasm composed of kaolin and 
glycerine, applied hot and thick, and covered with a layer of cotton-wool. 
Irritant applications are contra-indicated, and are harmful. 

When the animal lies down and is unable to rise, a large bed of straw 
should be provided. He should be turned from side to side every three 
or four hours, and the urine removed by means of the catheter at proper 
intervals. On the second or third day, if the animal is unable to rise, 
and if convulsions are absent, we should try to assist him to his feet by 
means of slings. If he can be got to stand up for even a short time it 
will be of advantage to carry out this procedure twice daily; but if con- 
vulsions develop, or if no weight can be borne by the hind-limbs, slings 
are useless. To combat the convulsions, chloral hydrate and bromide 
of potassium in full doses should be given. If, owing to the violence of 
the symptoms, drenching is deemed dangerous, these agents can be 
given in the form of enema, and by dissolving them in a menstruum of 
warm water, combined with a demulcent, such as powdered slippery elm- 
bark, they are likely to be retained by the bowel and absorbed. 

In our experience, when convulsions develop, the case is hopeless. 
All that can be done is to administer full doses of chloral hydrate in 
order to give temporary relief. In cases where paralysis persists beyond 
the third day the outlook is serious, as, although the animal may continue 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA 1365 


to feed, complications are likely to occur, such as pneumonia and exten- 
sive bedsores. Nerve tonics do not appear to exert any beneficial effect. 
We have on several occasions observed excellent results from the hypo- 
dermic injections of adrenalin in doses of 2 drachms of a 1 to 1,000 solu- 
tion of the drug, not only before the case assumes the recumbent position, 
but also when the animal goes down and is unable to rise. In the former 
instance a rapid recovery often results; in the latter the animal may get 
up after a short time. But in other instances this agent proves unsuc- 
cessful. We cannot explain the manner in which beneficial effects are 
produced. We have observed cases in which one hind-limb only was 
affected, and after the administration of one dose of adrenalin the symp- 
toms disappeared. We find that it is advisable to inject the solution 
into the affected muscles. 

In the American Journal of Veterinary Medicine, February, 1914, the 
results of thirty-four cases of azoturia treated with digalen* are given, 
and out of this number twenty-nine recovered. In some of the cases a 
hypodermic injection of morphine was administered twenty minutes 
prior to the digalen. The latter was given subcutaneously in doses of 
15 c.c. twice daily, but in some instances one dose was sufficient. In 
other cases 10 c.c. of a 4 per cent. solution of pantopon (a preparation 
containing all the alkaloids of opium in soluble form) was given in place 
of the morphine. It is advised in severe cases to combine the digalen 
with the pantopon, giving the latter twenty minutes before the former. 
If necessary, the digalen should be prescribed at intervals of six hours 
until the horse is able to rise. 

In cases where weakness of the heart is present Continental authors 
advise hypodermic injections of camphor or caffeine. Cadéac prescribes 
the subcutaneous injection of 20 to 30 grammes of camphor dissolved in 
ether as a cardiac stimulant, also large doses of bicarbonate of soda in 
the food or drinking-water. — 

Hink and Humann recorded good results from the administration of 
+ to 1 pound of sugar repeated several times. Braund claimed to bring 
about 95 per cent. of recoveries by giving 34 to 6 drachms of potassium 
iodide on the first day, and, if necessary, adding 2 drachms additional on 
the second day, also administering subcutaneous injections of eserine. The 
modus operandi of these various agents cannot be satisfactorily explained. 

It is interesting to note that Brunschwikt has observed good results 
from the subcutaneous injections of either air or oxygen gas. 


* Digalen is a proprietary preparation of digitalis, introduced by Hoffman 
La-Roche and Co. 
t Journal de Lyon, 1911. 


1366 SYSTEM OF VETERINARY MEDICINE 


Cadéac advises the intravenous injection of 2 to 3 pints of normal 
saline solution twice daily. In order to overcome the atrophy of the 
muscles, Maris and Ranvier recommend intramuscular injections of 
saturated solutions of sea salt. Injections of 5 grammes of this solution 
are made at two different points; these produce considerable swelling 
on the following day. Strychnine is then injected daily for five days. 
This treatment is said to cause a rapid return of the muscles to a normal 
condition. 

During convalescence from azoturia, gentle exercise 1s indicated and 
careful dieting. 

PREVENTIVE Mrasures.—Horses out of work should be exercised, 
and nitrogenous food should be restricted in amount. In cases where 
exercise is impossible, soft diet is essential, and it is advisable to give 
occasional doses of Epsom salt and bicarbonate of soda. Horses known 
to be predisposed to the disease require special care in dieting, even if 
left idle for one day. Such animals should be suitably clothed when 
sent to exercise after a period of idleness. Recognising the influence of 
cold in the production of the disease, the prevention of exposure to chills 
is of importance. 

Another point worthy of attention is that after a period of rest in the 
stable, horses should not immediately be put to severe or quick work; 
the pace should be gradually increased. It is well known that under 
these conditions horses are very fresh and inclined to exert themselves 
unduly, and it is usually in a short time after leaving the stable that the 
first symptoms of the disease are observed. The influence of sudden 
exertion must not be forgotten. Another matter of extreme importance | 
in the prevention of a severe attack is the recognition of the early symp- 
toms, so that the animal may be immediately placed in the nearest stable, 
suitably clothed, and otherwise treated. 

Finally, we may remark that instances are not uncommon in which 
the disease develops despite every preventive measure, and, as already 
remarked, acute symptoms may be manifested so rapidly that the horse 
assumes the recumbent position before any treatment can be adopted. 
No doubt, when further researches are made with reference to the etiology 
and pathology of the disease, it may be possible to adopt more efficient 
preventive measures. It is not improbable, as in the case of milk fever 
in cows, that a simple line of treatment for azoturia may be discovered 
in the future which will take the place of the diverse and unsatisfactory 
therapeutical measures which are adopted at present. 

Azoturia in Cattle——This is described by Krug, Hartle, Saur, Notz, 
and Baer and Kurtz, in working oxen. The cases occurred in some 


DISEASES OF DOUBTFUL ETIOLOGY: AZOTURIA = 1367 


instances after several days of rest; in others exposure to chills was 
regarded as the etiological factor. The symptoms observed were weak- 
ness in the hind-limbs, disturbances of locomotion, tumefaction and 
hardening of the muscles of the croup or thigh, and a _ brownish- 
red coloration of the urine. In three cases recorded by Notz the 
post-mortem examination showed tumefaction, softening, and a 


bluish-grey discoloration of the muscles of the croup, back, shoulder 
and elbow. 


1368 SYSTEM OF VETERINARY MEDICINE 


II. MILK FEVER. 
By E. Watts Hoarg, F.R.C.V.S., anp D. Imriz, M.R.C.V.S. 


Synonyms.—Parturient paresis; ‘“‘ Dropping after calving”; Par- 
turient apoplexy; Parturient collapse. 

GENERAL REMARKS.—This interesting and important disease is of 
common occurrence In some districts, and comparatively rare in others. 
Although its clinical aspects are very familiar to practitioners, its etiology 
and pathology are as yet unknown. Up to the present time the terms 
applied to it leave much to be desired, as none of them is expressive of 
the phenomena manifested. The term “milk fever” is inappropriate, 
because the affection is not accompanied by a rise of temperature, 
although Hutyra and Marek state that in the early stages a moderate 
degree of fever occurs at times; but the majority of authors and observers 
aetee that when the disease is developed, a subnormal temperature is 
present. The term “ parturient paresis ”’ is, perhaps, more suitable; but 
as there are other affections characterised by paralysis which may be 
associated with parturition, and as there seems to be little doubt that 
the disease depends on some abnormal condition in connection with 
the udder, the designation mentioned is by no means expressive. For 
a number of years the affection was described as “ parturient apoplexy,” 
but such a term is obviously erroneous, as not only are the lesions of 
apoplexy absent, but we are fully aware that the comparatively rapid 
recoveries aS the result of modern treatment negative the presence of 
such a condition. Pages might be filled with a description of the various 
theories advanced to explain the etiology and pathology of milk fever, 
but no useful purpose would be served by drawing attention to them. 
Owing to the eminently successful treatment devised by Schmidt of 
Kolding—viz., inflating the udder with air—the most important problem 
in connection with the disease has been solved. It might be said that 
such treatment is empirical, seeing that we are unable to explain the 
modus operandi of this therapeutical measure in a satisfactory manner. 
Much attention has been devoted to the subject, and attempts have 
been made to ascertain the pathological condition of the udder which 
gives rise to the well-known symptoms of the disease, and various theories 
are brought forward, based on the successful results of the treatment 
mentioned. 

While admitting that we have yet to learn the etiology and pathology 


DISEASES OF DOUBTFUL ETIOLOGY: MILK FEVER 1369 


of the affection and the rationale of the treatment, we must point out 
the great benefits which Schmidt has conferred on the owners of 
cattle and on practitioners by originating a therapeutical measure the 
success of which is world-wide. Up to the time of this discovery the 
losses from milk fever were enormous, and the efforts of practitioners to 
treat the disease successfully were unavailing. So much was this the 
case that the value of professional aid was often doubted, and many 
owners of affected cows either treated the animals with a variety of 
heroic remedies, or sent for the butcher in the early stages of the 
malady. The practitioner was seldom called to attend cases until 
irrational treatment had been tried by the owners. This state of 
affairs is now completely altered. Intelligent owners of cattle recog- 
nise the fact that treatment of this affection by drugs is inimical to 
recovery. One of the results is that practitioners are enabled to study 
and to treat the disease in the early stages, and our clinical knowledge 
of the affection has been largely increased. The most important point, 
however, is that we are now in possession of a successful method of 
treatment, and can attend cases of the disease with a practical certainty 
of successful results. The value of Schmidt’s discovery is probably 
appreciated more by practitioners who have had experience of the mor- 
tality of milk fever prior to 1897 than by those of the present time. We 
have no hesitation in stating that Schmidt deserves the highest honours » 
that could be accorded to him by the veterinary profession and the 
owners of cattle. The results may justly be described as brilliant, and 
the enormous losses which formerly occurred from this disease are now 
a thing of the past. 

History.—The disease is said to have been described by German 
veterinary surgeons at the beginning of the nineteenth century, being 
first mentioned especially by Jorg in 1808 (Hutyra and Marek). <Ac- 
cording to the authors mentioned, the period when the disease received 
attention corresponds to the time when intensive feeding of milch-cows 
was first instituted with the object of increasing the production of milk. 

In 1807 Skellet, an English veterinary practitioner, described milk 
fever in a work entitled “ A Practical Treatise on the Parturition of the 
Cow,” and gave a good clinical description of the disease. 

In a small work, “The New Useful Farrier and Complete Cow- 
Leech,” published by John Price in 1806, the treatment of “ falling after 
calving’ is given, and the therapeutical measure advised is to promote 
sweating by the application of clothing and heat. 

Keith* regarded the disease as depending on an interference with the 

* Veterinarian, 1868, p. 639. 


1370 SYSTEM OF VETERINARY MEDICINE 


secretion of milk, and the treatment advised was the administration of 
opiates. 

McConnell* gave a very lucid description of milk fever, and held 
that the disease depended on “‘ the sudden and total emptying of the 
udder by hand-milking at long intervals,” which brought about anemia. 
of the brain. He advocated the administration of chloral hydrate “ to 
allay the irritability of the vasomotor centre, to remove the morbid 
contraction of the cerebral arteries, and thus allow of a natural supply 
of arterial blood to circulate in the brain.” He claimed sixteen recoveries 
out of twenty cases treated with chloral hydrate. This method was 
largely used, but in many instances it did not prove successful; 
especially in severe Cases. 

In 1897 Schmidt of Kolding published his views on the disease and 
his method of treatment. This appeared as a translation by G. Mayall 
in the Veterinary Record of January 1, 1898. The treatment consisted 
of the injection into the udder of a 1 per cent. solution of potassium 
iodide. The small amount of air which entered the udder during the 
_ procedure was said to prove beneficial by favouring the liberation of 
free iodine. Aloes was administered if the animal was able to swallow, 
and caffeine was given hypodermically as a cardiac stimulant. During 
1898-99 many successful cases were reported in the Veterinary Record, 
and Hunter in that journal showed that chinosol could be substituted 
for potassium iodide with similar results. 

Kniisel of Lucerne, in 1902, introduced the method of insufflating the 


udder with filtered air, and later on he substituted oxygen for air. This — 


method proved more successful than the employment of solutions, and, 
besides, the risks of mammitis were avoided. 

In the present day the insufflation of the udder with air is the method 
adopted by a large number of practitioners, and the results are eminently 
satisfactory. 

OccURRENCE.—The disease is generally regarded as occurring only in 
milch-cows, but several authors have recorded occasional instances in 
goats, sheep, and swine. The affection is met with far more commonly 
in some districts than in others, and on some farms more than on others 
in the same district. A number of cases may occur on the same farm, 
following each other in quick succession, and leading us to suspect a 
microbial origin. We are well aware that some owners of cows never 
encounter the disease, although they do not adopt any of the measures 
which are regarded as capable of preventing the malady. This apparent 
immunity is difficult of explanation. It may also happen that a case of 


* Journal of Comparative Pathology and Therapeutics, 1891. 


DISEASES OF DOUBTFUL ETIOLOGY: MILK FEVER 1371 


the disease appears on a farm for the first time, and the same cow may 
suffer from an attack at the next period of parturition. 

Ertotoey.—Although various theories have been advanced with 
reference to the nature of the disease, nothing definite is known on the 
subject. The success of Schmidt’s treatment has led several authors to 
offer new theories based on the results of therapeutical measures directed 
to the udder. Schmidt suggested that toxins developed in the udder in 
a manner not yet understood, and after absorption into the blood they 
exerted toxic effects on the general system. Delmer attributed the 
disease to the absorption of toxic material from the udder, this material 
being formed by the disintegration of protein substances stimulated by 
some proteolytic ferment. According to Hutyra and Marek, there is a 
possibility that the affection is a form of anaphylaxis brought about by 
the specific protein of the placenta, or possibly of the glandular cells of 
the udder, and that the absorption of considerable amounts of these 
substances produces anaphylactic symptoms. A brief excitation of the 
cortex and of the subcortical centres (principally of the motor centres) 
occurs, and the toxic substance produces a paralysed condition of the 
cerebral functions, and also anemia of the brain, without causing any 
tissue changes in the nervous system. 

Whatever be the explanation of the success attending measures 
directed to the udder, we know that the simple insufflation of air has the 
effect of rendering a delirious animal gradually quiescent, and a semi- 
comatose one conscious. 

In our present state of knowledge it is not desirable to devote further 
space to the theories in: connection with the nature of the condition. 

There are certain predisposing factors which merit attention, but we 
must point out that not infrequently cases are met with in which some 
of these factors appear to be absent; while, per contra, instances are ob- 
served where these influences were present to a marked extent, and yet 
no case of the disease occurred. These factors may be conveniently 
discussed as follows: 

Age.—According to some authors, the great majority of cases occur 
in the fifth to the tenth years of life—that is, in the period after the 
third to the fifth calving—while older cows are attacked but seldom. 
In our experience, it is not uncommon for aged cows to develop the 
disease. | 

According to many observers, the affection is never met with after a 
first parturition, but this view is qualified by other writers. Thus, Fried- 
berger and Frohner state that it rarely develops after a first calving, and 
Jensen found in statistics collected by him that out of 931 cases 0°75 per 


1372 SYSTEM OF VETERINARY MEDICINE 


cent. occurred in cows aged three years. One of us (Imrie) has met with 
typical cases of the disease after a first calving. 

It is regarded as rare after a second parturition. W. Williams records 
two instances, and Archer* states that, when it does occur at this period, 
it is generally in cows that have not been bred from until they were about 
five years old, or when there was a long period between the first and 
second calving. Imrie has met with several instances in cows after a 
second parturition. 

Large Milkers and High Condition.—These are well-known predis- 
posing factors. The deep milker that is highly fed prior to parturition, 
and is in high condition, is specially hable to become attacked by the 
disease. We must point out, however, that the affection is occasionally 
met with in animals in low condition, more especially when they are 
allowed full feeding close to the period of parturition. 

Course of Parturition—More cases are observed after easy births 
than when parturition is difficult, and it is only occasionally that we 
meet with instances under the latter condition. According to Hess, the 
disease occurs only in cows that go to full term, or five to fifteen days 
beyond it. This is not in accordance with our own experience, as we not 
infrequently meet with the affection in cows that have aborted. 

Influence of Weather—Hot weather, especially if rapidly succeeding 
a moderate temperature, is an important predisposing factor, and more 
cases of the disease occur in summer than in winter. In some years we 
meet with a number of cases during the winter months. 

Fatigue succeeding parturition must be recognised as a predisposing 
cause. Thus, a number of cases of the disease are met with in cows 
recently calved that have been purchased by dealers at country fairs, 
and sent long journeys by rail or by road. 

Method of Milking —Mulking the udder dry immediately after par- 
turition predisposes the cow to an attack of milk fever. One of the 
most important preventive measures is to remove the milk gradually. 
It is well known that in many instances the symptoms of the disease 
appear after the first milking. 

Separating the Calf from the Cow.—This is regarded as a predisposing 
factor from two points of view: First, it causes intense nervous excite- 
ment in some cows; then, instead of the gradual withdrawal of the milk 
from the udder by the calf, we have the sudden depletion of the organ 
by the milker. We cannot definitely explain the effect of these factors 
in the production of the disease, but we are aware of the efficacy of 
leaving the calf with the cow as a preventive measure. At the same 

* Veterinary Record, August 5, 1911. 


DISEASES OF DOUBTFUL ETIOLOGY: MILK FEVER 1373 


time, we must admit that it is not uncommon to meet with the disease 
when the calf has been left with the cow. 

Influence of Previous Attacks ——The disease may recur at the next 
parturition. We have evidence of this in the present day, as, owing to 
the efficacy of modern treatment, the owners are not so likely to dispose 
of cows that have suffered from one attack of milk fever as was the case 
in former times. But, on the other hand, it is not uncommon to find 
that a recurrence does not take place. 

Morsip ANatomy.—According to Hutyra and Marek, there are no 
characteristic lesions. They record the following alterations in the 
uterus: The external os uteri is swollen, infiltrated with serum, studded 
with hemorrhages of various sizes, and more or less open. At times 
incomplete involution of the uterus is observed. The uterus contains a 
quantity of a chocolate-brown, reddish, or yellowish odourless fluid. 
The abdominal vessels contain a large amount of blood. The central 
nervous system may show anemia in some cases. Secondary lesions 
may be observed in some instances, such as ruptures of certain 
muscles, portions of ingesta in the air-passages, and evidences of 
inhalation pneumonia. Exceptionally, fractures of certain bones may 
be present. 

Lucet* published the following record of the lesions found in the 
nervous system of a cow that had succumbed to milk fever on the third 
day: The autopsy was made twelve to fifteen hours after death. The 
vessels of the dura mater were distended with dark clots, the cerebro- 
spinal fluid was abundant, the vessels of the pia mater were deeply 
injected and filled with clots. On section of the cord, it was found of a 
red colour. The meningeal vessels of the cerebrum and cerebellum were 
varicose, and distended by dark, firm clots; the cerebral convolutions 
were of a slightly deeper colour than normal; the lateral ventricles con- 
tained a small amount of liquid; the cerebral fluid was very abundant, 
and reddish in colour. On section, the cerebral substance was found 
dotted over with red points, which on pressure yielded each a drop of 
clear red serosity. It is interesting to note that the urine found in the 
bladder showed on analysis 21°83 grammes of sugar, and 2°70 grammes 
of albumin. 

SymproMs.—These may appear in a variable time after parturition, 
in some cases being manifested in twenty to twenty-four hours after the 
act; in others they are not observed until two or three days have elapsed, 
or even several weeks afterwards. Occasionally they develop a short 
time prior to parturition. We have met with cases in which evidences 


* Recueil de Méd. Vét., May, 1891. 


1374 SYSTEM OF VETERINARY MEDICINE 


of the disease were present before the birth of the calf, and continued 
after parturition. 

The clinical picture varies to a great extent. Mild cases are met with 
in which a staggering gait is observed and “ paddling” with the hind- 
feet, and if treatment be adopted at this stage, a rapid recovery may 
result. Some authors state that recovery can occur without treatment, 
even in cases that assume the recumbent position. Hess observed a few 
very severe cases that appeared to be hopeless, which recovered in a few 
minutes after being turned over. 

In many instances the primary symptoms are manifested after the 
first milking succeeding parturition. The animal “ paddles” with the 
hind-feet, hangs its head, staggers if forced to walk, “* knuckles over ”’ in 
the fetlocks of the hind-limbs, and finally falls down. In some cases at 
this stage marked excitement is present. The animal may bellow, and 
rush forward against surrounding objects; the eyes are staring, and 
vision is impaired, or even lost; she falls heavily, and dashes her head 
about, struggles violently with her limbs, and may even succeed in 
rising, but falls again in a helpless manner. These violent symptoms 
continue for a variable period, and are succeeded by a comatose condition. 

In other cases violent symptoms are absent, the cow goes down, 
makes no attempts to rise, and coma sets in early. When in the recum~ 
bent position the following symptoms are observed: Grinding of the 
teeth, bloodshot eyes, spasmodic twitching of the eyelids, profuse lachry- 
mation, dilated pupils, salivation, and inability to swallow. In mild 
cases the animal lies on the sternum, and is able to support her head; 
but in severe cases she lies half-way over on her side, with her feet drawn 
under her body, the head is turned towards one side, and is firmly pressed 
against the shoulder or neck. If it be forcibly placed in the normal 
position and released, it falls back to its former location. In some 
instances the muzzle rests firmly on the ground, and the animal is unable 
to lift the head. In others the cow lies upon her side, with neck stretched 
out, limbs extended, glassy eyes, mouth open, oral breathing, and tym- 
pany of the rumen. The pulse may be full and frequent in the early 
stages, but later on becomes small, soft, and finally imperceptible. The 
respirations become deep and slow, and in the later stages are stertorous, 
owing to vibration of the relaxed soft palate. The temperature, accord- 
ing to some writers, may be elevated to a moderate extent at first; but 
later on it becomes subnormal (96° F.). According to Nelke, the abnormal 
temperature should be attributed to failure of action of the sphincter ani 
muscle, as, when he placed the thermometer sufficiently far into the 
rectum, it always recorded a temperature between 102° and 103° F. 


DISEASES OF DOUBTFUL ETIOLOGY: MILK FEVER 1375 


There is interference with the peristaltic movements of the stomachs 
and intestines, so that tympanites of the rumen sets in, and the feces 
accumulate in the rectum. Retention of urine is generally present. 
According to Continental authors, the urine often contains albumin and 
sugar. Porcher points out that the presence of sugar in the urine is of 
no significance, as healthy cows after parturition often show glycosuria, 
but the sugar is generally in the form of lactose, grape-sugar being less 
frequently found in combination with the former. The secretion of milk 
may not be much interfered with in mild cases, but in other instances it 
is inhibited almost from the commencement. 

McConnell,* pointed out that the staggering gait observed in the first 
stages of the disease depended on cramp and loss of co-ordinate action of 
the muscles of the limbs, especially of the hind ones. He observed that 
this clonic spasm sometimes occurred to such an extent that first one 
hind-limb and then the other was suddenly jerked up close to the abdo- 
men, giving the idea of the presence of colicky pains. When the animal 
was made to move, one hind-leg was suddenly projected in front of the 
fore one, or abducted wide from the body, whilst the other was obstin- 
ately fixed behind and perhaps “ knuckled over ” at the fetlock. McCon- 
nell also described a serious complication which frequently arose at this 
stage—viz., spasm of the muscles of the thigh, generally of the gastroc- 
nemius, and sometimes also of the flexor metatarsi and extensor pedis, 
resulting, if the animal be kept alive, in fibroid degeneration and rapid 
atrophy of the muscular substance. This observer also pointed out that 
true paralysis does not occur until the later stage, as prior to this, when 
the animal lies at full length, all four limbs will be straightened out, and 
they can only be flexed with difficulty, especially the hind-legs. 

CoursE.—This depends on the severity of the case, and the stage at 
which treatment is adopted. By carrying out early treatment the course 
of the disease is greatly modified, and recovery may take place in from 
four to eight hours. By inflating the udder with air while the cow is in 
the standing posture the disease may be cut short, and a rapid recovery 
may result. 

In unfavourable cases deep coma occurs, the respirations become 
stertorous and oral, the lower jaw drops, the eyes are retracted, the 
pupils are often contracted to a marked extent, the pulse is small and 
indistinct, and death soon closes the scene. Occasionally the fatal ter- 
mination is preceded by convulsions. Cases are not uncommon in which 
the coma disappears, the animal is able to hold up her head and take 
food, but permanent paralysis of the hind-limbs occurs. 


* Journal of Comparative Pathology and Therapeutics, vol. iv., 1891. 


1376 SYSTEM OF VETERINARY MEDICINE 


Instances may be observed in which a relapse occurs, the animal after 
standing up and appearing on the road to recovery goes down a second 
time, and all the symptoms return. Occasionally cases are met with 
that succumb suddenly in the absence of any appreciable cause. 

‘SEQUELHZ AND CoMPLIcaTions.—These are various and important, 
but, owing to early and rational treatment, are by no means so common 
in the present day as in former times. Inhalation pneumonia may occur 
within a few days after the disappearance of the paralytic symptoms, or 
during the paralytic stage. It may be due to the entrance of ingesta into 
the bronchi while the animal is in the recumbent position, or it may result 
from attempts of the owner to administer drenches. Permanent paralysis 
is a very annoying sequel, and usually resists every form of treatment. 
Paralysis of the crural nerve is sometimes met with. It may be unilateral 
or bilateral, and temporary or permanent atrophy, and also degeneration 
of the muscles of the thigh (see p. 1375) may occur. Fractures of one 
of the bones of a hind-limb, or of the cranium, or of one of the vertebrae, 
are rare complications. Dislocation of the hip-joit has been recorded. 
Necrosis of the muscles of the thigh has been observed by Thomassen, 
and by Hutyra and Marek. Awde* recorded a case in which lameness 
of one hind-leg persisted after an apparent recovery from milk fever, and 
after a period of forty-six days was followed by sloughing and separation 
of the limb from about 3 inches below the hock. Mammitis was not an 
uncommon sequel when solutions of potassium iodide were employed in 
the treatment of milk fever, and cleanliness was neglected (see Vol. L., 
p. 391). 

Prognosis.—In the absence of complications, and with modern 
treatment carried out early, the prognosis is favourable, the mortality 
being about 10 per cent. according to some authors. But complications 
and sequele may occur in spite of all precautions, and cause a fatal ter- 
mination. The mortality appears to differ in -various localities, some 
practitioners claiming 99 per cent. of recoveries. In districts where 
early treatment is adopted, and the owners recognise the importance of 
avoiding the indiscriminate administration of medicines per os, successiul 
results are far more likely to be obtained. 

It is said that if the disease occurs before, during, or immediately 
succeeding parturition, the prognosis is unfavourable, but this is not our 
experience. McConnell found that if the pupil of one eye was widely 
dilated, and that of the other eye was strongly contracted, it was an 
unfavourable omen. Imrie regards persistence of the recumbent position 
and inability to carry the head, the latter being firmly placed in a spas- 


* Journal of Comparative Pathology and Therapeutics, 1891. 


DISEASES OF DOUBTFUL ETIOLOGY: MILK FEVER 1377 


modic manner against the shoulder or neck, as very unfavourable symp- 
toms. Pneumonia is generally a fatal complication. Instances of milk 
fever occur in which recovery takes place, although the animal is unable 
to rise for two or three days; yet we must regard the prognosis in such 
protracted cases as unfavourable, as complications are liable to set in. 
If the animal is permitted to lie on her side for a long period, there is 
always the risk of regurgitation of ingesta from the rumen occurring, 
and inhalation pneumonia may result. 

Fatigue or exposure to chills is likely to exert an unfavourable influ- 
ence, and the majority of fatal cases, according to our experience, occur 
in recently calved cows purchased by dealers at fairs, and sent long 
journeys by road or rail. We have observed that a flabby shrunken 
condition of the udder is an unfavourable phenomenon, especially when 
it is difficult to inflate the organ with air. Relapses should always be 
regarded as serious, although with careful treatment recovery occurs in 
many instances. We have seen a cow suffer trom three relapses, and 
yet recover; but it is exceptional. It is advisable to give a guarded 
opinion in all cases of milk fever, as mild attacks occasionally terminate 
fatally ; while, on the other hand, an apparently serious case may recover. 

DiFFERENTIAL DiaGNnosis.—In typical cases the diagnosis presents 
no difficulty, but there are many conditions occurring at the period of 
parturition which simulate milk fever, and, moreover, are benefited by 
inflation of the udder, so that a differential diagnosis cannot be carried 
out with facility. Lumbar paralysis and paralysis after parturition (see 
p. 1243) are often treated as milk fever, and success may result. If 
- however, no improvement occurs, some practitioners regard such cases 
as not depending on milk fever. Further investigation on the subject is 
desirable, but at present it seems justifiable to class these affections as 
synonymous with milk fever. 

In recent years cases have been observed which occur several months 
aiter parturition, and present all the phenomena of milk fever. In such 
the inflation of the udder with air often gives good results. Again, we 
are familiar with cases of the so-called ‘“ parturient indigestion ” which 
occur in from one to five weeks after parturition, and are benefited by 
- inflation of the udder (see pp. 390-393). The relation between this affec- 
tion and milk fever has not been definitely established. Some authors 
describe such cases as “‘ chronic gastro-intestinal catarrh after calving,” 
_ and state that inflation of the udder leads to a speedy recovery. 

Imrie has occasionally met with cases in which, after parturition, the 
animal, although possessing a good reputation as a milker, appears dull, 
has a capricious appetite, and does not ‘‘ come to her milk,” but fails to 

VOL. IL. 87 


1378 SYSTEM OF VETERINARY MEDICINE 


show any of the ordinary symptoms of milk fever. In such, inflation of 
the udder with air frequently proves successful treatment. 

TREATMENT.—In the present day the therapeutics of the disease can 
be summed up briefly as follows: The milk should be removed from the 
udder, and the organ should be inflated with air as firmly as possible. 
In order to prevent the air from escaping, the ends of the teats may be 
secured by applying pieces of tape. The latter should be removed in 
two hours. After inflation, the surface of the udder should be gently 
massaged, so as to diffuse the air in the organ. The cow must now be 
packed up by means of bags filled firmly with straw, etc., so that she 
will lie in a normal position on the sternum, and she should be turned 
from side to side every three or four hours. Care is necessary to see that 
the hind-limbs and the udder are not subjected to undue pressure from 
the weight of the body. The beneficial effects of this treatment may be 
apparent in four or five hours in some cases; in others twelve hours or 
longer may elapse before the cow rises of her own accord. In cases 
characterised by delirium, the treatment exerts a calmative effect; while 
in those showing evidences of coma, a return to consciousness is gradually 
observed. The best instrument for inflating the udder is the foot-pump 
made by Hauptner. Itis simple and rapid in action. An air-filter may 
be added if thought desirable, but we have always found that ordinary 
air produces the desired result. The important matter is to insure asepsis 
of the teat siphon, and to inflate the udder as firmly as possible. There 
is no necessity for a complicated apparatus. 

If the cow does not rise of her own accord in six or eight hours, the 
inflation of the udder should be repeated; in fact, this procedure should 
be repeated at intervals until the animal gets on her feet. The udder 
should not be interfered with for twelve to fifteen hours after the cow 
seems convalescent, and then only a small amount of milk is to be ze- 
moved at intervals for two or three days, as milking dry is likely to be 
followed by arelapse. Attention to diet is also necessary. Small feeds 
only should be allowed, and the animal must be kept indoors in a loose 
stall for a few days. Neglect of these precautions, especially in hot 
weather, often results in a relapse, and all the symptoms return. In 
such instances the treatment must be repeated. We have often found 
that the hypodermic injection of 2 drachms of adrenalin (1 to 1,000) 
acts as a valuable auxiliary to the air treatment. One of the most 
serious sequels of the disease is paraplegia, as it often proves resistant _ 
to treatment. Occasionally the administration of strychnine by subcu- 
taneous injection and the application of counter-irritants to the spine 
prove successful. In protracted cases attempts should be made from 


DISEASES OF DOUBTFUL ETIOLOGY: MILK FEVER 1379 


time to time to get the animal on her feet by means of mechanical 
support. 

Many practitioners hold that drenches should never be given at any 
stage of milk fever. The peristaltic action of the intestines returns when 
the animal regains her feet, hence purgatives are not necessary. Imrie, 
however, prescribes chloral hydrate in cases characterised by marked 
excitement, and claims good results. By its use the inflation of the 
udder can be more readily carried out, and it constitutes a safe form of 
first-aid treatment until the arrival of the practitioner. In some instances 
the use of the catheter is required to relieve the bladder. 

Pneumonia usually proves fatal, in spite of treatment. 

Some practitioners prefer oxygen gas to air for inflation of the udder, 
and claim quicker and better results. 

PROPHYLAXIS.—Many measures have been suggested for the preven- 
tion of milk fever, but it is not uncommon to find that cases occur in 
spite of these precautions. Owing to the success of the modern treat- 
ment of the disease, preventive measures do not receive much attention 
in some districts at present. As previously remarked, we are quite 
aware that in some parts of the country no means of prevention are 
adopted, and yet the disease is seldom seen. Two measures seem worthy 
of adoption—viz., avoidance of high feeding prior to parturition, and not 
milking dry for some days afterwards, but withdrawing the milk in small 
amounts at intervals. Some owners of cattle leave the calf with the cow 
for a few days, and claim this as a preventive measure; but cases occur 
even with this precaution. Moreover, it has the disadvantage of render- 
ing the calf unwilling to take milk in the ordinary way when removed 
from the cow, while the latter is inclined to “hold her milk” in some 
instances for some time after the calf has been taken away. Some 
owners advise that when the udder is full of milk prior to parturition a 
certain amount should be withdrawn; others condemn any interference 
with the udder at this stage. 

In our opinion the gradual milking of the cow after parturition is an 
important preventive measure, as we have frequently seen the first symp- 
toms of the disease manifested after the first milking subsequent to 
calving. | 

Finally, we may remark that owners of cattle should watch carefully 
for the premonitory symptoms of the disease, so that treatment can be 
adopted as early as possible, even before the cow goes down. The earlier 
the treatment, the shorter is the course of the disease, and the less likely 
is the secretion of milk to be interfered with—a matter of great import- 
ance to the cowkeeper and dairyman. We have not observed that sub- 


1380 SYSTEM OF VETERINARY MEDICINE 


sequent attacks of the disease are modified either in severity or other 
wise, so that no great risk follows the keeping of a cow which has suffered 
from the affection. 

Railroad Sickness.—This affection has been described by various Con- 
tinental observers, and recently Schmidt has made a special study of it. 
It occurs in cows far advanced in pregnancy, and also in animals in fat 
condition, either during or subsequent to a long journey by rail, asso- 
ciated with hot weather and a lack of food and water. Schmidt found 
that it occurred chiefly in pregnant animals just brought up from pasture. 
He formed the opinion that the affection depended on anemia of certain 
organs, owing to increased muscular activity during railway transport, 
which caused an increased flow of blood to the muscles of the body and 
extremities and to the skin, and in advanced pregnancy to the uterus 
and udder. When this condition continues beyond twenty-four hours, 
vasomotor paralysis occurs, also fever. There are no characteristic lesions 
found on post-mortem examination. 

The symptoms may occur during the journey or subsequently. They 
resemble the phenomena observed in milk fever, but the temperature 
varies from 101° to 103° F. Straining not depending on parturition may 
occur, and the udder contains a considerable quantity of normal milk. 
Similar treatment to that advised for milk fever proved successful. 

We are not aware if this affection is met with in the British Isles, but 
from the description given by Continental authors it is highly probable 
that it would be regarded as milk fever occurring previous to parturition, 
and would be treated as such. 


DISEASES OF DOUBTFUL ETIOLOGY: LYMPHANGITIS 1381 


III. LYMPHANGITIS. 
By E. Watuis Hoare, F.R.C.V.S. 


Synonyms. — Inflammatory oedema; Weed; ‘‘Monday morning 
disease.”’ 

GENERAL REeMARKS.—This is a constitutional affection of equines, 
chiefly occurring in heavy draught-horses, and characterised by the 
presence of fever of a sthenic type, and an acute inflammation of the 
lymphatic vessels and glands of usually one hind-limb, causing marked 
lameness and extensive oedema in the affected extremity. 

The disease possesses certain characteristics, which serve to distin- 
guish it from what is known as ordinary or traumatic lymphangitis. 
The latter depends on infection of a wound or abrasion of the skin by 
septic material, which produces inflammation of the lymphatics and of 
the surrounding tissues. In the affection under consideration the con- 
stitutional disturbance appears prior to, or immediately before, the 
development of the local manifestation. A period of rest, during which 
the animal is fed as usual, is generally one of the features in the history 
of the case, and one hind-limb usually shows the characteristic swelling. 
The disease has been termed the “‘lymphangitis of plethora,’’ and this, 
-no doubt, is descriptive of many cases. Heavy horses, well fed, and 
accustomed to hard work, furnish many instances of the affection when 
from any cause they are left idle for a varying period of time; but it is 
also met with in horses out of condition when they are suddenly changed 
in their surroundings, and put on high feeding to which they are un- 
accustomed. Thus, we meet with cases in country horses purchased for 
work in cities, when the animals are allowed full amounts of nitrogenous 
diet, instead of the change being made a gradual one. 

ErioLogy.—Although we are aware of the circumstances under which 
an attack of lymphangitis is likely to occur, we cannot explain in a satis- 
factory manner the causation of the affection. It is quite clear that 
further investigation is necessary in order to ascertain why high feeding 
and a period of idleness will in some horses produce the characteristic 
symptoms. Under similar conditions in other horses azoturia may 
occur, but generally not until the animal has been put to work; while in 
lymphangitis the symptoms are manifested in the stable. Again, there 
are many horses in which unlimited idleness and high feeding may not 
produce either of the affections. 


1384 SYSTEM OF VETERINARY MEDICINE 


tion for the latter to aggregate in masses. We have no definite know- 
ledge, however, of any changes occurring in the blood in this disease. 

Symproms.—lIn typical cases, at the commencement of an attack, well- 
marked rigors occur, accompanied by a varying degree of fever. The 
pulse is full and rapid, the respirations hurried and laboured, appetite is 
lost, and there is a general appearance of distress in the patient. Con- 
stipation and a scanty secretion of urine are present. There is dis- 
inclination for movement, and well-marked lameness is observed, usually 
in one hind-limb. Occasionally both hind-limbs are affected, or the 
disease may be located in a fore-limb, but this is rare. Some observers 
have found that the left hind-limb was most commonly attacked. 

Very frequently the practitioner does not see the case until the rigors 
have passed off. Thus, the attack may have commenced in the night, 
and the swollen limb and lameness may be the prominent symptoms 
presented next morning. If the case be seen in the early stages, only 
the constitutional symptoms may be observed, and it may happen that 
no local symptoms are presented at this stage; hence a definite diagnosis 
may be impossible. 

Usually, however, the constitutional symptoms are seen either | 
shortly before or concomitant with the local manifestation. When the 
animal is forced to move, the lameness is characterised by marked abduc- 
tion, and in severe cases little weight can be borne by the limb. 

Examination of the inguinal region and of the inside of the thigh 
shows the lymphatic glands hot, swollen, and acutely painful to even 
slight pressure, and on palpation being applied, the affected limb will 
be sharply abducted to such an extent that the animal threatens to fall 
over on the sound side. 

In a short period the rigors disappear, and what is termed the “ hot 
stage’ ensues. The swelling extends down the inside of the thigh, at 
first in a narrow line or distinct ridge along the course of the lymphatics. 
This steadily increases in width, extends over the greater part of the inside 
of the limb, reaches to the hock, and from thence to the foot. In the 
region from the hock to the foot both sides of the limb are involved by 
the swelling. | 

In severe cases general slight sweating may be observed, and a 
moderate serous exudation may be found on the inside of the limb, and 
especially on the flexures of the hock and pastern. The lower part of 
the limb becomes very much swollen, also the region of the inside of the 
thigh. The swelling is hot and painful to pressure, and retains the im- 
print of the finger in the region of the thigh. The swollen and distended 
lymphatic vessels appear in the form of tender rounded cords, extending 


DISEASES OF DOUBTFUL ETIOLOGY: LYMPHANGITIS 1385 


upwards towards the inguinal glands, but when the swelling is fully 
developed, it conceals the enlarged lymphatics. The pain and lameness 
persist until the local symptoms have reached their full development, 
when an improvement is observed. 

When the local symptoms develop in a fore-limb, the brachial lym- 
phatic glands are first involved. In some cases restlessness or even 
colicky pain may be observed in the early stages of the disease. 
W. Williams met with cases due to overfeeding with rye-grass, in which 
a condition approaching to diarrhea was present, in addition to the 
usual symptoms. He also described instances of the disease occurring 
in horses that showed loss of appetite for several days prior to the 
development of symptoms, and he believed that in such cases a highly 
fibrinous condition of the blood was present.* 

In very severe cases, especially in those that continue longer than 
usual, and when the cedema extends to the abdomen and sheath, or, if in 
amare, to the mammary gland, suppuration may occur in the lymphatic 
glands, generally those in the inguinal region being affected; or dis- 
seminated abscess may form in the subcutaneous connective tissue, 
chiefly on the inside of the limb or in the vicinity of joints. 

Milder forms of the disease may be met with. The constitutional 
symptoms and fever are slight, lameness is present in one hind-limb, 
the swelling is not extensive, but the inguinal lymphatic glands are 
enlarged and tender to the touch. 

Course.—Usually the constitutional and local symptoms reach their 
height in from twenty-four to forty-eight hours. The fever and pain 
then gradually subside, but the swelling of the affected limb remains for 
a longer period, as the absorption and removal of the exudate is not a 
rapid process. In recurring attacks, the vascular structures and con- 
nective tissue of the limb become weakened, and a portion of the exudate 
becomes organised, so that permanent enlargement results. Complica- 
tions, such as enteritis and pneumonia, are rarely met with. 

Prognosis.—Lymphangitis rarely proves fatal. The permanent en- 
largement of the limb which is likely to follow a very severe attack 
or a series of attacks, seriously affects the market value of the animal. 
The prognosis should be guarded with reference to the probability of 
the limb returning to its normal state. A recurrence of the affection 
may generally be expected if the animal be exposed to the conditions 
already mentioned. 

DIFFERENTIAL D1aGNosis.—This is based on the history of the case, 
and on the mode of development and characteristics of the local symptoms. 


* «The Principles and Practice of Veterinary Surgery.” 


1386 ‘SYSTEM OF VETERINARY MEDICINE 


From Purpura Hemorrhagica, lymphangitis is distinguished by the 
absence of petechie on the visible mucous membranes, and of the charac- 
teristic swellings in the region of the head, nostrils, and throat. Alsothe 
swelling of the extremity in purpura ceases abruptly as if a ligature 
had been applied to the limb, and it may start on any portion of the 
surface in the form of circumscribed patches (see Vol. I., p. 875). 
Moreover, purpura usually occurs as a sequel to affections such as influ- 
enza. 

From Erysipelas, lymphangitis is distinguished by the character of 
the swelling, and by its mode of origin from the inguinal lymphatic 
glands. In erysipelas the pain is far more acute in comparison to the 
extent of the swelling, and the latter spreads in a characteristic manner 
(see Vol. I., p. 254). 

From Cutaneous Glanders (Farcy).—For the differential diagnosis, see 
Vol. L., p. 84. 

From Epizodtic Lymphangitis—For the differential diagnosis, see 
Vol. I., p. 1298. : 

PROPHYLAXIS.—Much can be done by attention to dietetics and 
exercise in the prevention of this disease. Recognising the frequency 
with which permanent thickening of the limb remains as a sequel, it is 
clear that preventive measures are of importance. When from any 
causes horses are left idle in the stable, the quantity of nitrogenous food 
should be limited in amount, and diet of a soft laxative nature allowed 
instead. Horses from the country, when purchased for city work, 
should be carefully dieted, so as to get their systems accustomed to 
nitrogenous food. The change should’ be a gradual one, otherwise an 
attack of lymphangitis is likely to be induced. In horses that have once 
suffered from an attack extra precautions are necessary, aS even one 
day’s idleness with full feeding may cause a recurrence of the affection. 
When idleness is unavoidable, the administration of small doses of 
Epsom salt, with bran and linseed mashes, will assist in keeping the 
excretory functions normal, and thus prevent an attack. 

TREATMENT.—If the case be seen in the early stages, with rigors and 
febrile symptoms present, mild diffusible stimulants should be prescribed, 
such as solution of acetate of ammonium combined with sweet spirit of 
nitre. These should be repeated every three or four hours until the 
rigors disappear. In plethoric subjects, with a full strong pulse, and 
pain as a prominent symptom, aconite may be combined with the above. 
A full dose of aloes and calomel will also be indicated, provided the pulse 
be strong. Full doses of purgatives are condemned by some authors as 
being likely to induce enteric and pulmonary complications, or laminitis. 


DISEASES OF DOUBTFUL ETIOLOGY: LYMPHANGITIS 1387 


Diuretics, such as potassium nitrate combined with colchicum, should 
be given in the food after the purgative has acted. Venesection is 
highly spoken of by some practitioners in the treatment of this affection. 
Others have not found that it exerts any beneficial effect on the progress 
of the disease. Exercise should not be ordered until the animal is able 
to use the limb. It then proves beneficial, and assists in promoting 
absorption of the exudate. 

As regards local treatment, some practitioners advise hot fomenta- 
tions; others claim better results from cold. If hot water be selected, 
care should be taken that it is of a proper temperature, so as not to 
injure the skin. After fomenting, a soft hay band should be loosely 
applied to the limb as high up as possible. ‘ 

If cold water be preferred, the hay band may first be applied, and the 
water then poured at intervals between the limb and the band. The 
application of glycerine of belladonna relieves the pain. When the 
urgent symptoms are lessened, and exercise can be given, the above 
treatment is to be discontinued, and gentle massage applied to the limb. 
An astringent lotion, such as equal parts of Goulard extract and water, 
may be applied, and the part covered with cotton-wool and a bandage. 
In order to assist absorption of the exudate, iodide of potassium should 
be given twice daily in the food. The diet should be light and easily 
assimilated. In chronic cases, when permanent thickening of the limb 
results, treatment has very little effect. 

When suppuration occurs during the course of the disease, the case 
must be treated on ordinary surgical principles. The injudicious and 
excessive employment of hot fomentations is especially to be guarded 
against as likely to favour sloughing of the skin and subcutaneous 
tissues. | 


1386 ‘SYSTEM OF VETERINARY MEDICINE 


From Purpura Hemorrhagica, lymphangitis is distinguished by the 
absence of petechize on the visible mucous membranes, and of the charac- 
teristic swellings in the region of the head, nostrils, and throat. Alsothe 
swelling of the extremity in purpura ceases abruptly as if a ligature 
had been applied to the limb, and it may start on any portion of the 
surface in the form of circumscribed patches (see Vol. I., p. 875). 
Moreover, purpura usually occurs as a sequel to affections such as influ- 
enza. 

From Erysipelas, lymphangitis is distinguished by the character of 
the swelling, and by its mode of origin from the inguinal lymphatic 
glands. In erysipelas the pain is far more acute in comparison to the 
extent of the swelling, and the latter spreads in a characteristic manner 
(see Vol. I., p. 254). 

From Cutaneous Glanders (Farcy).—¥or the differential diagnosis, see 
Vol. L., p. 84. 

From Epizostic Lymphangitis—For the differential diagnosis, see 
Vol. I., p. 1298. 

PROPHYLAXIS.—Much can be done by attention to dietetics and 
exercise in the prevention of this disease. Recognising the frequency 
with which permanent thickening of the limb remains as a sequel, it is 
clear that preventive measures are of importance. When from any 
causes horses are left idle in the stable, the quantity of nitrogenous food 
should be limited in amount, and diet of a soft laxative nature allowed 
instead. Horses from the country, when purchased for city work, 
should be carefully dieted, so as to get their systems accustomed to 
nitrogenous food. The change should’ be a gradual one, otherwise an 
attack of lymphangitis is likely to be induced. In horses that have once 
suffered from an attack extra precautions are necessary, aS even one 
day’s idleness with full feeding may cause a recurrence of the affection. 
When idleness is unavoidable, the administration of small doses of 
Epsom salt, with bran and linseed mashes, will assist in keeping the 
excretory functions normal, and thus prevent an attack. 

TREATMENT.—If the case be seen in the early stages, with rigors and 
febrile symptoms present, mild diffusible stimulants should be prescribed, 
such as solution of acetate of ammonium combined with sweet spirit of 
nitre. These should be repeated every three or four hours until the 
tigors disappear. In plethoric subjects, with a full strong pulse, and 
pain as a prominent symptom, aconite may be combined with the above. 
A full dose of aloes and calomel will also be indicated, provided the pulse 
be strong. Full doses of purgatives are condemned by some authors as 
being likely to induce enteric and pulmonary complications, or laminitis. 


DISEASES OF DOUBTFUL ETIOLOGY: LYMPHANGITIS 1387 


Diuretics, such as potassium nitrate combined with colchicum, should 
be given in the food after the purgative has acted. Venesection is 
highly spoken of by some practitioners in the treatment of this affection. 
Others have not found that it exerts any beneficial effect on the progress 
of the disease. Exercise should not be ordered until the animal is able 
to use the limb. It then proves beneficial, and assists in promoting 
absorption of the exudate. 

As regards local treatment, some practitioners advise hot fomenta- 
tions; others claim better results from cold. If hot water be selected, 
care should be taken that it is of a proper temperature, so as not to 
injure the skin. After fomenting, a soft hay band should be loosely 
applied to the limb as high up as possible. 

If cold water be preferred, the hay band may first be applied, and the 
water then poured at intervals between the limb and the band. The 
application of glycerine of belladonna relieves the pain. When the 
urgent symptoms are lessened, and exercise can be given, the above 
treatment is to be discontinued, and gentle massage applied to the limb. 
An astringent lotion, such as equal parts of Goulard extract and water, 
may be applied, and the part covered with cotton-wool and a bandage. 
In order to assist absorption of the exudate, iodide of potassium should 
be given twice daily in the food. The diet should be light and easily 
assimilated. In chronic cases, when permanent thickening of the limb 
results, treatment has very little effect. 

When suppuration occurs during the course of the disease, the case 
must be treated on ordinary surgical principles. The injudicious and 
excessive employment of hot fomentations is especially to be guarded 
against as likely to favour sloughing of the skin and subcutaneous 
tissues. 


1388 SYSTEM OF VETERINARY MEDICINE 


IV. RHEUMATISM. 
By E. Wauuis Hoare, F.R.C.V.S. 


GENERAL ReMarKS.—Under the heading of rheumatism are usually 
included a number of affections, all of which possess certain character- 
istics in common. These characteristics are a tendency for the diseases 
to attack the limbs, and to produce lameness of various degrees, the 
lesions being located in joints, muscles, tendons, fascie, and fibrous 
tissues, and depending on inflammation arising in these structures from 
causes which are still obscure. There is also a tendency for the inflam- 
mation to subside in one region, and to appear in another (metastasis). 
In one form (acute articular rheumatism) lesions of the heart and serous 
membranes frequently occur. Again, the rheumatic complications of 
influenza would come under the heading of rheumatism, although their 
exact mode of development under such conditions is not yet under- 
stood. 

The pyemic arthritis which may occur in affections such as “‘ joint- 
ill,’ metritis, and mammitis, presents symptoms simulating rheumatism ; 
but on clinical and pathological grounds they should be differentiated 
from the latter affection. Similar remarks apply to the muscular lesions 
which occur in that disease known as “‘azoturia,”’ and are by some observers 
regarded as rheumatic in character. Also the inflammation of muscles 
due to overfatigue, although clinically resembling rheumatic myositis in 
some cases, must be regarded:as distinct from rheumatism. 

Forms of Rheumatism.—Acute Articular Rheumatism is by many 
authorities regarded as an acute infectious disease depending on an 
unknown infective agent. 

Chronic Rheumatism, which may occur as a sequel to an acute attack, 
or may arise in an insidious manner. It is a term which is rather loosely 
applied to obscure forms of lameness. 

Muscular Rheumatism, in which the voluntary muscles of various 
regions of the body are attacked by the disease. 

Acute Articular Rheumatism in the Horse—Synonym.—Rheumatic 
fever. 

This is an acute febrile disease, probably depending on an infectious 
agent, whose nature is as yet unknown. The local manifestations con- 
sist of an acute inflammation of certain joints which is metastatic in 
character, and there is a marked tendency to cardiac complications. 


DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1389 


Acute articular rheumatism per se is not a common disease in horses. 
No doubt the rheumatic complications which are met with in influenza 
resemble both clinically and pathologically the affection we are dis- 
cussing. But clinical experience teaches us that, independent of influ- 
enza, we occasionally meet with typical cases of rheumatic fever in the 
horse. The disease is more frequently met with in cattle, and next to 
these in dogs and pigs. In works on human medicine the affection is 
placed under the heading of infectious diseases, the reason for which we 
shall presently consider. If rheumatic fever be definitely proved to 
depend on a micro-organism, it seems likely that the other forms—viz., 
chronic rheumatism and muscular rheumatism—will be found to be also 
microbial in their origin. 

EtroLogy.—Formerly, exposure to cold, chills, and damp was re- 
garded as the chief cause of the disease, but in the present day such in- 
fluences are believed to be predisposing factors. Various theories have 
been brought forward to explain the etiology of the affection, in addition 
to the influence of cold and damp, but of all these the view that the 
disease depends on the presence of a micro-organism seems the most 
plausible. The phenomena peculiar to the malady—viz., the character 
of the fever, the involvement of the joints, the tendency to relapses, the 
liability to endocarditis, and implication of serous membranes—suggest 
an infectious disease, and resemble a pyeemic affection. 

The specific micro-organism has not yet been discovered. Researches 
have been conducted by various human pathologists, but the matter is 
still swb judice. Poynton and Payne, Walker, Beattie, and others, 
obtained organisms from the joint-fluid, the pharynx, the endocardial 
vegetations, and sometimes from the blood, of cases of rheumatic fever 
in man, and on inoculating animals with these, typical symptoms and 
lesions of the disease were produced. Beattie isolated a micro-organism 
which he termed the Micrococcus rheumaticus. Organisms isolated from 
the tonsils in affected human beings, and injected into animals, produced 
arthritis and endocarditis. According to Osler, there is considerable 
evidence against the view that the disease is simply a mild pyogenic 
infection. Thus, salicylates have no effect on ordinary streptococcus 
infections, and the clinical course in streptococcic arthritis is very dif- 
ferent; moreover, rheumatic joints never suppurate. The streptococci 
which have been isolated may be secondary invaders. 

As regards the cases of so-called rheumatic fever in cows, occurring 
after parturition, and said to depend on retention of the placenta, it is 
extremely doubtful if such should be regarded as rheumatic in character. 
Some authors term this condition “ puerperal polyarthritis.” 


A 


1390 SYSTEM OF VETERINARY MEDICINE 


In our experience, acute articular rheumatism more commonly 
attacks young animals, while muscular rheumatism and the chronic type 
occur more frequently in the aged. 

One attack does not confer immunity. There is a tendency for the 
disease to recur, generally in a subacute or chronic form. : 

Morsip ANATomy.—Rheumatic fever rarely proves fatal per se ; the 
majority of fatal cases depend on cardiac complications, pneumonia, or 
pleurisy. The chief lesions are found in the articulations, the adjacent 
tendons, synovial sheaths, and burse; also in the heart, pericardium, 
and pleure. There are no special characteristics in the various morbid 
changes produced by the disease. 

Articular Lesions.—Usually several joints are involved. These may 
be symmetrically affected in the fore or hind limbs, or may be attacked 
in an irregular manner. The joints most frequently affected in the horse 
are the fetlock, the elbow, the shoulder, the stifle, and the hock. The 
lesion is a serous synovitis. The swelling produced varies in extent, the 
distension of the capsule of the joint being due to an increase of synovia, 
also to the presence of a sero-cellular fluid. But the swelling, when well 
marked, depends more on an infiltration of the tissues around the joint 
(periarticular) with serum than on effusion into the joint, as it is rare 
to find the latter excessive. The adjoining tendons and tendon sheaths 
are also involved in the inflammatory process. Usually all the structures 
constituting the joint are implicated, but the synovial membrane is 
specially affected. In mild cases this membrane is but slightly con- 
gested, but in severe attacks it 1s swollen, hyperemic, opaque, and of a 
reddish colour, and the synovial villi are very vascular and enlarged. 
It may show extensive infiltration with a sero-gelatinous fluid. The 
lesions are best marked at the line of attachment of the membrane to 
the articular surface, and in the synovial fringes. The synovia is in- 
creased in amount, turbid, albuminous, and may contain flakes of lymph, 
also leucocytes. Occasionally it may be of a reddish colour. 

False membranes may be present, either floating or adherent to the 
surrounding parts. These may become organised, and interfere with 
free movement of the joint. Pus is never met with in uncomplicated 
cases. If present, it is due to a mixed infection. The cartilages become 
involved subsequent to the lesions of the soft structures. They are first 
congested, either in a uniform or in a ramified manner, and are of a 
reddish colour, which later on alters to a yellow tint. Softening, absorp- 
tion, erosion, and ulceration, may occur, the ulcers varying in extent. 
The articular ends of the bones may be hyperemic, infiltrated with 
hemorrhages, and the medullary portion may show similar changes, 


DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1391 


Occasionally the adjacent tendons may undergo softening, and cases of 
rupture of a tendon have been recorded. The tendon, and also the 
ligaments of the joint, may be adherent to the surrounding subcutaneous 
connective tissue. 

Alterations in the Blood.—Some authors describe marked alterations 
as occurring early in the blood, such as an excess of fibrin and an increase 
in the number of leucocytes. No acidity has been found in the blood, 
except in very rare Cases, 

Cardiac Lesions.—These consist of endocarditis, pericarditis, and myo- 
carditis. There are no special features to distinguish the lesions from 
those met with in ordinary inflammation of these structures. In those 
cases of rheumatic fever that terminate fatally during the height of the 
disease, marked lesions of endocarditis may be found at the autopsy. 
More frequently, however, the primary attack passes off, leaving the 
affected cardiac valves slightly damaged. The resulting alterations in 
the valves frequently lead to future sclerosis and retraction of the seg- 
ments, and thus to chronic valvular disease. Although cardiac lesions 
are usually regarded as complications of the disease, some authorities 
believe that the heart may be attacked prior to the occurrence of articular 
lesions. 

Endocarditis is the most-frequent lesion met with, and also the most 
serious. The mitral valve is involved in by far the larger number of 
instances; In some cases both aortic and mitral lesions are combined. 
The lesion of the valves is of the simple verrucose variety, ulcerative 
endocarditis being very rare. 

Severe endocarditis causing death is not commonly met with in 
rheumatic fever in horses, but is more frequent in cattle. | 

Pericarditis may accompany the endocardial lesions, or may exist 
independently of the latter, but is not so frequently met with. It may 
be of the simple fibrinous variety, or sero-fibrinous. Lffusion is not as a 
rule extensive. Itis rarely purulent, except when depending on a mixed 
infection. 

Myocarditis is not so common as the lesions mentioned above. It is 
believed to be an extension of the inflammatory action from the peri- 
cardium and endocardium. The cardiac muscle undergoes granular or 
fatty degeneration, which leads to weakening of the cardiac walls and 
dilatation of the heart. 

Pneumonic and Pleuritic Lesions may occur as an extension from 
pericarditis. It has been observed that in rheumatic fever, pleurisy and 
pneumonia are found to occur more frequently when both pericarditis 
and endocarditis are combined (endo-pericarditis). In the rheumatic 


4 


1392 SYSTEM OF VETERINARY MEDICINE 


complications of influenza and contagious pneumonia, cardiac lesions 
may accompany or follow the pleuritic and pneumonic lesions. Occa- 
sionally acute pulmonary congestion may occur during the course of 
theumatic fever. . 

Cerebro-Spinal Lesions are occasionally met with. Meningitis is 
rare, but may occur in those exceptional cases where the ulcerative form 
of endocarditis accompanies rheumatic fever. 

Congestion of the pharyngeal mucous membrane is sometimes ob- 
served, also congestion of the gastro-intestinal mucous membrane. 
Peritonitis is a rare complication. 

Symptoms.—Rheumatic fever may be accompanied by muscular 
rheumatism, and it is not always easy to distinguish these two forms 
clinically. The symptoms usually appear suddenly; occasionally they 
may be preceded by rigors. , 

The prominent symptoms are fever, lameness in one or more limbs, 
and a painful swelling of one or more joints. The temperature rises 
quickly, reaching from 102° to 105° F. Occasionally hyperpyrexia may 
occur, and the temperature may reach 107° or 108°; but this is by no 
means so commonly met with in animals as in man. The elevation of 
temperature may precede the articular symptoms, but usually both 
occur concurrently, and generally the height of the fever is in direct 
ratio to the severity of the articular affection. Occasionally the fever 
may not appear for some days after the occurrence of articular symp- 
toms. The fever is usually irregular, with marked remissions, which 
depend on the exacerbations of the articular inflammation and on the 
extent of the latter. The usual constitutional symptoms accompanying 
acute fever are present—viz., loss of appetite, thirst, constipation, and 
scanty, high-coloured urine of high specific gravity. According to 
W. Williams, the urine is acid in reaction. 

The pulse is frequent and of a hard character, the respirations are 
accelerated, restlessness 1s present, and an anxious expression of coun- 
tenance, due to acute pain. When the animal is forced to move or to 
turn round sharply he grunts, and cardiac palpitation may be observed 
Evidences of marked anemia are present in many cases. 

The jomts usually affected are, as already mentioned, the fetlock, 
hock, knee, stifle, elbow, and hip. It is rare to find the disease limited 
to one joint. The joints are often attacked in a bilateral manner, and 
the adjacent tendons and synovial burse are freqently involved. A 
special character of the disease is the tendency to metastasis. If one 
joint be first affected, the evidences of the disease may rapidly disappear 
from it, and another joint may become involved, perhaps in another 


DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1393 


region of the body. The affected joints are swollen and very tender to 
pressure, and the pain and lameness are acute. The swelling and tender- 
ness to palpation are not apparent when joints well covered by muscles 
are involved, such as the shoulder, elbow, or hip. The swelling is 
usually tense, and extends around the joint. Occasionally it may be 
soft, or it may be cedematous and may pit on pressure. When the 
tendinous sheaths are involved, the course of the tendons is rendered 
prominent, and they are very sensitive to pressure. The pain is not 
relieved by the advent of swelling, and handling or movement of the 
affected joint renders the pain more severe. Both pain and swelling are 
subject to remissions and exacerbations. The muscles in the vicinity 
may be involved, and we have then a combination of the symptoms of 
muscular and articular rheumatism. In rare cases swelling may be 
absent, lameness and tenderness being the only evidences present. The 
lameness may be excessive, and in some cases no weight can be borne 
by the affected limb, so that it may resemble a case of fracture. All 
movement of the affected part is avoided as much as possible, and the 
animal prefers the standing posture, the limb being held in a semi-flexed 
position. Sometimes a “cracking” sound is heard when the limb is 
moved, but this is more common in chronic cases. The cause of this 
sound has not been definitely ascertained. 

In very severe cases the animal lies down, and can only be made to 
rise with great difficulty, or may assume the recumbent position per- 
sistently. 

The fetlock-joint and sesamoid bursa are especially liable to be 
attacked. In such an instance the swelling may extend both up and 
down the leg, the chief pain being manifested in the region of the joint 
and in the tendons and bursa of the sesamoid region. In the knee- 
joint the carpal sheath and the burse in the vicinity are swollen and 
distended as well as the joint itself; the swelling also extends down- 
wards. In the hock-joint, in addition to swelling of the inside of the 
articulation, the tarsal sheath and sometimes the “cap” of the hock 
are involved. In the shoulder-joint the biceps muscle and its bursa 
over the bicipital grooves of the humerus are involved, causing a swelling 
to appear in the region of the joint. In the hip-joint the bursa of the 
middle gluteus is involved, causing an ill-defined swelling over the region 
of the articulation. In the stifle-joint the patellar capsule 1s involved, 
and occasionally the sheath of the flexor metatarsi. In the elbow-joint 
the sheaths of the flexor and extensor tendons may be involved, causing 
swelling and tenderness along their course. 

Comptications—Endocarditis.—In some cases but few symptoms of 

VOL, II. 88 


1394 SYSTEM OF VETERINARY MEDICINE 


this condition may be present, and its existence is likely to be over- 
looked unless the heart be carefully examined. The damage to the valve 
is in such cases slight at the time, but afterwards it may lead to a chronic 
valvular affection. In other cases the pulse becomes irregular and 
intermittent, blowing murmurs may be detected, accompanying the first 
sound of the heart, and other evidences of the presence of endocarditis 
are present (see Diseases of the Heart, p. 1036). 

Pericarditis —When this complication occurs, the symptoms are 
similar to those occurring in ordinary cases of this affection (see Peri- 
carditis, p. 1012). 

Pneumoma and Pleurisy.— The symptoms are similar to those 
occurring in ordinary cases of these affections (see Respiratory Diseases, 
p. 862). 

For the symptoms of rheumatism occurring as a complication or 
sequel to influenza and contagious pneumonia, see Vol. I., pp. 838, 858. 

Rheumatic Nodes and Nodules.—These are small, hard, pea-like, 
bodies, which are occasionally found attached to the tendons and fascie. 
They are said to be more commonly met with in chronic rheumatism, 
We have never observed them in any form of the disease. 

Nervous Complications —Cases of rheumatic fever are recorded in 
which symptoms suggestive of meningitis were observed. Judging by 
the paucity of such cases, we must regard such complications as very 
rare in this disease. 

Subacute Form of Rheumatic Fever.—This is a milder form of the 
disease, in which the fever is slight and the arthritis less acute. It may 
continue for a long period, and eventually terminate in the chronic 
form. We have observed this type in colts left on cold, unsheltered 
pastures. In these cases complications, such as cardiac valvular disease 
and dropsical effusions along the inferior aspect of the sternum and 
abdomen, may be the prominent symptoms presented, and metastatic 
swellings of the joints may accompany or follow these symptoms. 

Remissions and exacerbations are not uncommon. Under treat- 
ment the symptoms may temporarily improve, but a fatal termination 
may occur rather suddenly. 

CoursE.—The course of rheumatic fever is RE Relapses are 
liable to occur, with intermittent elevations of temperature. Some cases 
may to all appearances make a complete recovery in from two to three 
weeks, but cardiac complications, which may be overlooked, are usually 
present, and ultimately develop into chronic valvular disease. Cases of 
complete recovery are rare. The chronic form may supervene on the 
acute. 


DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1395 


DIFFERENTIAL D1acnosis.—This is based on the sudden appearance 
of the arthritis and its metastatic character, the history of the case 
being also taken into consideration. From pyemic arthritis or joint-ill 
it is distinguished by the fact that acute articular rheumatism is un- 
common in suckling foals a few days or weeks old, while it is at this 
period that joint-ill is usually developed. Again, the formation of an 
articular abscess does not occur in rheumatism unless a secondary infec- 
tion has taken place, while it is common in joint-ill; also the presence of 
a suppurative inflammation of the umbilicus is diagnostic of joint-ill. 

' Prognosis.—This must always be guarded, as, although the death- 
rate is not high in this disease, cardiac complications without definite 
symptoms may be present, and give rise to future valvular disease. 
Occasionally sudden death may occur from myocarditis. 

TREATMENT.—This may be discussed under—(1) Internal Treatment; 
(2) Local Treatment. 

Internal Treatment.—A mild purgative is indicated, such as repeated 
doses of Epsom salt, given in the food. Salicylic acid and the sali- 
cylates are recognised as specifics in the treatment of this affection, 
as they relieve the pain, and the majority of clinicians find that the 
effect of these agents is to shorten the course of the disease, to prevent 
relapses, and to exert a protective influence on the heart. The salicylate 
of soda is preferred to salicylic acid, as it is less liable to cause gastric 
irritation and derange digestion. In our experience, it should be given 
at first in full doses, and after the pain has been relieved the amounts 
should be lessened and prescribed at longer intervals. If administered 
in too large doses, and continued for too long a period, cardiac depression 
is likely to be produced. The usual dose is from 4 to 6 drachms ad- 
ministered every three or four hours. We have frequently given larger 
doses than these with good results, It is of advantage to combine 
alkalies, such as bicarbonate of potash or bicarbonate of soda, with the 
above. If the animal refuses the medicines in his food, they must be 
given in the form of electuary. Salicin, salol, and allied agents, have. 
also been found useful in the treatment of this affection. 

If the pain is severe in spite of the above treatment, antipyrin, anti- 
febrin, and phenacetin, may be tried, but must be prescribed with caution. 
In the later stages iodide of potassium proves of service in promoting 
absorption of arthritic exudates. 

Local Treatment.—The affected joints should be fomantsa at frequent 
intervals, and cotton-wool applied with bandages. If the pain be very 
severe, anodyne applications, such as belladonna or chloroform liniment, 
should be applied after fomenting. When acute pain is relieved, stimu- 


1396 SYSTEM OF VETERINARY MEDICINE 


lating applications are serviceable. Later on, when the disease becomes 
located in certain joints, a cantharides blister may be applied with 
benefit. 

In the treatment of the cardiac complications of this disease, no 
special rules can be laid down, and the lines of treatment are similar to 
those described under the heading of Endocarditis (p. 1045) and Peri- 
carditis (p. 1016). Some authorities believe that the early administra- 
tion of potassium iodide with the salicylates has an important influence 
in preventing and arresting endocarditis. 

The diet should be light and non-stimulating. A long rest is neces- 
sary after convalescence, and the animal should be protected from cold 
and chills. To counteract the debility and anzemia which so frequently 
follow the disease, iron tonics combined with vegetable bitters should be 
prescribed. 

Acute Articular Rheumatism in Cattle.—This disease is more frequently 
met with in cattle than in other animals, and in them cardiac complica- 
tions are more likely to occur. The supposed connection between this 
disease and retention of the placenta has already been referred to (see 
p. 1889). 

In addition to the symptoms mentioned as occurring in the horse, 
we observe in cattle suspension of rumination, dry muzzle, the milk is 
decreased in amount, is sour in flavour, and coagulates readily. Marked 
loss of condition occurs early in the attack. Abdominal complications 
may occur, such as gastro-intestinal catarrh, evidenced by colicky pains 
and diarrhoea. In other cases impaction of the rumen and constipation 
are present. Usually the animal is inclined to lie down for long intervals, 
and can only be made to rise with difficulty. 

When standing, the back is arched, and, if forced to move, the animal 
groans and the respirations are greatly accelerated. In severe cases 
lameness is well marked, and the animal walks on the toe of the affected 
limb. The joints most frequently affected are the fetlocks and knees, 
but the hip, stifle, hock, shoulder, and elbow, may also be attacked. 
The morbid changes in the joints are similar to those met with in the 
horse, According to some authorities, suppuration may occasionally 
occur in acute articular rheumatism in cattle. 

The treatment of the disease in cattle does not differ from that advised 
for the horse. te 

Acute Articular Rheumatism in Sheep.—In adult sheep this affection 
is very rare, but cases are recorded in lambs. 

On the other hand, muscular rheumatism, with the chronic articular 
form, is met with in sheep (see p. 1403). 


DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1397 


Acute Articular Rheumatism in Swine.—The disease per se is not 
common in this species, but is often associated with the muscular form, 
the dorsal and lumbar muscles being especially liable to become involved. 
In other cases the muscles of the quarter or shoulder are attacked at 
the same time as the joints. The animal usually assumes the recumbent 
position, and, when forced to stand, the limbs appear rigid, and the 
weight of the body is borne on the toes, the animal shifting it from one 
foot to another in an uneasy manner. Occasionally swelling may be 
absent from the joints. The latter, however, are very sensitive to pres- 
sure and to movement. The skin around the articulation is of a red 
colour. According to some authors, suppuration may occur in the 
affected joints. 

The course of the disease is irregular. Recovery may take place in 
from one to three weeks, or the case may merge into the chronic form. 

The treatment is similar to that advised for the horse. 

Acute Articular Rheumatism in the Dog.—This affection is not so 
common in the dog as muscular rheumatism. The stifle-joints are most 
frequently attacked, the swelling being most prominent on the inner side 
of the head of the tibia. Remissions and relapses are liable to occur. 

After a time the muscles of the quarter and thigh become atrophied, 
evidences of weakness in the hind-limbs appear, and the animal walks 
with a staggering gait. The acute form usually merges into the chronic 
type. . 

Cardiac complications occur in the dog as in the horse, and are 
evidenced by similar symptoms. 

As regards treatment, the therapeutical measures are similar to those 
advised for the analogous affection in the horse. Aspirin seems to suit 
some cases better than salicylate of soda. In order to relieve the pain in 
the joints, the application of an ointment containing oil of wintergreen 
is useful. 

Chronic Articular Rheumatism in the Horse—SyNonym.—Chronic 
rheumatism. 

The chronic form of rheumatism may occur as a sequel to rheumatic 
fever, or, as more commonly happens, it arises as an independent affec- 
tion. It is met with more frequently in aged animals. The attacks are 
intermittent in character, and are often excited by exposure to cold 
and chills, or to damp surroundings. 

Morsip ANAtoMy.—The larger joints are those most liable to become 
affected, and the tendons and muscles in the vicinity are frequently 
involved. The capsule and ligaments of the joint are thickened, and the 
synovial membrane is deeply injected; but extensive effusion as a rule 


1398 SYSTEM OF VETERINARY MEDICINE 


is not present, and free movement of the joint is interfered with. In 
cases of long standing, erosions may occur in the articular cartilages. 
Occasionally ossific enlargements form on the articular ends of the bones, 
or calcification of the articular cartilages may be present. In some 
instances, although marked symptoms may be shown during life, only 
very slight morbid changes may be found in the joint. 

The muscles and nerves adjacent to the affected joint may be involved, 
especially when the shoulder or hip are the regions attacked. Atrophy 
of the muscles may be observed in such cases. This may depend on 
diminished use of the limb due to the lameness, or, according to some 
authorities, it is to be ascribed to nervous influences. 

Cardiac complications are less frequently met with than in the acute 
form. 

Symptoms.—The leading symptoms of the disease are intermittent 
lameness and swelling of certain joints, the latter only being observed 
in those articulations which are not well covered by muscles. The 
lameness is of an intermittent character, being liable to recur at intervals, 
or when the animal is exposed to chills or damp surroundings. The 
metastatic character of the disease is not so well marked as in the acute 
form. Movement of the affected articulation is frequently accompanied 
by a characteristic ‘‘ cracking’ sound. The stiffness and lameness may 
improve during moderate exercise. In some cases no swelling of the 
articulations can be detected. 

It is not uncommon for more than one joint to be affected during an 
attack, and in some instances acute pain may be manifested. Muscular 
rheumatism often accompanies the chronic articular form of the disease. 
Permanent enlargement of the affected articulations may occur, and in 
some cases anchylosis may be observed. 

Evidences of cardiac valvular disease may be present, especially if 
the affection occurs as a sequel to an acute attack. 

The Prognosis is unfavourable. Many cases continue for an in- 
definite period, showing remissions and exacerbations. Others remain 
for a variable period free from lameness, but the disease is liable to recur 
at any time. 

‘TREATMENT.—Many cases resist all forms of treatment. In those 
instances where pain and acute lameness are present, the salicylate of 
soda combined with potassium iodide is indicated. Alkalies, such as 
bicarbonate of potash or bicarbonate of soda, may be given in the drink- 
ing-water in large doses. 

Some practitioners advise the administration of colchicum and nitrate 
of potassium. In our experience, the most reliable agent for this affec- 





DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1399 


tion is potassium iodide given in full doses, and continued for a length 
of time. 

As regards local treatment, if the pain be acute, we employ hot fomen- 
tations, succeeded by stimulating liniments. Afterwards counter- 
irritation should be judiciously applied to the affected joints. 

Chronic Articular Rheumatism in Cattle—This resembles the affec- 
tion already described as occurring in the horse. The hip, stifle, and 
shoulder are the joints most likely to become attacked. Treatment is 
to be conducted on similar lines to those advised for the horse, but in 
our experience the majority of cases are not amenable to treatment, as 
the improvement, if any, is liable to be followed by a recurrence. Occa- 
sionally severe counter-irritation applied to the affected joint may effect 
an improvement in the lameness. 

Chronic Articular Rheumatism in Swine.—This usually occurs as a 
sequel to the acute form of the disease. 

The symptoms usually observed are stiffness in progression, or 
actual lameness of a metastatic character, emaciation, and a tendency 
to assume the recumbent position. In some cases permanent enlarge- 
ment and rigidity occur in the affected joints, due to thickening 
and contraction of the ligaments, organisation of the exudate, or to 
anchylosis. 

TREATMENT.—The principles of treatment are similar to those advised 
for the affection in the horse. 

Chronic Articular Rheumatism in Sheep.—When the disease occurs in 
this species, it is usually found to accompany muscular rheumatism (see 
p. 1403). 

Chronic Articular Rheumatism in the Dog.—This usually follows an 
acute attack, similar joints being affected, and it is not uncommon for 
the affection to be complicated with muscular rheumatism. 

Muscular Rheumatism in the Horse—Synonym.—Myalgia. 

This affection is a form of rheumatism in which the voluntary muscles 
are involved instead of the articulations, and although theoretically this 
disease is recognised as an independent one, there are a large number of 
cases in which it is associated with articular rheumatism. 

While typical cases of the affection are by no means uncommon, we 
must admit that obscure cases of lameness are frequently ascribed to 
rheumatism, although the symptoms on which such a diagnosis is based 
are neither clear nor pathognomonic. 

Obscure cases of lameness attributable to the foot, but not due to 
navicular disease, are believed by many to be of a rheumatic nature, 
although no post-mortem changes can be adduced to support this view. 


1400 SYSTEM OF VETERINARY MEDICINE 


Probably the microbial infection is capable of affecting the sensitive 
laminee in a similar manner to the muscles. The history of such cases 
certainly favours the rheumatic theory, the lameness being intermittent, 
changing from one fore-foot to another, and tending to recur after an 
indefinite period of apparent soundness. 

The parts attacked in muscular rheumatism are the muscles, the 
fascie, and the periosteum to which the tendons of the muscles are 
attached. Any group of muscles may be involved, but there is a pre- 
dilection for certain groups or regions, such as the lumbar, gluteal, 
cervical, scapulo-humeral, and intercostal. Cardiac complications are 
by no means so frequently met with as in the articular form. 

The disease is often acute, but it may be of a subacute or of a chronic 
type. 

Er1oLogy.—Up to the present time little is known with reference to 
the causation of the affection. 

We know from clinical experience that exposure to cold, chills, or to 
damp surroundings, may induce an attack in those animals that are pre- 
disposed to the disease. 

In many instances, however, the affection may appear etl any 
apparent cause in an animal previously healthy. 

Morsip ANnatomy.—Although the muscular tissues are generally 
believed to be the seat of the disease, this view is not accepted by all 
authorities. Some hold that the affection depends on neuralgia of the 
sensory nerves supplying the muscles involved. In mild cases no post- 
mortem appearances can be detected in the affected muscles; but some 
authorities state that in severe cases pathological changes occur, con- 
sisting of myositis, hemorrhage, and serous exudation into the inter- 
stitial connective tissue, and softening and disintegration of the mus- 
cular fibres. In chronic cases muscular atrophy may result. 

Symproms.—The disease may occur in the acute form, in which a 
number of muscles may be affected, and is then accompanied by a 
variable degree of fever and constitutional disturbance. Or, as more 
frequently happens, it appears in a subacute or chronic form. In some 
cases metastasis 1s not so well marked as in the articular variety, the 
disease having a tendency to locate itself in a certain group of muscles. 
In other cases metastasis occurs, the affection suddenly leaving the fore 
extremity and attacking the muscles of a hind-limb. The affected 
muscles are tender to the touch, but show neither heat nor swelling. At 
times they feel hard and tense, and when in a state of contraction they 
may appear as if swollen. In some cases firm pressure may not give 
evidences of pain. 


5) 


DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1401 


The following varieties of the disease are recognised, according to the 
groups of muscles involved: 

Lumbago.—In this form the lumbar muscles and those of the loins 
are affected. The animal moves in a stiff manner, with the back slightly 
arched. There is marked difficulty in turning and in backing, and, when 
forced to carry out these movements, the animal groans. In some cases a 
straddling gait is observed during progression, while in others the animal 
has difficulty in rising, or may be unable to do so without assistance. 

Tortrcollis —This term is applied when the muscles of the cervical 
region are attacked. The neck is carried in a rigid manner, and may 
be either turned to one side or elevated. There is difficulty in lowering 
the head to the ground, and it may be even impossible for the animal 
to feed from the ground or to graze. 

Pleurodynia.—In this form the intercostal muscles of one or both 
sides are affected. The animal is disinclined to move, and grunts when 
forced to do so, or when the chest is percussed. The respirations are of 
the abdominal type, and the “ pleuritic ridge ’’ may be present. 

The muscles in the gluteal region may be involved, and evidences 
of lameness attributable to the hip will then be observed—viz., tender- 
ness of the muscles to manipulation, a dragging action of the hind-limb, 
and diminished flexion of the joint. 

The scapulo-humeral muscles, when attacked, give rise to symptoms 
attributable to shoulder-lameness—viz., tenderness of the muscles of the 
region, interference with the raising and advancing of the limb, and 
dragging of the toe when the animal is backed. 

We have met with cases in which the muscles of one side of the flank, 
abdomen, and chest were involved, and have observed a tense, painful 
condition of these muscles, and a peculiar wrinkling of the skin, which 
appeared if the animal was approached or handled. Moderate fever 
103° F.) and constitutional disturbance, with constipation, were also 
present. 

Course.—The course is usually irregular. In some cases the symp- 
toms may last for one or two weeks, and then disappear. In others the 
disease appears to locate itself in certain regions, such as in the muscles 
of the shoulder or hip, and may continue for an indefinite period. The 
affection is very apt to recur if the animal be exposed to cold chills, etc., 
or if kept in a damp, ill-drained stable. 

DIFFERENTIAL DraGNnosis.—The diagnosis is based on the history of 
the case, the sudden appearance of lameness in the absence of any ap- 
preciable cause, the metastatic character of the affection, and the marked 
tenderness of the muscles involved. 


1402 SYSTEM OF VETERINARY MEDICINE 


The differentiation of rheumatism afiecting the lumbar muscles and 
those of the loins and gluteal region, from azoturia may occasionally, in 
mild attacks of the latter, give rise to some difficulty. The history of the 
case, the sweating, and the alterations in the urine, enable us to differ- 
entiate the two affections. 

From ordinary strains of the muscles mentioned it may be difficult 
at a first examination of the case to differentiate a rheumatic affection. 
The history of the case, however, will prove of assistance. 

Tetanus in the early stages may simulate muscular rheumatism, 
especially if the cervical muscles are attacked. The absence of tonic 
spasms of the muscles and of protrusion of the membrana nictitans when 
the head is suddenly elevated, will distmguish the latter affection from 
the former. 

Pleurodynia may be confused with pleurisy, and must be differ- 
entiated by a physical examination of the chest (see Pleurisy, p. 914). 

TREATMENT.—Laxatives, such as Epsom salt, should be given in 
the food or drinking-water. When the affection is generalised, the 
salicylate of soda may be given as in acute articular rheumatism. In 
chronic cases, iodide of potassium, with full doses of alkalies, such as 
bicarbonate of soda, are indicated. 

Local treatment consists in applying stimulating liniments with 
friction to the affected parts. 

When the muscles of the shoulder or hip are involved, counter- 
irritation by means of cantharides ointment should be carried out. 

In chronic rheumatism of the shoulder, Continental authorities advise 
the hypodermic injection of veratrine, 3 to 14 grains of the drug dis- 
solved in 15 to 30 minims of alcohol being injected beneath the skin of 
the region involved. 

Mepico-Lecat Aspect oF RHEUMATISM.—From a medico-legal point 
of view, rheumatism in the horse is of great importance, as the lameness 
it produces may not be present at the time of examining a horse as to 
soundness, but may appear in a short period after the examination has 
been completed. Needless to remark, the veterinary surgeon is not to 
blame under such circumstances, as no evidences of lameness may be 
detected at the time of examination, the subjects of this disease often 
going perfectly sound for various periods of time, especially if puts under 
a course of treatment. 

Muscular Rheumatism in Cattle. —This resembles to a great extent 
the disease already described as occurring in the horse. It is more likely 
to be complicated with articular rheumatism in cattle, and may be 
localised, or a large number of muscles may be involved. The commonest 


DISEASES OF DOUBTFUL ETIOLOGY: RHEUMATISM 1403 


seats of the disease are the shoulders and the lumbar region. Occa- 
sionally the affection may be very acute, and the constitutional disturb- 
ance well marked. 

The course is usually chronic, and fatal results are rare. 

The constitutional disturbance, pain, loss of condition, and interfer- 
ence with general nutrition, tend to materially interfere with the value 
of the affected animal. 

The treatment is similar to that advised for the horse. 

Muscular Rheumatism in Sheep.—Young animals are those usually 
attacked, and the disease may be either local or general. Too early 
shearing and exposure to cold and wet are regarded as predisposing 
causes. The muscles of the neck and those of the lumbar region are 
frequently the seat of the disease. The animals walk in a stiff manner, 
or the head may be carried to one side. In many instances the recum- 
bent position is adopted. | 

The course is usually rapid, and the animals may recover in four or 
five days. At times, however, the disease may become chronic, and be 
complicated with the articular form of rheumatism. 

TREATMENT is to be carried out on similar lines to those advised for 
the disease in other animals. 

Muscular Rheumatism in Swine.—In this species the affection is often 
complicated with the articular form. Atrophy of the affected muscles 
may occur, especially those of the quarters. In some cases symptoms 
resembling those of partial paralysis may be present. Gastric symptoms 
have also been observed. 

Muscular Rheumatism in the Dog.—This affection is of frequent occur- 
rence in the dog. The muscles of the back and loins, and those of the 
neck, are most frequently involved, and metastasis is well marked. 
Occasionally the disease may be generalised. In many instances the 
abdominal muscles are attacked. | 

A characteristic symptom in the dog is the acute pain manifested 
when the animal is lightly handled, or even if an attempt be made to 
do so. 

Obstinate constipation is a frequent symptom, and depends on the 
pain induced by defecation, leading the animal to avoid the act as 
much as possible. 

When the cervical muscles are affected, the head and neck are held 
in a stiff manner, and the muscles give the appearance of being swollen. 
The muscles of the jaws may be involved, interfering with prehension 
and mastication, and if attempts be made to open the mouth, the animal 
shrieks with pain. 


1404 SYSTEM OF VETERINARY MEDICINE 


When the lumbar muscles are attacked, the dog walks in a stiff manner 
in the hind-limbs, and shows special difficulty in ascending stairs. In 
severe cases paralysis of the hind-limbs occurs, especially in the case of 
fat, pampered dogs. 

When the abdominal muscles are involved, distension of the ab- 
dominal region occurs, and the case may be mistaken for one of acute 
intestinal obstruction. 

DIFFERENTIAL Di4cnosis.—A disease which closely resembles mus- 
cular rheumatism in the dog is chronic ossifying pachymeningitis (see 
p. 1261). The two affections appear to be closely allied in their clinical 
manifestations, as metastasis is present in both, and the same painful 
condition of the muscles, also the tendency to recurrence, and the marked 
effect of cold and damp weather, in tending to induce an attack in sus- 
ceptible animals. Whether repeated attacks of rheumatism are capable 
of producing the lesions found in the spinal cord in chronic ossifying 
pachymeningitis is a point that is not yet definitely settled. It is highly 
probable, however, that rheumatism plays an important part in the 
etiology of chronic pachymeningitis in the dog (see p. 1262). 

CoursE.—Muscular rheumatism in the dog runs an irregular course. 
Some cases under suitable treatment recover in a short space of time, but 
there is a marked tendency towards a recurrence of the attack; others, 
especially when severe, may become chronic, and continue for an in- 
definite period. 

TREATMENT.—This is to be conducted on similar lines to those ad- 
vised for chronic ossifying pachymeningitis (see p. 1265). 


PARASITES AND PARASITIC DISEASES 
By A. W. NOL PILLERS, F.R.C.V.S. 


GENERAL REMARKS, 


Introduction.— Under this section it is proposed to deal with as many 
parasites and parasitic diseases as the scope of a general system of 
veterinary medicine will allow. The importance of this branch of the 
veterinarian’s work cannot possibly be over-estimated—in fact, the rise 
of parasitology during recent years can aptly be compared with that of 
bacteriology at the latter end of last century. Besides the minor affec- 
tions, one has only to reflect on the losses caused by the liver fluke 
(Fasciola hepatica) in sheep, Hamonchus contortus and other small nema- 
todes in ruminants, the red and small palisade worms (Cylicostomum 
tetracanthum and Strongylus vulgaris) in horses, and the warble fly (Hypo- 
derma bovis) of the ox, in order to become convinced of the great damage 
that arises from parasites. | 

Although it is hoped that these volumes will be of great use to veterin- 
arians outside the British Isles, it will be impossible to consider here in 
detail many important exotic parasitic species. The blood-sucking flies 
for instance, number some hundreds of species, and the list of those 
capable of transmitting disease is daily becoming larger. The same 
applies to a great number of disease-producing ticks. Among the hel- 
minthes, be they cestodes, trematodes, or nematodes, the same difficulty 
arises. It would, therefore, be advisable to consider the subject in a 
somewhat general manner, describing later in detail those diseases which 
are manifested by clinical pictures more or less definite. 

When a living organism takes up its abode temporarily or permanently 
on or within another living organism, the condition is spoken of as sym- 
biosis. Mutualism, commensualism, and parasitism, are three degrees of 
this union. In the first case, both organisms are benefited; the larger 
may provide shelter and the smaller obtain food for the combination; 
in the second, one alone profits, whilst the other is unharmed; in the 
third, one profits, and the other suffers injury in some way. Whether 
an organism is to be deemed mutual, commensual, or parasite, depends 

1405 


1406 SYSTEM OF VETERINARY MEDICINE 


upon many conditions, such as season, numbers, and condition of the 
host. It has to be admitted that the presence of one or two large white 
worms (Ascaris megalocephala) in the small bowel of the horse often does 
no harm, and may even assist in the secretion of duodenal juices. It 
cannot, however, be deemed even a commensual, because at times it does 
give rise to serious disturbance of the host. Various degrees of parasitism 
are recognised, although it is often difficult to say definitely into which 
category a certain species should be placed. 

Many of the higher animal parasites are constant or obligatory—+.e., 
in order to maintain their existence and reproduce their species, they are 
dependent upon their hosts. In some cases a species may be confined in 
its attacks to one animal, such as the cat louse (T'richodectes subrostratus), 
in which case it is said to be fived. On the other hand, it may be able to 
accommodate itself upon a great number of animals; such an one is a 
wanderer. A good example is seen in Ixodes ricinus, whose hosts include 
mammals, birds, and reptiles. The terms ectozoa and entozoa are used 
simply to designate the habitat of any species, and they have no classifi- 
catory value, although, of course, many of the ectozoa are arthropods, 
whilst most of the entozoa are helminthes. The bot (Gastrophilus equt) 
of the horse’s stomach is, of course, an exception. 

Animal Parasites.—Some of the vegetable parasites and most of the 
pathogenic protozoa have already received consideration in Vol. I. Most 
of the parasites important to the veterinarian are derived from five great 
sub-kingdoms of animals, thus: 


ANIMALIA. 


. Protozoa (piroplasms, etc.). 

Porifera. 

Coelenterata. 

Platyhelminthes (tapeworms, flukes, etc.). 
Nemathelminthes (round and hooked worms). 
. Trochelminthes. 

. Molluscoidea. 

. Annelida (leeches). 

. Echinodermata. 

. Arthropoda (flies, lice, fleas, ticks, mites, etc.). 
. Mollusca. 

. Chordata. 


= 
SOMAATP De 


eo 
bo 


Although we need no longer discuss the origin of parasites in or upon 
their hosts, they having, of course, arisen from ova of a former genera- 
tion, it is interesting to notice some of the various modifications which 
have taken place in their structure in order to adapt them to their para- 


PARASITES AND PARASITIC DISEASES 1407 


sitic habitat. Some of these have been so marked that it is almost im- 
possible to form any idea from which group certain species have arisen. 
Among the arthropods, it is often not so difficult to place these modified 
forms in their right place. 

As an example, one may take the wingless blood-sucking fly of the 
sheep (Melophagus ovinus). In this species the wings are entirely absent; 
in another (Lipoptena cervi), found on deer, both sexes lose their wings 
soon after leaving their pupe. Other winged species have adopted a 
running habit upon their hosts, and justly deserve the term often applied 
to them—viz., “‘ spider flies.”’ In this way one can easily trace the loss 
of the sheep-ked’s wings, making it suited for roaming over the skin in 
the depth of the fleece. Among the lice and fleas, the modifications are 
still more marked, and suitable to their habitat, although there is more 
or less uniformity in structure. In the case of the cestodes, nematodes, 
trematodes, and other groups which are almost entirely parasitic, there 
is great difficulty in tracing their origin from non-parasitic species. 

Parker and Haskwell! point to the obscurity of this among the 
nematodes, and show that the monogenetic trematodes have probably 
evolved from the lower ccelenterates and rhabdoccles. Through the 
branch from which the monogenetic trematodes passed have arisen the 
digenetica, and from the ancestors of these the cestodes took origin. 
Between the cestodes themselves and trematodes a close relationship is 
traceable: 





Monogenetica, 
Nemertinea. 
Digenetica. 
Cestoda. 
Rhabdoccelida. 
Ctenophora. 


Lower Coelenterata. 


ErioLocy oF Parasitic Diszases.—Although we are at present in 
doubt as to whether certain parasitic species are of what may be termed 
veterinary economic importance, there are a great many diseases which 
we know are due entirely to their presence. Certain conditions of the 
host, climate, and surroundings, have a predisposing effect upon the 
severity of the attack. Age has a great influence. The young of most of 
our domesticated animals are much more liable to the attacks of entozoa 
than older beasts. The frequency of bronchial and intestinal helmin- 
thiasis of calves is an example of this. Extreme old age, with its 


1408 SYSTEM OF VETERINARY MEDICINE 


weakening of the defensive powers of the various organs, allows an 
animal to become the prey of parasites much easier than does a robust 
adult in perfect health. Any debilitating condition of the vital forces 
also renders an animal more liable to parasitic invasion. Among climatic 
influences may be mentioned the frequency of blood-sucking flies in hot 
weather, and the increase of liver rot after periods of rain, making the 
life-history of the liver fluke more certain in the moisture-sodden and low- 
lying pastures. Occasionally very dry periods may be followed by 
severe parasitic invasion. 

Apart from climate alone, it has to be noted that bright sunlight is 
a stimulant to the attacks of some biting flies. Others, such as Hama- 
topota pluvialis, are to be found at work at the commencement of summer 
storms, whilst gnats appear most obnoxious at eventide. Geographical 
variations predispose to the attacks of parasitic species proper to the 
various countries—e.g., tsetse flies in Africa. Seasonal differences are also 
seen, such as the presence of the sheep blowfly (Lucila sericata) in © 
summer, and psoroptic mange in late autumn and winter. With regard 
to the surroundings of the host, it is only necessary to mention the 
freedom of cattle which have been housed during the summer from 
warbles (Hypoderma sp.) and the liability to infection by scabies of 
horses whose long coats have dulled the enthusiasm of their attendants. 

The methods whereby admittedly obnoxious species produce their 
injurious effects may be grouped under several headings, of which the 
following five are the most important :? 

1. Injury caused by the mere presence of the parasite. 

2. Injury caused by the migration of the parasite. 

3. Injury caused by the parasite feeding upon the tissues or juices of 
the host. 

4. Injury caused by toxins said to be eliminated by the parasite. 

5. Injury due to the transmission of disease-producing micro-organisms 
by the parasite. 

When considered from the point of view of the method whereby the 
parasite produces its injurious effects, it must necessarily follow that 
some of the parasites will fall into more than one of the groups. Thus, 
the mere presence of the adult flies of Hypoderma bovis causes a fall in 
the milk-supply of animals it has been trying to alight upon, as well as 
cedema and perforation of the skin of the back when its larval form is 
about to complete its migration through the affected animal’s body. 
However, the subject can be better appreciated under these five headings 
than by considering the parasites individually : 

Injuries caused by the Mere Presénce of the Parasites.—Although the 


PARASITES AND PARASITIC DISEASES 1409 


ectozoa form such an important group of obnoxious parasites, when 
their injurious effects are carefully looked into, they will in many cases 
be seen to fall into one or other of the remaining headings. This is so 
with the three groups of mange mites. But the mere presence of any of 
the flies from which animals have learnt to escape tends to produce 
stampedes, which may lessen the milk-supply in cattle, or cause accidents 
in beasts of burden. The presence of the adult form of Linguatula 
tceenvordes in the nasal fosse of the dog causes reflex sneezing, and by its 
irritation the secretions of the mucous membrane are increased. Cobbold 
explained the death of a dog which went out into the cold air by the 
migration of these parasites lower down the respiratory tract. The larval 
stages of Hstrus ovis, when producing symptoms, act in a similar way. 
In the horse, calf, and pig, large numbers of adult worms block many 
of the smaller bronchioles, and so by their mere presence give rise to 
collapse of the lung tissue supplied by it. Other effects are witnessed, 
but pigs are sometimes infested with Metastrongylus apri (Strongylus 
paradoxus in part) to such a degree that a great part of each lung is non- 
functional. A somewhat similar case of an ass affected with Dictyo- 
caulus arnfieldi (Strongylus arnfieldt) has been recorded. Perhaps a 
better example still is Syngamus trachealis of the fowl’s respiratory tract. 
The distressing gaping symptoms are often removed when the parasite 
and the débris round it are expelled. Generally speaking, amongst the 
round, flat, and tapeworms, the extent of injury produced depends upon 
the position in the body that they take up. The anatomical characters 
of the parasites cannot, however, be neglected. The larval stage of 
Multiceps multiceps (Caenurus cerebralis) in the brain of the sheep causes 
profound trouble by pressure as it increases in size, whereas a very similar 
hydatid—Multiceps serialis (Cenurus serialis)—in the subcutaneous or 
intermuscular tissue of the rabbit’s back gives rise to insignificant changes. 
In the muscular tissue of the pig, Cysticercus cellulose seems to pro- 
duce little or no trouble. In the eye, however, the effect is naturally 
more serious. Echinococcus cysts, when small and only two or three in 
number, produce very few changes; but great loss of tissue and increase 
of weight of the affected organs are seen when the infestation of the liver 
or lungs is a bad one. The presence of Filaria immitis interlaced among 
the chord tendinew of the dog’s heart causes dyspnoea, convulsions, and 
sudden death, from its mechanical interference with the circulation, 
The arrestation of Dioctophyme renale (Eustrongylus gigas) in a kidney 
is sufficient to lead to the destruction of that organ, with consequent 
hypertrophy of the other one. Gigantorhynchus hirudinaceus, a rare 


nematode of the pig’s small bowel, in its attempts to secure itself, 
VOL, II. 89 


1410 SYSTEM OF VETERINARY MEDICINE 


often perforates the bowel wall, with such results as to render the 
“skins”? useless for sausage manufacture. Generally speaking, the 
mere position of nematodes and cestodes in the alimentary canal does 
not give rise in itself to important troubles. Yet Ascaris in the various 
animals has often produced mechanical impaction, and Descomps re- 
corded a case where 15 litres of Ascaris vitulorum caused rupture of 
the bowel. Other cases of a similar nature have from time to time been 
recorded. 

Injuries caused by the Migration of the Parasites —T he damage done by 
parasitic species under this heading, so far as the veterinarian is con- 
cerned, is very important. The migration may be a natural one, such 
as the passage of an immature Cysticercus tenuicollis through the liver 
on its way to the abdominal cavity, or an unnatural one—as, for example, 
the journeying of bots of Gastrophilus through the horse’s brain. The 
movement may be further more unnatural, such as the passage of adult 
species of Ascaris or Tenia into the abdominal cavity. The wanderings 
have to be considered apart from the micro-organisms which they may 
convey, because that is dealt with under the fifth heading. Among 
cattle, Hypoderma bovis just before it leaves its host produces an cedema 
of the subcutaneous tissue of the back, rendering the part unmarketable, 
and “‘licked,”’ in the meat inspectors’ phraseology, and the hole in the 
hide produced by the warble’s exit greatly lowers the value of the hide. 
The total loss produced in this way in England per annum has been 
variously estimated as being from £2,000,000 to £7,000,000. 

During the migration of Trichinella spiralis through the muscles of 
man there is severe pain, accompanied by fever, and these phenomena ~ 
must be experienced by the lower animals. There is observed in India 
an intra-ocular filariasis of the horse. The disturbances in vision are 
due to the movements of an immature worm in the aqueous humour, 
which is stated to be a stage in the life-cycle of Setaria equi. 

The arrest of immature forms of Strongylus vulgaris (Strongylus arma- 
tus in part) at their “ predilection seats ’’ in important arteries supplying 
the large bowel leads to endarteritis, thrombosis, and the formation of an 
aneurism. Although the walls of these aneurisms are thick, they have | 
often been recorded as rupturing, and works have been written to describe 
the colics resulting from embolism, due to the disintegration of the 
primary thrombus in the affected artery. Oxyuris mastigodes can often 
be seen after it has migrated to the anus, where it causes much irritation, 
evinced by uneasiness, stamping, swishing, rubbing, and flapping of the 
tail, leading to the crushing of the female and the dispersal of the eggs— 
a state of affairs eminently satisfactory for the completion of the life- 


PARASITES AND PARASITIC DISEASES 141] 


cycle of this species. Trichuris ovis (Trichocephalus affinis) of ruminants 
is usually stated to be more or less harmless, but the depth to which its 
head may penetrate the cecal walls suggests that it is possible for organ- 
isms to gain access to the peritoneum. This accusation has already been 
made by Metschnikoff and Shipley against Trichurts of man in the 
etiology of some cases of appendicitis. In the bowel of American sheep 
one often comes across lesions due to immature forms of (sophagos- 
tomum columbianum. Bowels so affected are usually known as “ pimply- 
guts,’ and are useless. The immature worm enters by the mucous coat, 
and remains in the bowel wall until lesions the size of nuts are produced. 
This species may go farther, and become encysted in the mesenteric 
lymphatic glands. These are thereby weakened, and the bowel is ren- 
dered more liable to bacterial invasion. Immature forms of the various 
species of Oylicostomum (Strongylus tetracanthus) encysted in the bowel 
wall of the horse are responsible for a somewhat similar state, of 
which we often hear in the course of country practice. We have 
examples of the wandering of adult worms in Ascaris. The species 
affecting the pig has often been recorded, and blamed for causing 
death by leaving the small bowel, travelling into the liver, and rup- 
turing its capsule. 

Among cestodes it is quite common to find rabbit tapeworms piercing 
the bowel wall, the head being in the peritoneal cavity, and the hole 
tightly filled by the middle portion of the strobile. Similar perforation 
cases have been recorded with regard to Tenia serrata of the dog by 
Cadéac and Lahogue. As an example of an abnormal migration, the 
presence of larval (stride in the brain may be mentioned. Gastrophilus 
larvee have been recorded from this position on several occasions, the 
symptoms being those of erratic movements, with death in about four 
days, or those of an acute apoplectic and fatal type. Numerous other 
cases of migration could be mentioned under this heading. 

Injury caused by the Parasites feeding upon the Tissues or Juices of 
the Host.—The tendency in the past has been, perhaps, inclined to over- 
estimate the damage done in this direction by parasitic species. This, 
however, does not mean that little or no importance should be attached 
toit. Although we often describe cases of mange as being “‘ eaten alive,” 
it is doubtful whether we ought to discuss the mange mites here. Lice 
belonging to the genus Hematopinus certainly do suck blood, and in the 
case of severe infestations, such as we see on the horse and pig, the amount 
of blood taken daily must be considerable, in addition to the demand for 
more, which increases in a geometrical ratio with the hatching of young 
lice. To this must be added the irritant action of the biting. Remarks 


1412 SYSTEM OF VETERINARY MEDICINE 


of a similar kind may be made with reference to the blood-sucking flies 
and leeches. : 

A veritable case of being “eaten alive’ is the consumption of the 
flesh of the sheep by the larve of the green bottle blowfly (Lucila seri- 
cata). With regard to the entozoa, common observation has it that 
worms call forth an increase in the appetite, and it is suggested that this 
increase in many cases makes up for the loss of food which has been 
assimilated by the parasite. If we estimate that a female Ascaris mega- 
locephala is capable of producing between 14 and 2 ounces of eggs in 
a year, and take into consideration the great numbers of these worms 
which a horse may harbour, then we must admit that a certain amount 
of the animal’s ingesta has been used up to produce them, in addition 
to that required for the worm’s vital processes. Females of this species 
often weigh just under 4 drachms. Delamotte found 1,215 specimens, 
which weighed just over 7 pounds, in one animal. 

In bad infestations of lambs by Moniezia expansa (Tenia expansa), 
one does not like to pass over lightly the possible loss to the host of 
ingesta taken up by the parasite by cutaneous osmosis. The adult 
worm is often 9 to 12 feet long. A great number may be present, and 
these are daily giving off segments. In old animals intestinal nematodes 
do not produce so grave symptoms as they do in young ones, and many 
authorities are inclined to the belief that it is the loss of food which 
tells so upon young hosts, and not upon old ones. Infections by the 
various species of Strongylus and Cylicostomum of the horse are examples, 
but there are factors other than the loss of food to a growing animal to 
be considered here. In parasitic gastro-enteritis of ruminants there may 
be great numbers of T'richostrongylus, Ostertagia, or Hamonchus present, 
but all the symptoms cannot be attributed to materials extracted from 
the aliment or bowel wall. 

There yet remains much work to be done on the subject of the food 
of many of the intestinal worms. Looss has already shown that, con- 
trary to the generally accepted doctrine, Anchylostomum duodenale feeds 
on cells of the mucous membrane of the bowel, and that the ingestion of 
blood is accidental. The removal of the superficial cells and the wound- 
ing of the mucous membrane are possibly some of the most harmful 
effects of helminthiasis, be it of trematode, cestode, or nematode origin, 
and will be dealt with later on. Other species could be mentioned under 
this heading, but enough has been said to show that the appetite of the © 
parasite is not altogether negligible. 

Injuries caused by Toxins said to be eliminated by the Parasites—With 
the rise of bacteriology, and so much work on bacteria and their toxins, 


> 


PARASITES AND PARASITIC DISEASES 1413 


it is not unnatural that this line of thought should be developed in con- 
nection with the higher animal parasites. 

Among the ectozoa, the pruritus caused by the mange mites is attrib- 
uted to substances they produce. The sarcopt of man (Sarcoptes scabies 
hominis) is not felt even when it burrows. Bourguignon produced a 
vesicular eruption by inoculating the skin with fluid derived from acari. 
Gerlach classed the severity of the mange-mite toxins in the following 
order: (1) Psoroptes, (2) Sarcoptes, (3) Chorioptes. He crushed some acari 
of each of these groups, and then passed a fine needle into the epidermis, 
and after moistening it with the fluid, replaced it in the channel. Pain 
was produced when the derma was reached, and this was followed by 
vesication. This accounts for the intense pruritus often seen in thin- 
skinned animals when compared with the coarser breeds. 

Among the entozoa, various clinical pictures and post-mortem find- 
ings have long suggested etiological factors other than their mere presence 
or absorption of the host’s food. The chief symptoms in support of this 
are those of anemia and cerebral disturbance. Asan example of anzmia, 
one may instance the changes in the blood of persons affected with 
Anchylostomum duodenale. This worm produces changes in both the red 
and white corpuscles. Boycott and Haldane in this country have worked 
at the subject. The actual volume of blood is increased, the red cells 
are greatly decreased in numbers, so is the quantity of hemoglobin 
and the colour index, and there may be present normoblasts and megalo- 
blasts. All authorities admit that the eosinophile leucocytes are greatly 
increased in number, producing a condition known as “ eosinophilia.” 
Kspecially is this so in recent infections. Looss points to the cephalic 
glands as the originators of the toxin of the above species. 

The blood of persons bearing many other species has also been proved 
to suffer from eosinophilia. 

With regard to the species of Anchylostomum found in the dog, 
Neumann states that there is diminution in the number of red cor- 
puscles, and that leucocytosis is marked; and when the anzmia is 
rapidly developed, it is sometimes accompanied by convulsions. Anemia 
associated with other forms of nematode infection of the bowel has 
been observed in many of the lower animals, that of Strongylus vulgaris 
(Strongylus armatus in part) and the various species of Cylicostomum 
(Strongylus tetracanthus) being particularly well known. The small 
nematodes infecting ruminants also produce anemia. With regard 
to nervous symptoms, we have several observations, with various ex- 
planations of their origin. The presence of Belascaris marginata (Ascaris 
marginata) in only moderate numbers is generally held to be a cause 


1414 SYSTEM OF VETERINARY MEDICINE 


of convulsions in puppies. Some assert that their mechanical action on — 
the mucous membrane is sufficient to produce these, whilst others attri- 
bute the symptoms to the absorption of toxic products. In considering 
the subject, one has to bear in mind the close clinical relationship of the 
brain and stomach in pictures of this kind. 

Dieckerkoff has described the case of a horse which showed peculiar 
tetanic symptoms several times a day, and which was relieved soon after 
the passage of a number of Ascaris megalocephala. Many cases have 
been recorded of persons experiencing discomfort when dissecting Ascaris. 
It usually takes the form of excessive lachrymation due to a peppery 
odour which is given off by the worm. Extracts of Ascaris megalocephala. 
have killed a guinea-pig in forty hours (Vaullegeard). 

Among trematode infections, liver rot of sheep (Fasciola hepatica) is 
associated with very marked anemia, and it is difficult to see how the 
flukes themselves consume sufficient blood to produce so severe a form. 

The rupture of an Echinoccocus cyst in man is often associated with 
urticaria, and it would be interesting to know if any of the cases seen in ~ 
our patients are of that origin. Human beings affected with the tape- 
worm, Dibothriocephalus latus, show an anemia which differs only from 
pernicious anemia in that it disappears when the worm is voided. Schau- 
man and Tallquist produced grave anemia in a dog with extracts of the 
parasite, but failed to do so in a rabbit. Some authorities believe that 
the toxin only acts on the host when this worm is dead. Our patients 
often harbour cestodes without showing any inconvenience. When 
nervous symptoms have been recorded (Cadéac and Lahogue) from tape- 
worm infestations, there has usually been some recognisable damage to- 
the endothelial lining of the bowel. That certain of the higher parasites 
have effects of a more remote nature than those produced at their seat 
is further shown by the demonstration of an antibody in persons har- 
bouring Echinococcus cysts. 

Under another heading it was suggested that the removal of portions 
of the mucous membrane by parasites opened up important channels for 
the production of obscure symptoms. Irrespective of bacterial invasions, 
there must be exposure of nerve tissue and the absorption of unfit pro- 
ducts in an unnatural way. 

Injury due to the Transmission of Disease-Producing Organisms by 
Parasites —The trouble caused under this heading is, of course, only 
indirectly due to the higher parasite, but it is chiefly by virtue of this 
transmission of disease by flies and ticks that parasitology has acquired 
so great an importance. In human medicine the mosquito and malaria 
parasite, the tsetse fly and sleeping sickness, and many other examples, 


\o a 


PARASITES AND PARASITIC DISEASES 1415 


are familiar to all. In our own country we have the transmission of 
Prroplasma bovis (redwater) by means of the tick Iaodes ricinus. In 
our colonies the tsetse flies (Glossina) and ticks are still more important 
in the spread of trypanosomiases and piroplasmoses respectively. Recent 
work on what the house fly (Musca domestica) is capable of doing has 
completely changed our views as to the value of this old-timed scavenger, 
and public health authorities are now trying to restrict its harmful 
action. Although the list of diseases spread by flies and ticks is at 
present considerable, it will no doubt be greatly augmented in the 
future. 

Louping-ill has long been noticed to be associated with the presence 
of ticks, and experiments have been conducted to see whether the pig 
louse (Haematopinus urius) is capable of spreading swine fever. In man, 
certain worms have been shown to be fly-transmitted, and some genera 
of the tissue worms of the lower animals are likely enough spread in the 
same way—e.g., Oncocerca, Filaria, Spiroptera (Habronema). In every 
case where an interruption in the continuity of the skin or mucous mem- 
brane is made by an arthropod or helminth, the possibility of bacterial 
invasion cannot be dismissed, and there is to many minds no doubt that 
infection of the bowel often takes place in this way. Many cases of 
enteritis are so explained, and tetanus has been many times attributed 
to infection through parasite wounds of the intestinal tract. The 
material around the encysted immature nematodes of the horse’s large 
bowel often contains pus and its organisms. If the bowel wall is pene- 
trated, the chance of infection is, of course, greater. The bacterial flora 
of the digestive tube and cysts of some parasites has already been 
investigated, with promising results. 

It follows from what has been said above that the migration of the 
larval forms of cestodes and nematodes from the bowel is a further 
possible source of bacterial infection. 

Dr1agnosts.—From what has just been said, it will be gathered that 
in many clinical pictures the presence of parasites will have to be con- 
sidered before a definite diagnosis is made. In the case of many of the 
blood-sucking flies and ticks, it will be easy enough for the veterinarian 
to diagnose them as blood-suckers or possible disease-spreaders, but he 
cannot be expected to determine the exact species from so great a 
number. 

When deaths are occurring in lambs, calves, or other animals, the 
presence of a certain worm at many post-mortem examinations may 
lead one to incriminate that species, but early suspicions of parasitic 
invasion should have lead to the microscopic examination of the feces. 


1416 SYSTEM OF VETERINARY MEDICINE 


This procedure must become more common if these plagues are to be 
properly dealt with. Here, again, however, it is too much to expect the 
general practitioner to be able to distinguish the eggs of injurious species 
from those which are thought to possess slight pathogenic powers. In 
the British Isles, at least, veterinary parasitology has been greatly 
neglected. It is, however, certain that the help of the entomologist and 
helminthologist is as essential here as that of the bacteriologist. 

NomMENCLATURE.—Throughout the following pages many changes will 
be noticed in the names assigned to the various species. This has become 
inevitable on account of researches which have shown that what in many 
cases was formerly regarded as one species or genus is in reality many 
species of different genera. This is so in the case of Strongylus, into 
which were placed numbers of widely differing groups of species. An 
example is seen in the old S. armatus and S. tetracanthus of the horse’s 
intestine, and S. paradoxus of the pig’s lung. The first-named represents 
several species of at least two genera; the second, many species of quite 
a different group; and the third, two species of a more distinct group. 
We thus have such genera as Strongylus, Triodontophorus, Cylicostomum, 
Gyalocephalus, Cylindropharynz, Gisophagodontus, in the horse’s bowel, 
_and Metastrongylus in the pig’s lung. Similar remarks apply to the small 
nematodes of ruminants. With the disappearance of such genera as 
Sclerostomum we have to discard the terms designating the diseases they 
caused, such as sclerostomiasis. Many changes are likely yet to follow 
recent research, but eventually the difficulties will undoubtedly be 
lessened. 

BIBLIOGRAPHY. 


1 T. J. PARKER AND W. A. HASwELL: A Textbook of Zoology, vol. i., p. 267. 
2 A. W.N. Pitters: Veterinary Record, vol. xxv., p. 504. 
GENERAL. 


M. Braun: The Animal Parasites of Man. London, 1906. 
M. BRAUN AND M. Luue: A Handbook of Practical Parasitology. London, 1910. 


L. J. NrEumMANN: Parasites and Parasitic Diseases of the Domesticated Animals. 
London, 1905. 


A. RAILLeT: Traité de Zoologie Médicale et Agricole. Paris, 1895. 


BLOOD-SUCKING FLIES. 


IntRoDucToryY.—Flies which suck blood are important to economic 
agriculture on account of the irritation they provoke in the act of biting, 
and more so in the transmission of protozoan and bacterial diseases. 

The natural order Diptera of the class Insecta to which they belong 
is characterised by the possession of a single pair of wings, behind which 


PARASITES AND PARASITIC DISEASES 1417 


is a pair of knob-like balancers or halteres, which represent the second 
pair of wings of other insects. The mouth parts are modified for piercing 
the skin and sucking blood. In most of the groups it is the female which 
does the biting, whilst the male appears to spend most of its time in 
sunning itself. 

British Species.—In England the following six families are represented : 
Chironomidee (midges), Culicide (gnats and mosquitoes), Simulide (black 
flies), Tabanide (horse flies), Muscides and Hippoboscide (spider flies). 
The midges and gnats are not so important to the veterinarian as the 
remaining four families, although it is interesting to note that among the 
former are represented Culex and Anopheles, genera which are of the 
utmost importance to tropical public health. 

With regard to the Simulide, which contains one genus, Simulium, 
it may be said that they are to the domesticated animals what the 
Culicids are toman. There are about a dozen indigenous species of this 

_genus; they are about 4 millimetres long, usually of a black or dark 
colour, with a prominent thorax. S. reptans (L.) is met with in Scotland. 
The various stages in the life-history are passed in running streams. 
English veterinary literature does not contain much with regard to these 
flies, but they are very obnoxious in America and on the Continent. Of 
S. columbaczense Schin., Schénbauer gives an account of an outbreak in 
Servia, where several hundreds of animals, including horses, cattle, sheep 
(mostly), and pigs died from the attacks of this fly. 

Many animals also perished in Hungary during 1813, 1830, and 1878, 
and grazing could only be carried out at night. This species attacks 
chiefly the natural orifices, where it causes punctures, which give rise 
to a burning and itching sensation, followed by a hard and painful 
tumefaction. . 

The Tabanide, or gad breeze flies of this country, include the following 
genera: Hamatopota, Therioplectes, Atylotus, Tabanus, and Chrysops. 
In appearance all of them have comparatively bulky bodies with large 
heads, either concave or flat behind, and convex in front. The eyes in 
the males touch each other, and occupy most of the head; in the female 
they are separated. In Chrysops and Hematopota the eyes, when alive, 
are very briliant. The largest British blood-sucking fly measures over 
4 centimetres across the wings. 

Hematopota pluvialis (L.) (the small rain breeze fly) is about 9 to 10 
millimetres long, and of a greyish-black colour. It is very common, and 
is often found in great numbers near horses and cattle during June, July, 
and August, especially during thundery weather. Other species are 
H. crassicorms and H., ttalica. 


1418 SYSTEM OF VETERINARY MEDICINE 


Therioplectes is represented by six species, some of which have a 
limited distribution, whilst others are more general. T. tropicus Pz. 
appears to be most common in England. It is about 15 millimetres long, 
and has an orange-yellow patch on each side of the abdomen. Other 
species include: 7’. micans Mg., T. montanus Mg., T. luridus Fln., T. sol- 
stitialis Schin. Atylotus is rare in this country. Of the typical genus 
of this family—viz., Tabanus—there are six species found in the British 
Isles: T. bovinus L., T. sudeticus Zlr., T. autumnalis L., T. bromius 
L., LT. maculicornis Ztt., and T. cordiger Wied. Austen mentions a 
seventh, 7’. glaucopis Mg. 

The ox breeze fly (7. bovinus) is probably the largest of our flies, 
being 27 millimetres in length. It is of a dark brown colour. The 
abdominal segments have their posterior borders yellow, with central 
spots of a whitish colour. The legs are yellow, with dark extremities. 
The external or anterior border of the wings has a yellow tinge. 

The autumn breeze fly (7. autumnalis) is smaller, being about 
20 millimetres long; whilst my specimens of 7. bromius measure about 
15 millimetres. The largest members of this genus make a humming noise | 
when approaching animals, but the smaller species are apparently silent. 

Four species of Chrysops are listed as occurring in this country—viz., 
C. cecutiens (L.), C. quadrata Mg., C. relicta Mg., and C. sepulcralis Fabr. 

This genus is distinguished from the preceding genera by the posses- 
sion of three accessory eyes on the top of the head. The small blinding 
breeze fly (C. cecutiens) is 9 millimetres long, with a flattened and square- 
shaped abdomen, which is yellow at its base and grey for the remainder 
of its extent. The wings are brownish, with hyaline areas at their base 
and tips. It attacks the regions around the eyes. 

The family Muscide contains three British genera—viz., Stomoxys, 
Hematobia, and Lyperosia. Glossina, so important in the etiology of 
some tropical diseases of man and animals, is an exotic group, which is 
also included in the Muscide. Most members of this family, of which the 
house-fly (Musca domestica) may be taken as a type, are not blood- 
suckers; but where the blood-sucking habit is acquired, it is manifested 
in both sexes. Many species pass the early stages of their life-history in 
the dung of the larger domesticated animals. 

The stable fly (Stomoxys calcitrans Geoff.) is very like the house fly, so 
much so, that the latter is often blamed for biting, which it is incapable 
of doing. It is, however, easily distinguished from this species by the 
presence of an elongated proboscis, which is bent near its base and extends 
beyond the head in a horizontal direction. It is about 6 millimetres 
long, and is very common in stables from May until October; but in town 


PARASITES AND PARASITIC DISEASES 1419 


cowsheds, where the temperature is kept high, it is present all the year 
round. It is very annoying to sick and convalescent horses. 

Hematobia stimulans (Meig.) closely resembles the foregoing species, 
but differs from it in that its palps are as long as the proboscis. It is 
just as bloodthirsty in its habits, but does not appear to enter animals’ 
habitations. 

Lyperosia trritans (L.), the smallest of our blood-sucking flies, attacks 
cattle. It is about 5 millimetres long, and of a dark brown hue. It is 
an important pest in the United States, where it is usually described 
under the name of Hematobia serrata Robin Des. 

The last family to be considered—viz., the Hippoboscida—are flies 
which show marked adaptations to a more permanent parasitic habitat 
upon birds or mammals. Their bodies are flattened, the wings are little 
used, and disappear at the adult stage, or are wanting, and the limbs are 
furnished with claws for clinging purposes. Reproduction is not by 
eggs, but a full-grown larva is expelled, which immediately becomes a 
pupa. These and flies with similar life-histories are sometimes included 
in a group called the Pupipara. Stenopteryx hirundinis, Oxypterum 
pallidum, and Ornithomyta avicularia (L.) are winged forms found on birds, 
whilst Lipoptena cervi (L.), found on deer, closely resembles the sheep ked 
(Melophagus ovinus), from which it is distinguished by the possession of 
wing stumps. 

The New Forest fly (Hippobosca equina L.) has a somewhat wider 
distribution in this country than its name indicates. It is about 8 milli- 
metres long. The head is yellow, with a brown spot on its summit, and 
is distinct from the thorax, which is brown. The abdomen is yellowish- 
brown, the legs are deep yellow, with brown bands and bifid tarsal hooks. 
The wings are oblong, with nervules at the anterior third only. It is 
found on horses, cattle, and sheep. 

The sheep ked (Melophagus ovinus [L.]) is from 3 to 5 millimetres long 
and without wings. The general colour is ferruginous, head distinct from 
thorax, which is somewhat narrow. The abdomen is rounded and greyish- 
brown in colour. This wingless fly is still sometimes spoken of as the 
“sheep tick.” It is, however, an insect (six legs), and not a tick (eight 
legs). The life-history is completed on the sheep, which the parasite 
never quits. 

Exotic Species.—Most of the genera which have been previously 
mentioned occur in other parts of the world, especially in our large and 
important stock-raising Colonies. Thus there are many other obnoxious 
species of Stmuliwm, such as the Grey Simulium and the Spotted Simulium 
(S. cinereum [Mac.], and S. maculatum Meig.). S damnosum is found in 


1420 SYSTEM OF VETERINARY MEDICINE 


the fly belt from Victoria Nyanza northwards along the right bank of the 
Nile. The Tabanide in hot countries are represented by a great number of 
genera and species. Although it is unusual to find Tabanus in habita- 
tions in this country, they are often seen in Indian stables. I have 
specimens of a large species (7. albimedius Walk.) taken from inside the 
roof at night. Hippoboscide have exotic species in Hippobosca camelina 
Sav. (of the camel), H. cantina Rodan (of the dog), and H. maculata Leac. 
(of the ox). 

One of the most important genera which is not represented in this 
country is Glossina (tsetse flies), the species of which are confined to Africa. 
It belongs to the Muscide, which rarely suck blood; but, as previously 
mentioned, when the blood-sucking habit is acquired by this family, 
both male and female participate. The species of this genus are some- 
what larger than the house fly, the palpi completely ensheath the pro- 
boscis, and the arista of the antenna is feathered by lateral branches on 
one side. The wings, which are large, have the fourth vein curved 
abruptly round in the middle. The terminal segments of the male have 
a marked protuberance. Tsetse flies are pupiparous, after maturation 
within the female, the larva is expelled, buries itself in the soil, and changes 
almost immediately to the pupa. From this the perfect insect emerges 
and gains the air. 

There are several species, the most important of which are G. morsitans 
Westwd., G. palpalis Rob. Des., G. pallipedes Aust., and G. fusca Walk. 
In G. morsitans the proboscis is slender and about twice as long as the 
head, the thorax is chestnut, with four longitudinal black lines; and the 
abdomen, yellowish-white in colour, is composed of five segments, the 
last four of which have large black spots on the middle line. The wings 
appear somewhat smoky. 

Insurnious Errects.—All the above flies are capable of producing 
injury to the animals they attack by (1) irritation from bites, (2) trans- 
mission of micro-organisms, or helminthes. 

The extent to which bites affect animals depends upon many con- 
ditions, not the least of which is the nervous organisation of the animal. 
Before the bite is effected, if the flies gather round the head, most animals 
evince annoyance, and when grazing resort to the shade or water, in 
which way accidents may sometimes happen. With the large blood- 
suckers, whose approach is signalled by a buzz, horses and cattle often 
try to escape by galloping away. Peaceful grazing in the former and milk- 
production in the latter are thereby greatly interfered with. In some 
cases, as previously mentioned, it has become necessary to graze animals 
by night when the pests are not on the wing (Simuliwm columbaczence). 


PARASITES AND PARASITIC DISEASES 1421 


The actual bite causes a puncture in the skin through which blood is 
extracted, and in many cases a small flow is visible when the parasite 
quits its host. The parts attacked vary, but they are generally those 
where the skin is thin, and reached with difficulty by the animal. 

Simulium has a preference for the ears, Chlorops attacks the region 
round the internal angle of the eye, and the members of T'abanus and 
other genera seem fully acquainted with the thickness of the skin in 
relation to their mouth parts, so that those whose piercing organs are 
long alight anywhere. So intent are the flies when feeding, that they 
can often be captured before their meal is finished. The direct piercing 
of the skin in regions where it is thin often causes stampedes, which have 
from time to time been noted on army manceuvres or in the harvest field. 

The usual result of a bite is a small wound which cicatrises imme- 
diately, without untoward results. However, in hot weather or in hot 
countries an appreciable amount of blood may exude from each bite. 
I have seen the necks of grey horses in Portugal so bitten by a small 
blood-sucking species as to appear as if the animals were perspiring 
blood in that region. The lesion of a bite may become cedematous and 
painful, varying in size from 3 to 5 centimetres, and if left alone by the 
host, may disappear on the following day. Sometimes horses bite these 
elevations and convert them into small sores. Melophagus ovinus by 
its bites produces in lambs and sheep great itching, which makes the 
animals pull their fleece and rub against objects. ‘hese symptoms often 
suggest scab if animals are being examined on the “ walk-past” or in 
market pens. Hippobosca equina, although it possesses wings, remains 
on its host until forced to leave, and its bites in the region of the perineum 
often give rise to violent kicking; yet lethargic animals appear to get used 
to its attacks. 

By far the most damaging effects produced by the group now under 
consideration is the transmission of disease. Although we are not 
habitually accustomed to regard certain diseases in this country as 
being fly borne, such a possibility must never be lost sight of. The 
epizodtiology of anthrax in relation to Stomoxys calcitrans deserves atten- 
tion. A reference to Vol. I., p. 1045 et seq., will show the importance of 
blood-sucking flies in the etiology of tropical diseases of animals. There 
it is shown that various species of Glossina, Tabanus, Stomoxys, and 
Hippobosca are the natural carriers of the various trypanosomes. Not 
only do they carry them in a mechanical way, but some have been shown 
to transmit the diseases from the sixteenth to the seventy-fifth day after 
feeding—+.e., the transmission is cyclical. 

Glossina morsitans and G. palpalis appear at present to be very impor- 


1422 SYSTEM OF VETERINARY MEDICINE 


tant species in veterinary epizodtiology. For a detailed account of the 
various flies which transmit the different protozoan diseases, reference 
must be made to Vol. I. With regard to the trypanosomes affecting 
birds, it has been shown that Culex pipiens is capable of carrying the 
infection (Vol. I., p. 1113). 

Many parasitic nematodes have been shown to require final and inter- 
mediate hosts. As an example one might mention Filaria bancrofts, 
the adults of which have for their normal habitat lymphatic glands in 
man, where they give rise to elephantiasis, lymphatic enlargements, and 
chyluria. The larval forms are found in the blood, whence they are 
taken up by a mosquito (Culex). After certain changes within the inter- 
mediate host, it regains man when he is bitten by the mosquito. In the 
domesticated animals, F. immitis of the dog’s heart has been shown 
to be transmitted by species of Anopheles and Culex. Filaria are found 
extensively in the lower animals, and doubtless many of them are fly 
transmitted. Similar remarks apply to allied genera, such as Oncocerca 
(worm-nests in cattle), and some species until recently classified as 
Spiroptera (Habronema). It has been recently announced that Dr. Leiper 
has discovered in Nigeria that the metamorphosis of Filarta loa (of man) 
takes place in the salivary glands of a species of Chrysops, a genus 
represented in this country. 

REMEDIAL MrasurEs—1l. Against Immature Forms.—An intimate 
knowledge of the life-history and habits of this group is essential for their 
control. Those which pass their life-history in stagnant water or moist 
earth, such as some of the mosquitoes, black flies, and breeze flies, can 
be greatly controlled by drainage of stagnant pools, careful screening of 
water cisterns, and the collection of all old unused receptacles which 
are likely to hold water, such as tins, buckets, etc. Where this is not 
possible, breeding-pools can be dressed with such agents as oil of tar, oil 
of turpentine, quick-lime, kerosene, and petroleum. This latter has been 
satisfactorily used against adult Tabanide in Russia. When the flies 
resorted to the pools to drink, they were soon killed. Some districts 
were cleared of these pests in this way. Hamatopota was, however, not 
so affected. In the case of the stable fly (Stomoxys calcitrans), which 
breeds in fermented horse manure, and the house fly (not a blood-sucker), 
which breeds in stable manure and decaying vegetable matter, all pits 
containing these substances should be emptied and cleansed weekly. 
A barrel of chloride of lime should be kept near the midden, and a little 
sprinkled over it after each addition. A little on the dung in the channel 
of a cow-tying is to be recommended. Other agents, such as calcium 
sulphide, may be added to the breeding-places, Natural enemies of 


PARASITES AND PARASITIC DISEASES 1423 


the flies should be encouraged, such as starlings, which alight on the sheep’s 
back in search of the ked (Melophagus ovinus); or fowls, which consume 
great numbers of house-fly larve in manure heaps. Aquatic fauna 
may also be encouraged where it is known that they destroy the larve 
of obnoxious flies. : 

2. Against the Flies’ Shelter —Dense bushes on grazing-land are often 
the resting-places for blood-sucking flies, from which they emerge in 
sunny weather to attack the animals. Glossina palpalis is known to 
breed in a strip of brush along the sides of rivers, so that the reduction 
of brush by burning along the river banks near man’s dwelling reduces 
the prevalence of these flies. 

3. Against Flies entering Habitations.—On the Continent it is a common 
thing to see stable windows blued. This is done to subdue the light and 
so prevent the entrance of flies into the buildings, or, if they enter, to 
lessen their activity. In addition to this, windows should not be directly 
opposite to each other, and if covered by even large-mesh netting, flies 
will alight on it and not enter the interior. It is customary to have the 


lower window inside the upper one thus - (outside). The result is that 


flies pitch on the lower pane, and, as is their habit, start to ascend, and so 
enter the building. If the sashes were reversed, no flies would enter, and 
those inside would gain the exterior. A grove of walnut trees outside 
stables has long been recognised as a preventative against severe fly infes- 
tation. Very elaborate fly-proof buildings are used in man’s dwellings 
in hot countries, and in experiments with fly-borne. diseases on animals. 

4. Against Flies in Buildings—Flies in empty buildings can be 
destroyed by sulphur and coke on red-hot shovels. Inflammable blocks 
containing formic aldehyde can also be obtained. In occupied stables 
a bundle of dried evergreen can be suspended by a single string, and cut 
down at night, when it can be burned with its resting flies. Various 
fly-papers and traps, both mechanical and those using light, can also be 
employed. Ten per cent. formic aldehyde in sweetened water or milk 
placed about the building in dishes is a good fly-killer. 

5. To protect Animals while at Rest or Work.—W hilst in the field, the 
mane, long tail, and panniculus muscle do much to protect the animal 
from fly attacks. When harnessed, branches of trees, especially walnut, 
may be hung on the gears so as to brush over the body. Har-caps with 
tassels may be applied, or a net completely over the animal, the meshes 
of which move with the animal, and so dislodge any flies on the upper 
part and sides. If it hangs low, the inside of the thighs may also be 
protected. Sick horses can have thin cloths thrown over them, 


1424 SYSTEM OF VETERINARY MEDICINE 


Various dressings can be applied to the skin, such as a decoction of 
walnut leaves, oil of cade, which, however, makes the hair oily; oil of 
laurel, which has not the above objection; and fish oil on the parts likely 
to be attacked, 1s spoken highly of by some practitioners. 

6. Against, the Actual Bite—The actual bites of blood-sucking flies 
on the short-coated animals rarely call for treatment. However, in thin- 
skinned animals where there is pain and swelling cold applications are 
beneficial; cold water, ice, lead acetate and zinc sulphate, or nitrate of 
potash and chloride ammonia in lotions, may be used with advantage. 
The bites of Melophagus ovinus will not call for treatment, but should 
the lesions they occasion become marked enough to show symptoms, 
then the animals must be treated by shearing and dipping according to 
the season (see p. 1474). 

BIBLIOGRAPHY. 


AvstEN: British Blood-Sucking Flies. London, 1906. 

Boyce: Mosquito or Man? London, 1910. 

Braun: The Animal Parasites of Man. London, 1906. 

Hewitt: House Flies and how they spread Disease. Cambridge, 1912. 

LerpeR: Metamorphosis of Filarialoa. British Medical Journal, 1913, p. 39. 

MeEantin: Les Parasites Articulés. Paris, 1895. 

NEwsTEAD: Preliminary Report on the Habits, Life-Cycle, and Breeding-Places 
of the Common House Fly (Musca domestica). Liverpool, 1907. 

RAILLET: Traité de Zoologie Médicale et Agricole. Paris, 1895. 


Ransom: The Life-History of a Parasite Nematode (Habronema musce). Science, 
N.S., vol. xxxiv. 


BLOW FLIES. 


Blow flies are in commoner language meat flies. They nearly all 
belong to the Muscidee, some of which were considered in the previous - 
section. They are, however, parasitic in the larval stages, and the adults 
themselves are not very injurious. We are accustomed to apply the 
term myiasis, cutaneous or internal, to infestations by “‘ maggots.” The 
passage of dipterous larvee, with the feeces or vomit of man and animals, 
nearly always depends on the ingestion in an uncooked state of organic 
material wherein such larvee would have matured. In most cases of this 
kind the condition must be looked upon as accidental, although in some 
cases serious symptoms are shown. It is needless to point out that the 
remarks in this section do not apply to the warble flies, as they will receive 
consideration later. Among those causing internal myiasis of man may — 
be mentioned Phora rufipes (Meig.), the larvee of which are found in mush- 
rooms; cheese maggots (Piophilia casei L.) have passed alive through 
man; the larvee of the house fly and small house fly (Fannia canicularis 
L.), which breeds in fermenting vegetable matter, have also been 
recorded from human feces. Myiasis interna is rare in the lower animals. 


PARASITES AND PARASITIC DISEASES 1425 


The dog may vomit larve of ‘“‘ meat flies’? or ‘“‘ blue bottles,” the pre- 
vailing species being Calliphora vomitoria (L.) and C. erythrocephala. 

Quite a large number of flies are known to deposit their eggs either 
in the natural orifices, wounds, unhealthy or unclean areas of man and 
animals. The chief genera are Lucilia, Sarcophaga, Compsomyia, and 
Ochromyia, the two former being the most important so far as we are 
concerned. 

The sheep maggot fly (Lucilia sericata Meig.) is of a blue-green colour, 
about 8 to 9 millimetres long; epistome and face white, and the first seg- 
ment of the abdomen black. The eggs, of which as many as 500 are laid, 
are deposited in clusters in the damp wool of sheep and lambs. The 
life-cycle through egg, larva, and pupa to adult occupies about twenty- 
eight days, according to temperature and other conditions. The larve 
found in the wounds are about 15 millimetres long. I have reared this 
species repeatedly from greasy legs, cracked heels, and thrushy frogs of 
live horses. It also occurs in canker of the foot. The larvee of an allied 
species (LZ. cwsar [L.]) are found in decaying animal matter. 

Sarcophaga magnifica Schiner.—General colour ash-grey, thorax with 
three longitudinal black stripes, abdomen light grey, with three black 
spots on each segment; legs black. The length is from 10 to 13 milli- 
metres. It attacks the natural orifices and wounds of man, the ox, 
sheep, dog, horse, and even birds. It is viviparous. 

There are many other species of this genus, such as S. carnarva (L.) 
and S. hemorrhoidalis Meig. I have not been successful in rearing larvee 
suspected of belonging to this genus from wounds. All those which 
hatched have been Lucilia. 

Compsomyia macellaria (Fabr.).—This species, which deposits its eggs 
in wounds of man and animals in North and South America, is about 
9 to 10 millimetres long, and is recognised by three longitudinal black 
bands on the two first segments of the thorax. The colour varies between 
green and blue. The eggs may be deposited in the auditory canal or 
nostrils of sleeping man or animals. The larve are called screw worms, 
and may do grave damage to the animals they infest. 

Ochromyia anthropophaga Blanch.—This species is known as the 
‘‘ Senegal ” or “ Cayor”’ fly when adult, and “‘ Cayor worm” in the larval 
stage. It is greyish-yellow in colour, the head covered with small black 
hairs, style of antenna plumose, and the thorax has two longitudinal 
black bands in front. The abdomen, especially the posterior segments, 
is covered with black spots. The wings are slightly smoky. Length 
varies from 8 to 10 millimetres. The life-history is somewhat similar 
to the sheep maggot fly, save that it is thought to deposit its eggs in sand. 

VOL, I. 90 


1426 SYSTEM OF VETERINARY MEDICINE 


It affects chiefly man and the dog. The larva produces a small tumour ~ 
under the skin, which it leaves to become a pupa. The region of the 
tail, ears, and paws are most often affected. Some authorities considered 
that this species was closely related to the warble flies. 

Ingurious Errects.—The presence of any flies on wounds must be 
considered a means of conveying pus-forming or other micro-organisms 
even on the feet of the flies. In this way several writers have explained 
the appearance and spread of epizodtic lymphangitis by the mechanical 
transference of Cryptococcus rivolte. Castration wounds may be con- 
taminated in a like fashion. 

In the case of maggots which develop in wounds, damp wool, hair, 
or foetid discharges of grease, thrush, and canker, there is a gradual 
absorption of tissue, with its consequent inflammatory processes, until 
the larve fall out to become pup. In sheep actual death is rare, but 
badly fly-blown animals do not become fat, and make less money when 
sold. 

SymproMs IN SHEEP.—When carefully observed, the first symptom — 
noticed is that of wagging the tail. At first this happens at intervals, 
later it becomes more continuous; there may be rubbing or even attempts 
at biting to allay the irritation. The parts most often affected are those 
around the root of the tail, but the lesions may be on the back. The larvee 
cause the skin to become raw, and then go deeper into the muscular tissue. 
The fleece now becomes matted, dark coloured, and the fluid which oozes 
out of the wound trickles down the side, the larve follow its course, and 
the lesion increases. There is a smell, and inflammatory processes lead 
to discoloration and falling out of the wool. With this the animal loses 
condition. 

RemMEpDIAL Mrasures.—Afiected animals should be caught and all 
the maggots carefully removed. This can usually be done with an old 
knife or little piece of wood, without the removal of the fleece. In bad 
cases, however, some wool may have to be removed. The wounds are 
then treated antiseptically. Carbolic acid does well, and then the area 
should be dusted with sulphur. The animal should be examined daily 
for a few days. 

With a view to prevention, sheep should be inspected daily from 
the month of May, and night and morning in warm, sultry weather which 
follows later on, and affected animals should be treated as above. All 
the wool likely to become urine-sodden or dung-clogged should be re- 
moved with the shears. This removes the peculiar smell which attracts 
the flies. All dead animals should be speedily destroyed or buried. 
Sheep should occasionally be “ fly-powdered.” There are many pro- 


PARASITES AND PARASITIC DISEASES 1427 


prietary powders. The odour from powdered sulphur is a good preventa- 
tive. All wounds of susceptible animals in suspicious weather should be 
carefully dressed with some fatty ointment. The larve extracted from 
wounds should not be allowed to pupate by falling on the ground, but 
should be burnt. 

In the other animals treatment should follow general lines. Animals 
with bad wounds may be housed in a well-ventilated stable with subdued 
light. Wallis Hoare recommends as a dressing to protect wounds from 
flies the following: creosote 3i1., terebene 3vlii., in a pint of white 
vaseline oil. 


WARBLE AND BOT FLIES. 


The family (stride, to which the above flies belong, is one of the 
most remarkable groups of the natural order Diptera, both on account 
of the habits of the adult species and the peculiar life-histories through 
which the different genera pass before reaching maturity. 

The family contains a number of genera which are parasitic upon 
mammals, from the elephant to the squirrel, and upon man himself. 
Possibly, however, Gastrophilus, Hypoderma, Géstrus, and Dermatobia are 
the most important. The first three genera are included in the sub- 
family CHstrine, and the last in that of Cuterebrine. The members of 
the first subfamily fall into three groups, according to the position that 
the larval stage takes up in the host, thus: Gastricole (Gastrophilus), 
Cuticole (Hypoderma), and Cavicole (Gistrus). To be of value, any 
account of this group should include descriptions of the adult flies and 
all the various stages at which the practitioner is likely to encounter them. 
That, however, is hardly within the scope of the present work. In the 
perfect state these flies do not feed, and the mouth parts are accordingly 
reduced. They live, when compared with other flies, only a short time, 
and death takes place soon after the completion of laying. The females 
of some species may be seen hovering around their hosts in hot and dry 
weather, but the males are rarely seen. 

Gastrophilus equi (Clark), (the horse bot fly or horse bee), may often 
be seen hovering around the ‘knees of grazing horses. The female is 
woolly, the head being fawn coloured, the thorax reddish, and the 
abdomen yellowish-brown, with dark spots. The abdomen of the male 
is abrupt, but that of the female is extended by a long, soft ovipositor, 
which is doubled under the abdomen when at rest. Length 12 to 14 
millimetres (excluding ovipositor). This species has a world-wide 
distribution. It flies chiefly during August, and affects horses, asses, and 
mules, and lives for quite a time. The eggs, about 1 millimetre long and 


1428 SYSTEM OF VETERINARY MEDICINE 


whitish, are often deposited on the hairin the region of the cannon-bone. 
A small larva issues from the egg, and its irritation of the skin causes the 
animal to bite the part. In this way the mouth and, later on,the stomach 
is reached. The cardiac portion of this latter organ is its resting-place. 
When found in other situations such as the pyloric portion of the 
stomach and the duodenum they must be regarded as wanderers. The 
larva produces a small area of inflammation and ulceration at its point 
of attachment, and upon the products of these it develops. As it increases 
in size the colour gradually changes from a rose-pink to dull yellow. 
It is then about 18 to 20 millimetres long, and somewhat conical in shape. 
The second to eighth segments inclusive carry on their anterior dorsal 
border two rows of spines, the first row being more developed; the ninth 
has only a few spines, and the tenth one or two. 

On the ventral aspect a similar arrangement exists from the second 
tio tenth segments. After about ten months in its host the larva leaves 
the stomach and gains the exterior. They are therefore passed from 
May to August, and then burrow and become black pup, in the soil 
from which the adult fly issues in about four to six weeks. 

G. hemorrhoidalis (L.) is a smaller fly, 9 to 10 millimetres, and whose 
wings have no spots. The eggs, which are dark in colour, are laid around 
the lips, and the tickling produced by the newly hatched larvee causes 
licking. In this way the stomach is reached. The final larval stage is 
smaller than the preceding, and deep red in colour; the spines are about 
the same size in each row, and there are no dorsal spines on the tenth 
segment. Although they are found on the membrane lining the left sac 
of the stomach, they may often be seen in other portions of the alimentary 
canal, such as the pharynx, rectum, or adhering to the anus, where they 
evince a greenish hue. ‘There are several other species, such as G. pecorum 
(Fab.), G. onermis (Brauer), G. flavipes (Oliv.), and G. nasalis (L.), all of 
which are parasitic in equines. 

There are several species of Hypoderma, such as H. bovis, H. lineata, 
H. stlenus, and H. diana. Quite a number of others have been described, 
but many of them appear to be varieties of H. bovis. The three first 
mentioned species are, however, the most important. 

H. bovis (De Geer). The general colour is black and hairy, the face 
is grey; there are whitish hairs on the anterior half of the upper surface 
of the thorax, the posterior portion being black. Abdomen black, with 
whitish hairs in front, black in the middle, and orange-red at the posterior 
extremity. Wings brownish; length 13 to 15 millimetres (exclusive of 
ovipositor). The latter structure is soft. The adult fly is on the wing 
between May and September. The life-history of this species has been 


PARASITES AND PARASITIC DISEASES 1429 


variously stated, and authorities are not yet agreed upon it. It seems 
probable that the eggs are deposited on the hairs and fastened there 
by their clasps, and that the larve which emerge from these cause 
the animal to lick the parts, and so they reach the cesophagus, from whence 
they pass through the various tissues until they come to rest underneath 
the skin of the back. Several changes take place in the larve during 
this migration. In its final stage it again acquires spines, and its hinder 
extremity, with its spiracles, is directed towards the skin. The irritation 
it provokes causes the characteristic ‘‘ warble,” from which the mature 
larva drops to the ground. It is about 2°5 to 3°5 centimetres long and 
is brown in colour. The last two segments have no spines. Pupation 
takes place in, or upon the ground, and the adult fly appears in about 
four to six weeks. The life-cycle occupies about a year. This species 
is world-wide in its distribution, and is probably the common warble 
fly in England, although this is a disputed point in favour of the next 
mentioned species. It affects cattle. 

H. lineata (Villiers).—This is a black and very hairy fly, but differs 
from the preceding in possessing grey longitudinal lines on the upper 
part of the thorax, and is, moreover, smaller, being 12 to 13 millimetres 
long (without the ovipositor). The life-history is certainly as described 
for H. bovis, save that the eggs are deposited on the legs and hoofs of 
cattle. The mature larva is about 2°5 to 3°5 centimetres long, but is 
greyish-brown in colour, with stripes of a lighter hue; the terminal 
segment only is free from spines. This fly appears to be most common 
in America, but its distribution is wide, and many English warbles in the 
ox are due to it. 

H. silenus (Brauer).—Under this name have been described the larvee 
which have from time to time been found under the skin of equines in 
the region of the collar or back. The same parasite has been called 
H. equi and H. loiseti. The full-grown larva is certainly smaller than the 
ox warble fly, being about 9 to 10 millimetres long. Its cuticle is thin 
and somewhat transparent, and the segments, which are well defined, 
have no spines. This parasite is not common in this country, but it 
does occur. 

Dermatobia noxialis (Goud).—This and other species of the same 
genus play in South America a réle similar to Hypoderma in this country. 
Man, cattle, and dogs are most often affected. 

The cavicole (stride affecting wild ruminants are numerous, but 
the typical and most important species is that of ovines—viz., the 
Sheep nostril fly (Hstrus ovis L.). General colour yellowish-grey, slightly 
hairy, face yellow, upper surface of thorax brownish-grey, abdomen 


1430 SYSTEM OF VETERINARY MEDICINE 


spotted with white, yellow,and black. Wings transparent, with three black _ 
points at their bases. Length, 10 to 12 millimetres. The ova, twelve to 
fifteen in number, and kidney-shaped, are deposited around the sheep’s 
nostril in bright sunny weather; but if fertilisation be followed by dull 
days, the female does not seek out a host so quickly, and then larve are 
deposited. The larve seek out the air-spaces of the sheep’s head, and at 
maturity are 20 to 30 millimetres long and 8 to 10 millimetres broad, of 
a whitish colour, with transverse streaks on the segments. After a 
sojourn of about ten months in the nasal cavities, the larve are expelled, 
and a little below the surface of the ground turn into pupe, from which 
the adult flies emerge. | 

Ingurnious Errects.—The damage which the above three groups of 
flies are capable of doing depends upon their number in the individual, 
and also the number of individuals attacked. 

In Gastrophilus it is possible to have a great number of larvee present 
in the stomach without any apparent derangement in health. However, 
the risk of bacteria] invasion through the insertion apertures always 
exists, and the possibility of weakening the gastric wall, or even its 
rupture when other abnormal conditions are in operation, must not be 
lost sight of. Those species which wander are likely to produce some 
irritation, such as pharyngitis, and even penetration of the duodenum. 
In the case of Hypoderma the disturbance produced in a herd when the 
flies are on the wing may lead to accidents and a reduction in the milk- 
supply ; whilst in its final resting-place under the skin of the back, a quan- 
tity of meat, in slaughtered animals, is rendered cedematous and unfit 
for food. The hides are greatly depreciated by the presence of warble — 
holes. The total loss in this country from this means alone has been 
variously estimated at from £2,000,000 to £7,000,000 per annum. 
Cattle themselves do not seem to suffer much inconvenience from 
warbles; in fact, rumour has it that warbled cattle are usually the 
best. In the working horse warbles often give rise to sore backs and 
shoulders. 

Sheep affected with Mstrus larvee may not show much economic loss, 
although in bad seasons the set-back or loss of flesh and the occasional 
loss of a sheep may be important to the flock-master. All the warble 
and bot flies produce myiasis externa or interna. 

Symproms.—In horses affected with Gastrophilus nothing definite 
is shown, and their presence is often only detected on post-mortem 
examination, or when passed in the feces at their natural time. Although 
in most cases affected animals enjoy robust health, the usual clinical 
picture of gastric derangement, with its general consequences, is some- 


PARASITES AND PARASITIC DISEASES 1431 


times described. Horses take in the larve during summer and early 
autumn. 

The presence of Hypoderma larve is indicated by small elevations 
of the skin of the back, which gradually increase in size, and about May 
show a soft centre, out of which the parasite will shortly escape. 

Sheep with Gstrus larvee in the nose, if only few in number, show 
little disturbance. If numerous at the approach of summer, there are 
indications of irritation, manifested by a discharge from the nostrils. As 
this increases in thickness, there is sneezing and other efforts to remove 
the parasites, such as rubbing the head; the head may be carried low, 
or the gait may be exaggerated. There is sometimes interference with 
respiration, and later on loss of condition. 

REMEDIAL MrasurEes.—Medicinal treatment of horses affected with 
‘bots ” is useless, because they will resist, when in vitro, agents which 
would cause damage to the living gastric mucous membrane. Many 
agents are, however, given, among which may be mentioned iodine, 
benzine, and bryonia root. In cases where the anus or rectum harbour 
larvee, these can be removed by the hand. It has recently been suggested 
that as the larve are only found in the viscera of those animals which 
have no gall-bladder, that bile should form an effective medicant. The 
experiments performed in the laboratory with alcoholic solutions of this 
substance seem encouraging. In cattle whose skins harbour warbles, 
the only treatment consists in removing the grub by means of pressure 
or lancet, and treating the cavities with some antiseptic wash. The 
nasal cavities of sheep can be irrigated or fumigated with irritant solu- 
tions and gases, but these do not produce much effect on the larve. 
Trepanation or the removal of the horn cores has been resorted to with 
good results in valuable animals. 

PREVENTATIVE MEAsuRES.—These are by far the most important, and 
should be applied if the flies are frequent in hot and dry weather. They 
must follow those laid down under blood-sucking flies (p. 1422). In 
addition to this, grazing horses may have a dressing of fish oil and tar 
smeared over the parts likely to be chosen by Gastrophilus for oviposi- 
tion, and animals that come up from grass with many ova on them may 
be singed on the affected parts. In cattle similar dressing may be 
applied to the back. In sheep the dressings may be applied round the 
' nose, or, better still, salt-boxes may be so constructed that the sheep 
tars and oils its nose when it uses the box. In all cases pastures 
known to harbour warble flies should be avoided, plenty of shade sup- 
plied, and any larve destroyed. ; 

In some countries measures against the ox warble have been marked 


1432 SYSTEM OF VETERINARY MEDICINE 


by success. In this country at least the larval forms of these flies appear 
to have no natural enemies; in Africa, however, there is a genus of 
starlings known as beef-eaters or ox-peckers (Buphaga). B. africana is 
a useful friend to cattle in ridding them of subcutaneous larve. These 
birds do not, as their name indicates, eat beef, but live on the grubs. 


BIBLIOGRAPHY. 


BRAUvER, F': Monographie der (striden. Wien, 1863. 

CassELs: Natural History. London, 1893. | 

CLARKE, Bracy: An Essay on the Bots of Horses and Other Animals. London, 
1815. 

Coxttinez, W. E.: Note on the Deposition of Eggs and Larve of Wstrus ovis 
Lin. Journal of Economic Biology, vol. i., 1906. 

Imus, A. D.: Life-Histories of Ox Warble Flies, Hypoderma bovis (De Geer), and 
H. lineata (Villiers). Journal of Economic Biology, vol. i., 1906. 

Mere@ntin, P.: Les Parasites Articulés. Paris, 1895. 

OrmMEROD, E. A.: Observations on the Warble or Ox Bot Fly, Hypoderma bovis. 
London, 1894. 

RAILueET, A.: Traité de Zoologie Médicale et Agricole. Paris, 1895. 

VILLEMOES: The Campaign against the Warble Fly in Denmark. Journal of 
Comparative Pathology and Therapeutics, vol. xxiv., 1911. 


FLEAS AND JIGGERS. 


Speaking in a broad sense, these insects are not of great importance 
to the veterinarian, although they are known spreaders of diseases which 
concern public and tropical officers of health. They are generally re- 
garded as constituting an order, Aphaniptera, of the Insecta. They 
are wingless, and the thoracic rings are not amalgamated; the abdomen 
has nine segments; the antenne are tri-jointed, the legs are very 
powerful; and the mouth parts are modified into serrated puncturing 
organs. The metamorphosis is complete, the egg giving rise to a 
segmented larva, which later on forms a cocoon, from which emerges 
the perfect insect. Although many of the smaller animals (rodents) 
harbour different genera and species of flea, there are only four that 
attack the domesticated animals: Pulex irritans, L. (the human flea), 
Ctenocephalus canis Curt. (the dog flea), C. felis Bou. (the cat flea), and 
Dermatophilus penetrans (L.) (the jigger). 

P. irritans is a reddish or dark brown colour, with an oval body and 
a rounded head. The male is about 2 millimetres long, and the female 
about twice this length. It attacks man, the dog, cat, and rabbit, 
especially the ears of the last two animals. 

C. cams (P. serraticeps Ger.) is a little larger than the moneda 
species, from which it is distinguished by its slightly larger size, lighter 
colour, and by the presence of a row of black spines (comb) on each side 
of the lower aspect of the face, and another row of seven to nine on each 


PARASITES AND PARASITIC DISEASES 1433 


side of the posterior border of the prothorax. It is found on the dog, 
cat, rabbit, and very occasionally on man, whom it rarely bites. 

C. felts is very similar to the above, but is distinguishable. 

D. penetrans is much smaller than the above species. The female 
measures about 1:25 millimetres, and is smaller than the male. The 
latter only occasionally bites; the fertilised female, however, bores into 
the skin. It is prevalent in the tropics, and has recently been reported 
from the Transvaal. It is found in woods and sand, and attacks man, 
equines, ruminants, carnivores, and many other mammals. An allied 
species attacks poultry and even children in Ceylon and North America. 

Ingurious Errects.—The actual bite of fleas proper has little effect 
upon the dog and cat, save for the irritation at the time it is inflicted, 
when it causes biting or scratching. Its power of transmitting disease 
must, however, not be neglected. Fleas have been shown to readily 
take up Letshmania tropica (vide Vol. I., p. 1162). The dog flea is known 
to be the intermediate bearer of the cystic stage of the tapeworm Dipy- 
lidium caninum (T'. cucumerina) of the dog and cat. The human flea 
sometimes adheres to the skin of the conchal cartilage of the cat in such 
numbers as to cause sores. With these there is marked scratching. The 
jigger, however, produces lesions of a more important nature. The male 
and unfertilised female are like the fleas in their action, but the fecundated 
female penetrates the skin, where it undergoes changes and causes an 
inflammatory process, which later on becomes ulcerated. Long-haired 
cats and even dogs may sometimes drop from their coats the small 
rounded and semi-transparent eggs of their respective fleas. 

RemepiaLt Mreasures.—Afiected animals are usually sprinkled with 
some insecticide powders which contain pyrethrum, wormwood, or 
stavesacre. Dogs are washed some hours after in a soap bath. Liquid 
dog soaps impregnated with harmless antiseptics are to be recommended. 
As the parasites are not constant, they may escape the powder. Atten- 
tion is therefore to be given to kennels and other houses which should 
be very clean and free from cracks. Frequent scalding with boiling 
water, antiseptic applications, and white-washing, have to be resorted to. 
Although the parasite usually breeds in bedding and other similar 
material, the life-history may be completed on the host. 


BIBLIOGRAPHY. 


Braun, M.: Animal Parasites of Man. London, 1906. 

RUSSELL: The Flea. Cambridge, 1913. 

Wenyovn, C. M.: Experiments on the Behaviour of Leishmania and Allied Flagel- 
lates in Bugs and Fleas, etc. Journal of London School of Tropical 
Medicine, 1912. 


1434 SYSTEM OF VETERINARY MEDICINE 


BEES, WASPS, AND HORNETS. 


The above stinging insects belong to the great natural order Hymen- 
optera, all the species of which possess as a rule four membranous trans- 
parent wings, destitute of scales. These wings are of moderate size, and 
the anterior pair are larger than the posterior. The areas into which 
the wing surface is divided by the nervules never exceed twenty in the 
front and fifteen in the hinder pair. In the bees the hairs covering the 
body are plumose, whilst in the wasps they are simple. They cannot | 
be said to be an important group from the veterinarian’s point of view. 
The chief genera are Aphis (honey bees), Bombus (humble bees), and 
Vespa (wasps and hornets). A. mellifica L., the hive bee, rarely attacks 
animals. Of Bombus there are many species which, contrary to popular 
talk, are capable of stinging. They are recognised in most cases by their 
comparatively large size. B. lapidarius is large and black, with the - 
terminal abdominal segments reddish. B. terrestris has a yellow band 
across the thorax and another on the anterior portion of the abdomen, 
the end of which is greyish-brown. B. agrorum has a black and tawny 
abdomen. ‘These species nest in, or upon, the ground, and are flower- 
loving, and it was the lack of them that prevented the successful cultiva- 
tion of clover when this plant was first introduced into New Zealand. 
Humble bees have since been imported there and become numerous. 

Vespa vulgaris L. (the common wasp), is about 18 millimetres long, 
and is easily recognised by its yellow abdomen with black bands. Other 
species are V. germanica, V. rufa, whose nests are usually subterranean, 
V. norwegica and V. sylvestris, the nests of which are usually found — 
hanging from branches of trees. 

V. crabra L. (the hornet) is the largest species of the genus, being 
27 millimetres long. This feature, together with its colour, which is 
reddish-brown and yellow, serves to distinguish it from allied species. 
The nest is usually found in hollow trees, and itis not so common in this 
country as it used to be. The life-histories of all the above species, 
although interesting, are outside the veterinarians province. 

Insurious Errects.—The propensity of stinging is confined to 
females and neuters. The apparatus whereby the act is effected corre- 
sponds to an ovipositor of the female reproductive system, and is situated 
in the posterior abdominal segments. It consists of a hard director, 
which pierces the skin in order to prepare the way for the true sting and 
venom. This latter is derived from two glands, one acid and the other 
alkaline. The sting is used in defence, and if a hard-skinned insect is 
attacked, the hole caused by the sting remains open, and the wasp or bee 


PARASITES AND PARASITIC DISEASES 1435 


is able to withdraw its apparatus; but if a mammal is the prey, then the 
elastic skin contracts round the “sting,” and this, by means of its barbules, 
is often retained in the skin, and the insect escapes mortally wounded. 
The seriousness of the lesions depends upon the number of stings and the 
parts affected. In the region of the throat or in the mouth there is 
marked cedema and encroachment on the respiratory functions, leading 
to death by asphyxia. Dogs often become affected about the head by 
digging and biting up nests, and horses and cattle when sheltering under 
trees, or even by swarms settling upon these animals’ heads when at 
plough. Deaths from stings have been recorded in man and the lower 
animals. 

SymMptoms.—One or two stings give rise to the usual train of symp- 
toms suggestive of local irritation, followed by slight swelling. When 
the stings are numerous, there is great excitement, hurried respiration, 
rapid and frequent pulse, swelling of the affected parts, prostration, 
and a history of the attack. 

TREATMENT.—If the “stings” can be seen still in the tissues, they 
should be extracted, and then cold fomentations applied. Various 
antacid solutions, such as weak ammonia and bicarbonate of soda, 
are useful. Refrigerant lotions and ice are beneficial. In extreme 
cases cardiac stimulants, and even tracheotomy, may be indicated. 
The attacks of ants may be similarly treated. 


9 


BIBLIOGRAPHY. 


LatTTER, O. H.: Bees and Wasps. Cambridge, 1913. 
RaILueT, A.: Zoologie Médicale et Agricole. Paris, 1895. 


LICE. 


Small though the lice be, they form, when mammals and birds are con- 
sidered, a very important group of ecto-parasites. The term “lice ”’ 
has practically no zoological signification. Thus there are such expres- 
sions as “ bird lice,” “‘ plant lice,’’ and “‘ fish lice,” groups of parasites 
related only in the widest sense; the former two of which are Insecta, 
and the latter Crustacea. 

The natural order Rhynchota, to which the lice of mammals and birds 
belong, is characterised by the possession of an incomplete metamorphosis, 
anterior wings of a variable structure, the posterior being membranous, 
and a suctorial mouth. The suborder, Anoplura, contains the lice 
of man and other mammals. Lice fall naturally into two groups. 
Those of the first have an elongated head, indistinct prothorax, and the 


1436 SYSTEM OF VETERINARY MEDICINE 


buccal apparatus modified for blood-sucking—viz., Hematopinus and 
Iinognathus, of the family Hematopinide. Those of the second group 
have usually a broad head, a distinct prothorax, and a masticatory 
mouth—Trichodectes. Being insects, lice have naturally three pairs of 
legs. The hematopines, then, are blood-suckers, from 1:5 to 5 milli- 
metres long, and may be found on any part of the body. The old genus, 
Hematopinus, has been recently split up by Enderlein, and the species 
of the domesticated animals now fall into two genera—viz., Hamatopinus 
and Linognathus. 


Species Host. 
Hematopinus asini (l.) ae .. Horse and ass. 
H. suis (L.) “0 th a Ls 
H. eurysternus (N.) 4 ad wns Ox 
H, tuberculatum (N.) “ eis .. Buffalo. 
Linognathus piliferus (Biirm.) : apo pal BL 63a. 

L. vituli (L.) oe oe hye Ox and calf. 
LL stenopsis (Biirm.) i Mi .. Goat. 
L. pedalis (Osborn) a we .. Sheep. 


A few other comparatively rare species have been described. The 
hematopine of the pig is the largest species, it being 5 millimetres long. 
The trichodects are much smaller than the above parasites, being usually 
about 1 to 1:5 millimetres long; they are not blood-suckers, but live on 
products of the skin. The head, as already stated, is wide and short in 
distinction to the first group, the heads of which are elongated. The 
following is a list of species and their hosts: 


Species. Host. 
Trichodectes pilosus Piag. .. ie .. Horse and ass. 
7’. parumpilosus Piag. is vs .. Horse and ass. 
T'. scalaris Nitz. .. Bi mi ar ab 
T. ovis (L.) ts . ea .. Sheep. 

T. climax Nitz. .. a ay .. Goat. 
T'. latus Nitz. 7 ais a “i WOR: 
T’. subrostratus Nitz. ih ots .. Cat. 


The life-histories of these two genera are very much the same. The 
female lays eggs, which are usually spoken of as “‘ nits’; these are small 
and pear-shaped, and are fixed by an agglutinous material to the base 
of a hair by theirsmall end. After a period varying with the season of 
the year, the young and complete insect escapes from the large end 
opposite to the point of attachment. This is accomplished by the raising 
of an operculum. In a short time they become adult and capable of 
reproduction. 

Insurious Errrcts.—The hematopines being blood-suckers, give rise 
to irritation at the time of biting. They may also, in some cases, transmit 


PARASITES AND PARASITIC DISEASES 1437 


diseases. Experiments in this direction have been successful in some 
cases and negative in others. T'richodectes species are less irritant in their 
action; those infesting the dog and cat are liable to harbour Cryptocystis 
trichodectis, the cystic stage of a tapeworm of carnivores—Dipylidium 
caninum. 

Symproms.—The symptoms shown are variously spoken of as pedicu- 
losis (Pediculus, 2 human louse), phthiriasis (Phthirius, the human crab 
louse), and lousiness. The latter term is probably the most suitable. 
The manifestation depends to a great extent upon the number of 
parasites present, the lesions of Haematopinus and Linognathus always 
being more severe than those of T'richodectes. 

The horse and ass, especially old animals, are often affected by the 
larger lice. Their presence is manifested by stamping, rubbing, biting, 
localised elevations of the coat if short, excess of dandruff, and the 
presence of nits and adults. The chief breeding-ground is the hair of 
the legs. The small lice are most often seen in young animals recently 
taken from grass. It is important to note that mange may coexist. 
In the ox excessive licking is noticed, with a tendency to rub. 

Sheep and goats sometimes suffer severely from lice. In the former 
there is rubbing and pulling of the fleece, and in the latter great numbers 
of L. stenopsis may cause a veritable dermatitis, with falling out of 
the hair. | 

Pigs are often greatly disturbed .by their large hematopine. This 
is shown by the great extent to which they scratch, rub, bathe in mud, 
and lose flesh. The back, sides, and ears are the parts most often 
affected. 

In the dog, especially long-haired breeds, trichodects and their eggs 
may cause extensive matting of the hair, whilst Lonognathus causes 
irritation, with its attendant scratching, rubbing, biting, and sleepless- 
ness. j 

In all cases the parasite must be discovered before lousiness can be 
diagnosed. 

TREATMENT.—This will vary with the animal affected, the extent 
of the infestation, and the species of parasite present. The best drug 
for lice is perchloride of mercury, but it must be used with great care. 
In the horse trichodectes are easily eradicated by two washings in a 
3 per cent. solution of coal-tar disinfectants at intervals of four or five 
days. 

Heematopines and their allies, however, require very energetic treat- 
ment to exterminate them. Usually it will be best to clip the animal all 
over, especially the legs of cart-horses. After this a great number can be 


1438 SYSTEM OF VETERINARY MEDICINE 


killed by careful singeing. The patient can then be scraped all over with 
a thin kitchen knife. This will remove vast numbers of nits. The legs 
can then be “tubbed ” in perchloride of mercury, 1 in 1,000, and the 
body dressed with strong liquid ammonia 1 part, liquid oil of tar 5 parts, 
and water 50 parts. This treatment should be carried out twice in seven 
days. Stavesacre decoctions are also used, about 4 ounces of powdered 
seeds to the gallon of water. Ruminants are generally subjected to 
dipping, as described on p. 1474. The pig usually has an oily dressing of 
sulphur applied to it—1 to 2 pounds to the gallon of a non-blistering 
paraffin, such as train oil. The dog can be dealt with as described under 
Fleas (p. 1433). 

If perchloride of mercury is used, great care must be taken to prevent 
licking or absorption. 

PREVENTATIVE MrAsuRES.—It is needless to remark that affected 
animals should be isolated, and all the harness, clothing, and grooming 
utensils thoroughly disinfected. The bedding and habitations should 
also undergo similar treatment, and any hair removed should be burnt. 


BIBLIOGRAPHY. 


DeEnNy, H.: Monographia Anopluorum Britanniz. London, 1842. 
ENDERLEIN: Zool. Anz., vol. xxviii. 
Murenin, P.: Les Parasites Articulés. Paris, 1985. 


THE LINGUATULES. 


All the arthropod parasites previously considered are included in 
the Insecta, the remainder belong to the class Arachnida; animals in 
which the head and thorax are fused, cephalo-thorax; the abdomen is 
often non-segmented; there are no antenne, and four pairs of legs. 
There are several natural orders, but only two are important to veteri- 
narians—viz., Linguatulida and Acarina. The former are somewhat 
worm-like in shape, in the adult stage possess no limbs, and in England, 
at least, they are not numerically important. 

LInnguatula lanceolata (Chabert), (LZ. denticulata, Rud. [larval form], 
L. temoides, Rud.). Body elongated, with an enlarged and rounded 
anterior extremity, gradually tapering to the posterior end. The 
integument shows about ninety segments. The male is white in colour, 
and about 18 to 20 millimetres long. The female is darker, and often 
shows a brown colour down the centre, due to the presence of eggs, and 
is about 8 to 10 centimetres long. The anterior extremity is 8 to 10 
millimetres broad, and the posterior 2 millimetres. In the adult stage 


PARASITES AND PARASITIC DISEASES 1439 


this parasite is found in the nasal fosse of the dog, horse, sheep, and 
even man. The larval stage may occur in the liver, lungs, and mesen- 
teric glands of the horse, ox, sheep, goat, cat, rabbit, and man. The 
eggs at birth contain an embryo, which arrives at the exterior in the nasal 
discharges provoked by the adult. It is then ingested usually by a 
herbivorous animal. The embryo passes from the alimentary canal, 
and becomes encysted in the various organs, and after a series of moults 
larval development ceases. On the death of the host, carnivores are 
infected by eating the larve in affected organs. The nasal cavity is 
reached by way of the mouth. 

Insurious Errects.—These are due chiefly to the adult in the nasal 
fossee, although larval forms in the mesenteric glands destroy the func- 
tions of these important organs. The glands contain a brown material, 
and sometimes holes by which the larve have escaped. There is indura- 
tion, which is sometimes followed by calcification. The adult in the nasal 
cavity of the dog causes irritation by its attachment, and there is slight 
sneezing, and this becomes more marked with the growth of the parasite. 
Occasionally there is interference with the respiration, and attempts to 
dislodge the source of irritation by the paws. Mucus escapes from the 
nostrils, it may be blood-tinged, and usually contains the brown and 
oval eggs. Rarely the adult parasites are expelled. Nervous symptoms 
resembling epilepsy have been recorded. 

RemepiaL Mrasures.—Nothing can be done for sheep and cattle 
affected with larval forms. In meat inspection affected organs should 
be condemned. When in the nose of dogs, antiseptic or irritant solutions 
are injected with varying success. Weak ammonia or benzine are most 
often used. The life-history should be the means of pointing to the 
exact lines of prevention of spread—e.g., affected dogs should not be 
allowed near grazing-pastures, and the larval stages discovered at the 
slaughter-house should not be permitted to come in contact with dogs’ 


food. 


THE ACARIENS. 


All the arthropod parasites included under this name belong to the 
natural order Acarina, and the class Arachnida. Broadly speaking, they 
are characterised by the possession of structures which closely resemble 
those of the spiders. They vary in size from the microscopic mange 
mites up to engorged female ticks, the size of a hazel nut. There is a 
head which is fused to the chest, forming a cephalo-thorax, behind which 
is a non-segmented abdomen. There are four pairs of legs in the adult, 
and the mouth parts are in the form of a rostrum. Usually they are 


1440 SYSTEM OF VETERINARY MEDICINE 


oviparous; the larva on leaving the egg possesses se three pairs of legs— 
hexapod larva. 

After moulting, the larva becomes a nymph, with four pairs of legs— 
octopod nymph. They only differ from the adults by the absence of 
genital organs. During the last moult these are acquired, and the 
parasites become adult males or females. The order contains a number 
of families, some of which are of no interest to the veterinarian, 
others which deserve only slight mention, and, again, others which 
are of the utmost importance. As disease - producers themselves, 
there are the mange mites, and as transmitters of serious protozoan 
diseases, the ticks. Most of them are, however, blood-suckers, often 
robbing their hosts to a marked degree. The females are chiefly respon- 
sible for this; some of the males and immature forms are not always so 
persistent in this direction. It is proposed to consider as fully as the 
scope of this work permits the following families: 

(1) Gamasidee (red mites), (2) Argaside, (3) Trombidiidee (harvest 
bugs), (4) Ixodide (ticks), (5) Demodecide (follicular mites), and 
(6) Sarcoptidee (mange mites). The ticks, follicular mites, and mange 
mites, will be discussed under separate sections, but the first three 
families will be dealt with in this article. 


1. The Red Mites. 


The Gamaside, to which the red mites belong, generally have a 
hard body, and are parasitic on birds and mammals. The only impor- 
tant species is included in the subfamily Dermanyssine. 

Dermanyssus galline (De Geer)—As the common name indicates, 
this species is red when engorged, but whitish when young. The 
abdomen is soft and pear-shaped, the posterior extremity being the larger. 
It is margined by fine bristles. The legs are five-jointed, and the last 
segments carry tarsi. The female is distinguished from the male by the 
chelicere projecting from the rostrum in the form of a stylet. The body 
of the male is 6 millimetres long and 3 millimetres broad, whilst the 
female is a little larger. This mite is found on poultry, pigeons, and in 
their nests and habitations. A closely allied species is parasitic on 
swallows—D. hirundinis (Herm). 

Insurnious Errects.—Red mites are nocturnal in their habits, resting 
by day in crevices. Their attacks upon sitting birds and their young, 
especially pigeons, are most formidable. Their blood-sucking habits 
cause the old birds to leave their nests and squeakers to become un- 
thrifty. During its nightly rambling it sometimes attacks horses. 


PARASITES AND PARASITIC DISEASES 1441 


This has often been noticed where there were pigeon lofts or fowl-houses 
above the stable. The pricking of the skin and blood-sucking causes 
an elevation of the hair, which gives the animal a flea-bitten appearance. 
Occasionally the irritation is so severe that other parasitic skin affections 
are likely to be diagnosed. Dermanyssic acariasis is, however, com- 
paratively rare. Its sudden morning appearance and the proximity of 
bird-pens to the stable should be of sufficient importance to insure a 
correct diagnosis. 

REMEDIAL MrEasurEs.—These must follow palliative lines when 
applied to the patient, with the application of a thorough cleansing 
and disinfecting to the infected lofts, or, better still, the removal of these 
from the stable. 


2. The Argasid Ticks. 


The Argaside are distinguished from the other ticks by the slight 
dimorphism of the male and female, and by the absence of a scutum 
and festoons. The mouth parts are ventrally placed, the spiracles are 
situated between the third and fourth pair of legs, and there is no cushion 
on the legs. The family contains two genera—viz., Argas and Ornitho- 
dorus—both of which are not so important to the veterinarian as to 
medical men. They are great pests to man and birds, and transmit 
important human and avian diseases. 

Argas reflezus (Fabricus) is of a yellowish colour; often the ingested 
blood shows red or brown through the intestine. The skin is wrinkled. 
The male is 4 millimetres long, and the female, when fertilised and 
replete, 6 to 8 millimetres long, and about 4 millimetres broad. It 
usually attacks pigeons. Fowls are attacked by the nymphs and adults. 

Larve have been found on the horse. 
| A. persicus (Oken) is larger than the preceding, the engorged female 
reaching 10 millimetres in length. It is not only found on man in Persia, 
but also in Europe, Asia, Africa, and America. A. americus and 
A. miniatus are regarded as synonyms of this species. It is found on 
man and most of the domesticated birds. 

Both of these ticks appear to be very long-lived. Robertson 
kept A. persicus unfed for two years and three months, and Ghiliani 
A. reflecus for twenty-two months. The life-history has two nymphal 
forms. 

Ingurious Errects.—The ravages of these ticks. amongst birds, 
especially young ones, is often of great economic importance. In Africa 
the Argas is regarded as one of the mdst pernicious of poultry pests. 
The bites are chiefly seen on the neck under the wings and around the 

VOL, II. 91 


1442 SYSTEM OF VETERINARY MEDICINE 


anus. The irritant effects of the Persian Argas to travellers have long 
been dreaded A. persicus transmits spirochetosis of fowls, which is 
caused by Spirocheta marchouxt. The disease may be very rapidly fatal 
(see Vol. I., p. 1227). 8S. anserina.—Goose spirochetosis has also been 
shown to be transmitted by this species. 

RemepiaL Measures.—Afiected birds are usually isolated in portable 
pens until the ticks drop off, the pens can then be burnt. Birds are 
sometimes dipped in the various sheep dips (see p. 1475). Fowl-houses 
of sheet iron afford little opportunity for hiding-places, and are therefore 
to be advised. Old habitations should be cleared of all structures and 
then thoroughly cleansed. The main walls, all cracks and crevices, 
should then be hot tarred. Perches and nests should be suspended by 
iron rods from the roof. Lime-washing and periodic disinfection are 
essential to keep the parasites in check. 

The other genus of this family, Ornithodorus, contains several species, 
the chief of which are: O.moubata (Murray), of man and poultry ; O. megnona 
(Dugés), of man and most of the domesticated animals; O. savignyt — 
(Audouin), O. turicata (Dugés), of man and swine; and O. lahorensis 
Neumann, of sheep. They inhabit chiefly hot countries, and some of 
them are capable of living for long periods without food. In some 
instances for two years. 

O. megnini (the spinose tick)—The female is 5 to 6 millimetres long 
and 3 to 4 millimetres broad, and the male slightly smaller. The integu- 
ment is covered with small depressions, from which emanate short hairs. 
The rostrum is very short. This species, which is common in the Americas, 
attaches itself to the inside of the ear of its host. ; 

Insurious. Errects.—The bites of these parasites vary in severity, 
but they always deprive their hosts of a considerable amount of blood. 
O. megnint causes local irritation in the ear; O. moubata, besides trans- 
mitting “tick fever’ of man (Spirocheta duttoni), is capable of spreading 
spirochetosis of fowls (S. marchouxt); and the spirochetes have been 
found alive in the tick 103 days after feeding on an affected bird. 

REMEDIAL Measures.—These will be similar to those just described. 
For removing them from the ears of cattle and horses, the pouring in 


of some bland oil, followed by destruction of the tick when it drops off, 
is recommended. 


3. The Harvest Bugs. 


These occasional parasites are the hexapod larve of various species 
of the family Trombidiide. This group is composed of small soft- 
skinned acarina, which in the adult stage are found chiefly in gardens and 


PARASITES AND PARASITIC DISEASES 1443 


on woody undergrowth. Barley stubble in autumn has been often 
noticed to be a favourite resort. The adults are not parasitic.. 

Trombidium holosericeum (Lin.).—The body of the mature mite is 
trapezoid in shape, with the greatest width anteriorly. It is red in 
colour, with dark spots. Pedunculated eyes are present. The eight legs 
are composed of six articles each, and, like the body, are covered by 
small red hairs. It measures 3 to 4 millimetres long. The eggs are 
laid in late summer, and the hexapod larve are prevalent during the early 
shooting season. They are almost spherical, and measure about 2°8 milli- 
metres long. Before it was recognised to be a stage in the life-history 
of an acarian, this larva was regarded as a separate species (Leptus 
autumnalis Latr). It attacks man, the domesticated mammals, birds, and 
even invertebrates. There are many other species, amongst which may 
be mentioned 7. pussilum (Herm), TY. americanum (Riley), and 
T. irritans (Riley). The former has been found on the cat and man, 
and the latter two on most of the domesticated animals in America. 

Insurnious Errects.—In this country, sporting dogs are those most 
often attacked; the irritation produced by the insertion of the mite’s 
long hypopharynx is often very severe, if they are present in great 
numbers. The lesions are found on the head, especially round the orbits, 
limbs, and abdominal wall. In man the condition is sometimes spoken 
of as autumnal erythema; it is manifested by redness and itching, with 
a disseminated miliary eruption. Cats are occasionally attacked on the 
feet and end of the tail. The other animals may be invaded on those 
parts likely to come into contact with the hiding-places of the parasite. 

RemepDiaL Mrasures.—In most cases, although the irritation may 
be severe, the symptoms gradually abate, because the larva can only live 
for a few days on their hosts. The application of sedative antiseptics 
to the skin is usually sufficient to kill the parasites. Lysol in 3 per cent. 
watery solution is to be recommended: Emmolient unguenta con- 
taining sulphur, boracic acid, or salicylic acid, are also used. Small 
areas may be dressed with a little petrol or turpentine. These agents, 
as well as flowers of sulphur, are recommended to be applied to the base 
of the feathers of affected poultry. Important losses due to T. poriceps 
Heim. and 7. striaticeps Heim. have been recorded among fowls. 


BIBLIOGRAPHY. 


PituEeRS: Dermanyssic Acariasis. Veterinary Journal, 1908. 

NEvEU-LEMAIRE: Parasitologie des Animaux Domestiques. Paris, 1912. 

NUTTALL, WARBURTON, CooPER, AND RoBINsON : A Monograph of the Ixodoidea. 
Part I.: Argaside. Cambridge, 1908. 


1444 SYSTEM OF VETERINARY MEDICINE 


THE TICKS. 
The ticks, or ixodes proper, belong to the family Ixodide. They 


are of great economic importance, on account of the numbers of them 
which are capable of transmitting disease-producing protozoan parasites 
of the genera Babesia (Piroplasma), Theileria, Nuttallia, Spirocheta, 
and Anaplasma. They are usually large acarians, and are found in all 
parts of the world. The rostrum in this group is terminal, and is com- 
posed of two chelicere situated dorsally, a hypostome below these, and 
laterally two palpi, all of which are important organs in fixation and 
blood-sucking. The shape and size of the body varies greatly in the two 
sexes. There is a well-marked digestive apparatus, and the genital 
organs are simple. The passage of pathogenic micro-organisms from 
ingested blood to ova is explained by the close connection between the 
ceca and ovaries. Much confusion has arisen over the nomenclature of 
the various species. This has no doubt arisen from the different systems 
of classifications which have been put forward by entomologists. The 
species and even genera are so numerous that, to obtain a zoological 
understanding of the group, the reader must consult the standard. works 
on the subject, such as those of Neumann or Warburton. The following 
classification is taken from Nuttall, Warburton, Cooper, and Robinson : 





Ixodide. 
| Juntaiden 
| 
Prostriata. Metastriata. 
Brevirostrata. Longirostrata. 
bow | | |: 
Group 1. Group 2. Group l. Group 2. 
| | | | 
1. Ixodes. 2. Heemaphysalis. 3. Dermacentor. 8. Hyalomma. 9. Amblyomma. 
4, Rhipicentor. (Aponomma). 
5. Rhipicephalus. 
6. Margaropus. 
7. Boophilus. 


A great number of species and sub-species of the above genera are — 
parasitic on the domesticated animals in different parts of the world. 
In England, however, Ixodes ricinus and Hamaphysalis punctata are the 
two most important species. | 

The life-histories of many species still remain to be worked out, but 
they all go through the stages of egg, larva, and nymph to adult. As 
an example, that of I. ricinus may be cited. The female deposits her 
eggs In groups in grass, and being then much reduced in size, dies. The 


PARASITES AND PARASITIC DISEASES 1445 


ova, which are covered with a material causing them to adhere in clumps, 
are about 0°5 millimetre long. 

After a period varying from two to five months, small hexapod larvee 
emerge, and these poise themselves upon herbage, until they come into 
contact with a host, upon which they feed, and then fall to the ground. 
The time spent upon the host varies from a few days to much longer. 
Whilst on the earth they moult and acquire four pairs of legs, and become 
nymphe, which regain another host, engorge, and fall off. They remain 
in this position for several weeks, when they go through a final moult, 
which brings them to adult males and females. Fresh hosts are sought 
out, and the female becomes greatly distended with blood. The male 
does not increase in size to any extent. After fertilisation the female 
drops off and then commences egg-laying, thus completing the cycle. 

The number of hosts required by the various species in passing from 
larva to adult varies, as do the feeding habits and stages at which disease 
transmission usually takes place. Thus, Boophilus decoloratus completes 
its life-cycle upon one host, others have two, and Rhipicephalus appen- 
diculatus requires three. Such an one as the latter is called a dropping- 
off tick. The engorged female of Amblyomma hebreum may attain the 
size of one’s finger-nail. The length of time required for the completion 
of the life-history varies considerably in the different genera and species. 
It is influenced by seasonal and other factors. The species last men- 
tioned may take as long as nine months from egg to egg (see Vol. I., 
p. 1260). Like the argasid ticks, many members of this group can live, 
apart from their hosts, for considerable periods. Larval, nymphal, and 
adult forms of Ixodes have been so kept for several months. Although 
present in some numbers in this country, the ravage of ticks are most 
prevalent in our Colonies and other tropical and sub-tropical regions. 

‘Ixodes ricinus (L.) (the dog tick).—The male is about 2°3 to 2°8 milli- 
metres long, with a dark brown, or almost black, body,and a light-coloured 
margin. The shields are oval. The female is 3:5 millimetres long when 
unfed, but may be three times this length when engorged. The legs are 
almost black. When replete the body is greenish or dark red to dark 
brown, with yellowish streaks. Its hosts are very numerous, it being 
found on many classes of terrestrial vertebrates; butit is not, as its name 
indicates, common on the dog. It is found on ae! sheep, and more 
rarely on man, horse, dog, goat, and cat. 

I. hexagonus Leach is common on hunting-dogs and ferrets in this 
country, and is sometimes found on the ox and sheep. 

Hemaphysalis punctata Can. and Fanz.—The male is about 4 milli- 
metres long. The body, which is narrow in front, is of a yellowish or 


1446 SYSTEM OF VETERINARY MEDICINE 


red-brown hue, and the dorsal shield almost covers the body. The last 
pair of legs have long spines projecting backwards, whilst on the anterior 
three pairs of limbs they are very short. The female is about the same 
size as the male, but when engorged measures 12 millimetres long and 
3 to 7 millimetres broad. The colour is reddish-brown, and dark grey 
when replete. The dorsal shield is deeply notched in front. The legs 
are brown. This tick enjoys a wide distribution, and has been found on 
birds, most of the domesticated animals, and even man. JH. leachi 
(Audouni) is an important African species found on many wild carnivores 
and the dog and cat. 

Dermacentor reticulatus (Fabr.).—The rostrum is the same in both 
sexes; the palpi have the first article short, and the second and third 
well developed. The male is 5 to 6 millimetres long by 3 millimetres 
broad. The body is egg-shaped, being larger in front. The dorsal shield 
covers the body, and is divided posteriorly into eleven festoons. The 
female is 6 millimetres long and 4 millimetres broad, of a brownish-red 
colour; the shield is large and covered with a thin silvery metallic rust. 
The engorged female is about 16 millimetres long and 10 millimetres 
broad, and nearly as broad in front as behind. The colour is a slate-like 
brown. It has been found on man, cattle, horses, sheep, goats, dogs, and 
Swine In various parts of Hurope and Asia. 

Rhipicephalus sanguineus (Latr.)—The palps are short and strong, 
and their three first articles are furnished with rigid bristles. The male is 
about 3°5 millimetres long and 1:5 millimetres broad. The dorsal shield 
almost covers the body. The body of the female is elliptical, and measures 
11 millimetres long and 7 millimetres broad. It is chestnut in colour, — 
and, like all the species of this genus, has two distinct eyes. On the 
Continent of Europe this tick is common on cattle, sheep, dogs, cats, 
and even man. In hot countries its distribution is wide. Specimens 
have recently been sent me from a dog at Wrexham by Mr. W. J. 
Fletcher, M.R.C.V.S. Other important African members of the genus are: 
Rk. appendiculatus Neum., R. bursa Can. and Fanz., R. capensis Koch, 
R. evertst Neum., R. nitens Neum., and R. simus Koch. 

Boophilus decoloratus, Koch (the blue tick)—The male is of a pale or 
dark brown hue, with four anal shields, which end in points. It is about 
2:25 millimetres long and 1°3 millimetres broad. There is a well-marked 
caudal appendage. The female is of a slate-like blue, and varies from 
2:2 millimetres long by 1:3 millimetres broad when young, to 12 milli- 
metres long and 8 millimetres broad when engorged. The legs are yellow or 
red in colour. The eyesarered. This species is very prevalent in Africa, 
where it attacks the horse, ox, sheep, goat,anddog. In America B. annu- 
Jatus (Say) is a disease carrier. B. dugesi is another important species. 


PARASITES AND PARASITIC DISEASES 1447 


Amblyomma hebreum Koch.—A full description of this species appears 
on p. 1259, Vol. I. 

The following is a list, cba from Neveu Lemaire, of the most impor- 
tant ticks which are parasitic on the various domesticated animals: 


HoRsE (27). 


Ixodes ricinus. Rhipicephalus evertsi. 
>» ovatus. : oy SINUS. 
»  ptlosus. a swpertritus. 
Hemaphysalis leachi. = kochi. 
99 punctata. tricuspis. 
¥ aie hae M argaropus Lounsburit. 
3 leporis. Boophilus annulatus. 
Dermacentor reticulatus. th decoloratus. 
=e electis. Hyalomma cegyptium. 
* occidentalis. Amblyomma cayennense. 
“t nitens. 5 triguttatum. 
Rhipicentor bicornis. ir morelic. 
Rhipicephalus sanguineus. oe versicolor. 
Le bursa. 
Ox (43). 
Ixodes ricinus. Rhipicephalus nitens. 
»  evatus. . kochi. 
»  pilosus. . cuneatus. 
»  hexagonus. . 3 duttoni. 
»,  holocyclus. es longus. 
» scapularis. ., hemaphysaloides. 
Hemaphysalis punctata. Re zvemanni. 
concinna. oculatus. 
x flava. M argaropus lounsburii. 
=f parmata. Boophilus annulatus. 
a neumanni. AZ decoloratus. 
i spinigera. Hyalomma egyptium. 
Dermacentor reticulatus. oe syriacum. 
4 electus. Amblyomma cayennense. 
we occidentalis. = hebreeum. 
s variegatus, -, americanum. 
Rhipicephalus sanguineus. 6 splendidum. 
- bursa. PP variegatum. 
“f evertst. + maculatum. 
+ siumus. triguttatum. 
Be appendiculatus. Aponomma trimaculatum. 
capensis. 


SHEEP (21). 


Ixodes ricinus. Dermacentor variegatus. 
»  hexagonus. Rhipicephalus sanguineus. 
»  holocyclus. = bursa. 
» scapularis. ¢0 evertst. 
»  rubicundus. % appendiculatus. 
Hemaphysalis punctata. Boophilus annulatus. 
oa concinna. be decoloratus. 
“ flava. “ Hyalomma egyptium. 
parmata. Amblyomma hebreeum. 
Dermacentor reticulatus. - variegatum. 


oe occidentalis. 


1448 SYSTEM OF VETERINARY MEDICINE 


GoaT (9). 
Ixodes ricinus. Rhipicentor bicornis. 
»  rubicundus. Rhipicephalus sanguineus. 
Hemaphysalis punctata. >» «+ bursa. 
ies bispinosa. an pulchellus. 
Dermacentor reticulatus. 
Pia (4). 
Ixodes pilosus. Amblyomma hebreeum. 
Dermacentor reticulatus. A splendidum. 
Doe (26). 
Ixodes ricinus. Dermacentor variegatus. 
»  hexagonus. Rhipicephalus sanguineus. 
»  australiensis. oe bursa. 
»»  holocyclus. ~ evertst. 
>, ovatus. of simus. 
» scapularis. Boophilus annulatus. 
Heemaphysalis punctata. # decoloratus. 
concinna. Hyalomma egyptium. 
95 flava. Amblyomma cayennense. 
“5 parmata. Ae, maculatum. 
_ neumannt. A calcaratum. 
- hirude. “9 striatum. 
Dermacentor electus. Aponomma exoratum. 
Cat (11). 
Ixodes ricinus. Dermacentor variegatus. 
»»  hexagonus, Rhipicephalus sanguineus. 
Hemaphysalis leacht. “, bursa. 
oe punctata. Be everts?. 
~ concinna. Hyalomma egyptium. 


aA parmata. 


Insurnious Errects.—Ticks produce their evil effects in several ways. 
The bite itself may be the means of producing bacterial invasion of the 
underlying structures, as is seen in orchitis following tick-bite. The 
points of fixation usually chosen are those where the skin is thin, but 
they may be found almost anywhere on the body. When about to fasten 
itself the parasite projects its cheliceree and forces them into the skin. 
When they are fixed by means of their fine teeth, the hypostome is 
introduced, and then the palps spread out, but do not enter the skin. 
The backward projecting teeth on the hypostome and the disposition of 
the cheliceral teeth make the fixation such that it is impossible to remove 
the ticks by traction without leaving the rostrum in the skin. 

In addition to bacterial infection, there is irritation of the affected 
parts, and this becomes more severe as the infestation becomes more 
marked. Great damage is also done by the actual extraction of blood 
from the host. This is brought about by the pharyngeal muscles, and the 
digestive organs soon become filled. Often an engorged female gains 
ten times her original weight. 

Theiler records an experiment in which a horse died of acute anemia 
from the withdrawal of blood by B. decoloratus. During three days 


PARASITES AND PARASITIC DISEASES 1449 


14 pounds of engorged ticks dropped from the animal, and this was 
about half of the parasites on it. In many other cases the infestations 
are often so bad that whole areas of the skin are packed with ticks, and 
the animals become greatly reduced in flesh. 

The most important pathogenic role of these parasites, however, 1s 
the transmission of diseases which are due to various species of protozoa. 
The following is a list of some of the most important of these which 
affect the domesticated animals and the ticks which have been shown to 
be capable of transmitting them. The only one of interest to the home- 
practising veterinarian is bovine redwater, which in this country is spread 
by Ixodes ricinus and Hemaphysalis punctata. 











Prot:zoan Parasite. Disease. Transmitting Ticks. 
Babesia equi oy .. | Equine malaria Rhipicephalus evertsi 
Equine piroplasmosis | Dermacentor reticulatus 
DB. DOV + nics aE .. | Texas fever Ixodes ricinus 
Redwater »  hexagonus 
Bovine piroplasmosis | Haemaphysalis punctata 
Rhipicephalus evertsi 
be: capensis 
rs appendicu- 


latus 
Boophilus decoloratus 
»  annulatus 


»  dugesr 
EPOOraS © Aes ne .. | Ovine piroplasmosis Rhipicephalus bursa 
| A : ae 
B. cams... oe .. | Malignant jaundice Ixodes ricinus 
Canine piroplasmosis »  hexagonus 


Hemaphysalis leachi 
Dermacentor reticulatus 
Rhipicephalus sanguineus 





Theileria parva .. .. | East Coast fever Rhipicephalus everts 
e simus 
Bs appendicu- 
latus 
oe capensis 
ay nitens 





T. mutans a .. | “Gall sickness ”’ | Rhipicephalus evertsi 
os appendicu- 
latus 





Anaplasma marginale .. | ‘* Gall sickness” | Boophilus decoloratus 


Spirocheta theileri .. | ‘Gall sickness ”’ | B. decoloratus 


| Leishmania canis .. | Leishmaniasis Rhipicephalus sanguineus © 








Undescribed es .. | Heartwaterin sheep | Amblyomma hebreum 
i | 





1450 SYSTEM OF VETERINARY MEDICINE 


The stage in the life-cycle of the tick which transmits the disease 
is not always the same, and in many cases the blood parasite may pass 
from one generation of ticks to another, and only be transmitted by the 
adults. Thus larvae and nymphs hatched from eggs of an adult female 
Rhipicephalus bursa infected with Babesia ovis do not convey the disease, 
yet when the adult stage is reached individuals resulting from them do 
transmit the infection. In the case of Boophilus decoloratus and Babesia 
bovis, larvee whose mothers were infected before dropping off to lay, are 
chiefly responsible for transmission. Amblyomma hebreum, which -pro- 
pagates heartwater in sheep, does not pass the infection on to its offspring, 
so that the larve or nymphs pick up the infection and transmit the 
disease as nymphs or as adults. In this case the infection is taken 
up by a larval form, and should be transmitted by the ensuing nymph; 
but if an unsusceptible host be alighted upon, the adult then conveys the 
disease. : 

RemEpIAL Mrasures.—The immediate remedies for a single tick-bite 
which may have become infected with pyogenic micro-organisms must 
follow general lines. In this country, where the parasites are not very 
numerous, some care can be bestowed upon their removal from the host. 
A little chloroform, benzine, or turpentine can be applied, and the ticks 
removed whole. A similar result can be obtained by the application of a 
hot knife. This is the usual procedure with dogs and ferrets, which 
become infected in the shooting seasons. In the Colonies, where cattle 
harbour immense numbers of ticks, hand-picking is sometimes carried out 
with less regard to leaving the mouth parts embedded in the skin. For 
destroying ticks upon the large animals a mixture of a non-blistering oil 
and some acaricide is used, such as train oil 2 parts and paraffin or kerosene 
1 part. Similar preparations, as well as those containing tar, may be 
used in conjunction with weekly dipping. Such dressings should be 
applied to the soft parts, especially behind the ears, root of tail, axille 
and inguinal regions. Dipping, such as described on p. 1002, Vol. I., 
is an effective and practical method where large numbers of suitable 
animals are concerned. Use can sometimes be made of the fact that 
ticks when fully engorged drop off their hosts. 

The question of the eradication of ticks depends upon a series of 
complicated problems, not the least important of which are the conditions 
of civilization and agriculture of the infected areas and the diseases which 
are present therein. The control of the various piroplasmoses is so 
intimately connected with tick destruction, that the reader is referred 
to that section in Vol. I. 

If one district is freed from ticks, and animals are reared free from 


PARASITES AND PARASITIC DISEASES 145] 


disease, they would become infected when moved into tick and disease 
infected zones. Or, if perchance redwater and tick-bearing cattle be 
accidentally imported, the result would also be disastrous. Many species 
of disease-transmitting ticks are also found on small wild animals, whose 
contro! or destruction are most difficult, so that limitation in numbers 
is as much as can be hoped for. The means by which this is achieved 
in the field are many. A combination of them, with due regard to the 
bionomics of the tick, has greatly reduced the number of ticks in some 
countries. The chief are: burning the grass, dipping the cattle, and starv- 
ing the ticks. , 

Grass and scrub burning destroys a certain number of ticks which 
are active, but it can rarely be completely carried out. It does not appear 
to greatly harm buried ticks, and its effects on the soil are not all that 
could be desired. | : 

Dipping at short intervals of three days by means of the method and 
formula recommended by Watkins-Pitchford (Vol. I., p. 1004) has reduced 
the tick population in various parts of Africa to a low ebb, and has been 
responsible for the control of many of the diseases. Dipping at longer 
intervals, such as every fifteen days, has a marked effect in the reduction 
of one-host ticks. As has already been mentioned, it should in some 
cases be accompanied by the application of some oily dressing to the 
favourite seats. Further important remarks upon this subject will be - 
found in Vol. I., p. 991, with regard to Texas fever; on p. 1002, referring 
to Hast Coast fever; and on p. 1267, concerning sheep infested by ticks. 

Starvation of ticks is carried out by adequate fencing and keeping 
the hosts from the pasture for such a period as will insure the death 
of the ticks that may be lying hidden therein. This duration is about 
eight months for the redwater tick and much longer for others, even 
fourteen or fifteen months. Under this heading may also be included 
whenever it becomes possible the cultivation of non-grazing crops for a 
couple of seasons. Generally speaking, it is a difficult procedure to carry 
out completely. 

In a combination of these methods due consideration will have to be 
paid to the efficacy of the burning, dipping, starving, fencing, and the 
presence of uncontrollable hosts, introduction and isolation or treatment 
of new animals, and the species of ticks which may be present. 


BIBLIOGRAPHY. 


LAWS AND MANNING: Eradication of Ticks by the Starvation Method. Veterinary 
Journal, 1910. 

Nrvevu-LEmMAIRE: Parasitologie des Animaux Domestiques. Paris, 1912. 

THEILER: Ticks and Tick-Born Diseases, Veterinary Journal, 1910. 


1452 SYSTEM OF VETERINARY MEDICINE 


THE FOLLICULAR MITES. 


These small ectozoa belong to the family Demodecide. At present 
it is usual to recognise a single genus, which contains but one species 
and its varieties or subspecies. The adult acari, which are only about 
0-22 to 0°30 millimetre long, and almost colourless, are found in the 
sebaceous glands and hair follicles of man and several of the domesticated 
animals. They are vermiform in shape, the cephalo-thorax is followed 
by a transversely striated and gradually tapermg abdomen. The four 
pairs of legs are short, and composed of three articles each. The rostrum 
is wide and salient. The male is somewhat smaller than the female. 
The female lays a number of fusiform eggs, which possess a thin shell, and 
are about 70 to 90 w long and 25 p broad. From these hatch out larve, 
furnished with rudimentary mouth parts and three pairs of tubercles, 
which represent the future legs. After moulting, the three pairs of 
tubercles become legs, and the fourth pair of legs are represented by 
tubercle-like projections. A further moult changes this second larva into 
a nymph, whose legs and mouth parts are complete. The acquisition of 
sexual organs brings the adult into being. These have aptly been com- 
pared with the Irish shillelagh. The number of parasites which may be 
found in a pustule varies considerably. Megnin states that fifty is usual. 
They are nearly always found with the anterior extremity pointing to the 
bottom of the follicle or gland. 

Demodex folliculorum (Owen).—This, as has been mentioned above, 
is the only species. It has been found upon man, the dog, cat, goat, pig, 
sheep, ox, and horse; and varieties or subspecies with the following names 
are recognised: hominis, canis, cati, suis, ovis, bovis, and egur. These 
varieties vary considerably in size, as will be seen from the following 
measurements : 


























Female. | Male. 
Variety. ire | ah . 
| Length. | Width. Length. Width. 
| 
Demodex folliculorum hominis .. ASU. tp | 45 p 300 40 pu 
D. folliculorum canis i ne ey eT fh 45 u 240 p 45 
D. folliculorum suis et bs oy) 250) pte BGI 220 mu 55 pe 


The variety found on the pig is comparatively short and thick, and 
has been regarded by many as a distinct species—D. phylloides Csokor. 

Insurious Errects.—lIt has for years been recognised that D. follicu- 
forum canis is associated with follicular mange of the dog, and Csokor 


PARASITES AND PARASITIC DISEASES 1453 


described the affection of the pig. In man, however, the demodex may 
be found in many positions without apparently causing any harm. 
Similar remarks apply to the small demodex found on the nose and ear 
of the cat. Very little importance clinically need be attached to the 
presence of the parasite in the Meibomian glands of the horse and sheep. 
Pustular eruptions on the goat and ox associated with the presence of 
the demodex have certainly been recorded, but they are rare. It can 
be argued with some force that of the eight varieties of demodex found on 
different animals only one is said to produce a serious and prevalent 
disease—viz., on the dog—and that in this case it is difficult to transmit 
-the disease experimentally or by contact; and, further, that associated with 
the parasites are micro-organisms, which yield a vaccine well worthy 
of trial. Follicular mange, in short, differs from all other skin diseases 
due to ectozoa by the rarity in which the parasites as a group produce 
disease, by the difficulty with which it is spread by contact, by the 
apparent hopelessness of treatment by means of acaricides, and by the 
fact that vaccination with killed cultures of organisms from the pustules 
bids fair to be a useful method of treatment. 


1. Follicular Mange of the Dog. 


Follicular mange is known by a number of vernacular names, the 
most important of which are red mange, black mange, acarus mange, 
and demodetic mange. The disease varies considerably in prevalence; 
at certain periods of the year more cases appear to be shown for treatment. 
In some districts it is far more common than in others. It occurs in 
most countries, and is seen in most parts of England. 

Apparently it affects all breeds of dogs, but most often the short- 
haired ones; lap dogs show a decided predisposition towards the 
disease. Animals already affected with some non-parasitic skin lesion 
or systemic disease seem more liable to infection than healthy animals. 

MetTHop oF Spreap.—It has been previously remarked that the 
disease is difficult to convey from one animal to another. <A great number 
of experiments have been carried out in this direction. Many authors 
have failed to produce the disease by direct inoculation, and a great 
number of failures to infect animals by cohabitation have been recorded. 
In some cases which bear a striking resemblance to the usually described 
clinical pictures of the disease the demodex may not be found, whilst in 
pus, from cases where the lesions consist of sloughing of the skin, it may 
be present. On account of these peculiarities, a number of workers 
have affirmed that the demodex may be present in small numbers without 


1454 SYSTEM OF VETERINARY MEDICINE 


producing lesions, and that the disease is a dermatitis, the inflammatory 
condition of the skin allowing the demodex to increase greatly in numbers. 
This would explain the difficulties of experimental transmission; much 
work, however, is needed to settle the point. 

Symptoms.—The disease varies greatly in its manifestation. At the 
commencement, the parts usually affected are the ends of the limbs, 
elbows, hocks, and the areas around the eyes. As the lesions increase 
in size, the hair falls out, the skin becomes reddened and then thickened. 
Small papules, which turn into pustules, now appear; wrinkling of the skin 
is then seen, as well as swelling of the affected limbs. There is a quantity 
of bran-like scales on the skin. The condition may gradually invade the 
whole body. At different regions are to be found pustules somewhat 
larger than the others, and from them can be squeezed a sero-sanguinolent 
fluid. There is sometimes given off an odour somewhat resembling 
freshly cut hemlock. The amount of irritation manifested by scratching 
and rubbing varies, sometimes being marked, and at others not so notice- 
able. The progress of the disease is usually slow, and, if allowed to 
continue, affects the general condition and health. In addition to this, 
the pustular form, a squamous form is described. It is ushered in by the 
falling of the hairs from the affected parts and the prevalence of epidermal 
scales. Often the lesions are in patches, resembling somewhat alopecia 
areata ; the skin usually becomes reddened, and, if the disease is general- 
ised, it may be much darker than normal. Saint Cyr mentioned a third 
—the circinated form—in which small areas were affected at their periphery 
with small red papules or pustules. In these forms the itching is usually 
slight. If it be accepted that Demodex folliculorum is the sole cause of 
this disease, then the most important symptom will be its demonstra- 
tion from the lesions. The micro-organism present in the pustules is a 
staphylococcus. 

Diacnosis.—This must depend upon the characters of the lesions 
and the presence of the parasite, because the various forms of the disease 
in the different stages resemble a number of skin lesions of the dog. The 
possibility of a dual infection must not be lost sight of. 

Proenosis.—The prognosis of follicular mange is most grave, and, all 
things considered, it has to be admitted that, in a great number of cases, 
treatment seems to be of little avail. In those that are said to recover, 
the course of treatment is full of difficulties and disappointments, for it 
often happens that no sooner is one area better than another commences, 
and, when that is cured, the old lesion starts afresh. If the disease is 
extensive, then destruction appears to be the best course to adopt; even 
moderately bad cases of the pustular form are often so treated. Localised 


PARASITES AND PARASITIC DISEASES 1455 


areas of the other forms have been cured by the application of great 
patience, thoroughness, and perseverance. 

TREATMENT.—Before discussing medication, reference must be made 
to an article by Mettam on the subject of vaccine therapy and follicular 
mange. His views seem to agree with those of many other workers 
upon this mange. He isolated from the skin of a badly infected case 
Staphylococcus pyogenes albus, and from it prepared a vaccine, and 
this, combined with an emollient on the lesions, effected a complete 
cure. Other similar cures have been recorded, but they are not all so 
reliable as the above. Failures have been experienced, probably from 
employing the wrong organism. Autogenous vaccination therefore 
deserves an early and extended trial. There is no skin disease in which 
so many acaricides have been employed without satisfactory results, 
chiefly on account of the situation of the demodex. Nodoubt follicular 
eczema is often mistaken for follicular mange, and accounts for some of 
the reputed “‘cures” of the latter disease. According to the extent of 
the disease, the animal should be closely clipped around the lesions or 
allover. Localised areas have been successfully treated with the follow- 
ing ointment: Equa] parts of salicylic acid, sublimed sulphur, and 
storax, with lanoline 3 parts. A liniment for which success has at various 
times been claimed is creosote 1 part, liquor potasse 2 parts, and olive 
oil 14 parts. The purpose of the potash solution is to destroy the 
sebaceous material in which the parasites are found, and such a liniment 
is usually attributed to Hunting. 

Another system employed successfully by Siedamgrotzky consists of 
close clipping and opening all the pustules, lathering the parts with 
terebene soap, and then applying daily, for a long period, balsam of 
Peru, diluted with 4 parts of spirit. Bruasco had success by scrubbing 
the affected parts with a solution of potassium sulphurata (xl. grs. to 
water Oi.), then applying cantharides ointment in lard (1 to 6) to limited 
areas, and covering the remaining portions with balsam of Peru. This 
is repeated daily for a week, fresh portions being covered by the oint- 
ment on each occasion. After a week’s treatment, a bath is given, a rest 
of a few days allowed, and then the dressings are repeated. Care should 
be taken not to allow the cantharides ointment to come into contact with 
the eyes. 

Megnin recommended daily baths in sulphuret of lime for a month, 
followed by a month’s treatment of three baths a week. 

Nicolas has had success by injecting into the skin a 2 to 23 per cent. 
solution of carbolic acid; only one or two drops are, however, injected at 
each point. 


1456 SYSTEM OF VETERINARY MEDICINE 


Miller, following the suggestions of Gmeiner, has had good results by 
clipping, washing in potassium sulphurata solution, and then applying 
to the affected areas oil of caraway and spirit (1 part each), with castor 
oil (15 parts). The dressing is rubbed in with the finger. 

Nearly all the above methods are sometimes protracted; and whit 
has given good results at one practitioner’s hands has failed at another’s. 
Thoroughness is an important factor throughout, and some authorities 
advocate frequent changes in the drugs employed. At the best, most 
systems of treatment are at present only empirical, and it is to be hoped 
that future work will definitely settle Gmeiner’s statement that Staphy- 
lococcus pyogenes albus is the real cause of the disease, and that Demodex 
folliculorum only plays an intermediate réle. 

PropHyLactic MrAsures.—lIn the present state of our knowledge 
affected animals should be isolated, their haunts disinfected, and in- 
contact animals washed in appropriate dressings. 


2. Follicular Mange of the Ox, Goat, and Pig. 


Although in no way so important as in the case of the dog, isolated 
cases in the goat and pig, and even outbreaks of this disease in the ox, 
have been recorded. 

Bugge has described a number of cases which occurred in two herds 
of cattle where, out of 480 animals, over 70 showed lesions. There were 
present nodules varying in size from ;}, to % inch in diameter; their 
colour was usually that of the skin, with an occasional tendency towards 
yellow. The number of nodules on an animal varied from a few to over 
a hundred, and the parts affected were the neck, shoulders, and the 
region between the fore-imbs. The pus in the nodules contained varying 
numbers of the parasites. No irritation was noticed, and there appeared 
to be no loss of hair. Stiles and Faxon have also seen the disease in 
America. 

In goats the disease appears to have been first noticed in Switzerland 
by Niederhausen, then by Nocard and Raillet in France, and by Kitt 
Bach, Prietsch, and Rissling in Germany. The lesion is usually in the 
form of a nodule, as has been described in the case of the ox. There 
appears to be no loss of hair. In each animal the hides are either greatly 
reduced in price, or become valueless for tanning purposes. 

In the pig the disease, which cannot be said to be common, affects those 
areas covered by thin skin, such as the under-parts of the head, neck, 
abdomen, and inside the thighs. The pustules are at first small, but, 
becoming united, may even reach the size and shape of a longitudinally 


PARASITES AND PARASITIC DISEASES 1457 
slit horse-bean. The disease has been noted in several countries, and 
occurs in England. It is, at the most, a rare lesion of meat inspection; 
sometimes the nodules have a hemorrhagic zone around them in the 
subcutaneous fat. 

BIBLIOGRAPHY. 


Buace: Follicular Mange in Cattle. Extract from Berliner Tierarztliche Wochen- 
schrift, in the Veterinary Record, vol. xxii., 1909-10, p. 107. 

GMEINER: Follicular Mange in Cattle. Extract from Berliner Tierarztliche Wochen- 
schrift, in the Veterinary Record, vol. xxii., 1909-10, p. 291. 

MEtTTAM: Vaccine Therapy and the Treatment of Follicular Mange. Veterinary 
Record, vol. xxii., 1909-10, p. 390. 

MinLuER: The Treatment of Follicular Mange. Abstract from the Berliner 
Tierarztliche Wochenschrift, in the Veterinary Record, vol. xxiv., 1911-12, 
p. 502. 

NEUMANN: Parasites and Parasitic Diseases of the Domesticated Animals. London, 
1905. 

Niconas: The Treatment of Follicular Mange. ‘Translation from Journal de 
Médecine Vétérinaire et Zootechnie. September, 1907. Veterinary Record, 
pp. 353, 391, and 479. 

Rissyin@: Follicular Mange in Goats. Extract from Berliner Tierarztliche Wochen- 
schrift, in the Veterinary Record, vol. xxiii., 1910-11, p. 157. 


THE MANGE MITES. 


Without doubt, so far as the United Kingdom is concerned, the mange 
mites are the most important group of ectozoa. Possessing all the 
characters of their class, they belong to the subfamily Sarcoptineg, of the 
family Sarcoptide. They are all of small size, varying from 0°26 milli- 
metre to 0°65 millimetre in length, and have no eyes or trachee. 

The body is usually oval and of a yellowish-white colour, and has a 
delicately transversely striped cuticle. The eight legs are short, and 
composed of five segments, the last of which are furnished with either 
ambulacral suckers or thin bristles. These two characters are important 
in the differentiation of the various genera. They are all parasites of 
the epidermis, some being found on its appendages, others on the surface, 
and others even bury into it. 

In most cases these mites are oviparous, but some are ovoviviparous. 
Roughly speaking, the life-cycle is completed in about three to four 
weeks, but many factors influence this. Among the chief are season of 
the year and its varying degrees of temperature, etc., and the species of 
mite concerned. In the fertile egg an embryo gradually appears, and 
this issues from the shell as a hexapod larva in about four to seven days, 
By a process of moulting of this larva the nymph is reached in about 
three to four days. At this stage eight legs are usually present, and two 
sizes are recognisable. Further changes, occupying another three to 


four days, bring the nymphs to adult males and pubescent females. The 
VOL, II, 92 


1458 SYSTEM OF VETERINARY MEDICINE 


latter are characterised by an ano-vulval slit, which after fertilization 
becomes tle thoracic vulva of the ovigerous female. This change takes 
about four days, and in a further four days oviposition takes place. The 
number of eggs produced varies; fifty-one have been seen in a single 
sarcopt gallery. The length of time that the various stages in the life-. 
history of the different species may live apart from their hosts has not 
been accurately determined in all cases. Eggs appear not to be capable 
of hatching out after leaving the warm body, and about thirty days 
would seem to see an end to any activity on the part of the adults of most 
species. In some cases it is much less. 

It is customary amongst veterinarians—at least in this country—to 
recognise only three genera of mange mites—viz., Sarcoptes, Psoroptes, 
and Chorioptes. In the first mentioned are included the parasites of 
scaly leg in poultry and of sarcoptic mange of the cat, but the differences 
in these species are so great as to be of generic value. Cnemidocoptes and 
Notedres should therefore be added to the list. The difference in the 
two recognised species of choriopt are such that it seems possible that 
generic separation is desirable. The determination of the various groups 
is Important, Inasmuch as some of the manges are scheduled under the 


Contagious Diseases of Animals Acts, and others are not. Thefollowing — 


table shows the main differences of the chief groups: 


Anterior two pairs of legs marginal. Anus terminal Sarcoptes. 
Posterior two pairs of legs subabdominal. 
Males with two copulatory suckers or 
abdominal lobes. 
Ambulacral suckers with a short pedicle 
on first and second pairs of legs in both 
‘sexes. Often on fourth in the male. | Anus dorsal, Notedres. 
Parasitic on mammals. 


Legs as above. 
Copulatory suckers may be present. 
Male ambulacra] suckers on all legs. 

None on females, Cnemidocoptes. 
Anus terminal. , 
Ovoviviparous. 

Parasitic on birds. 


Ambulacral suckers with long tri- 


Alllegs marginal. jointed pedicle on first, second, 
Male with bi-lobed extrem-| and third pairs of legs of the} Psoroptes. 
ity to abdomen, Copula- male, and on the first, second, 
tory suckers present. and fourth pairs on the female. 
Parasitic on mammals. Ambulacral suckers almost sessile Chori ; 
on all legs of the male.* \ Cronies. 


* The disposition of the ambulacral suckers on the legs of the females of this 
group is not the same. In the parasite of leg mange they are present on the first, 
second, and fourth pairs, whilst the ear parasite female has them on the first and 
second pairs only. ‘This difference has given rise to the creation of a oe for these 
latter mites—Ofodectes. 


PARASITES AND PARASITIC DISEASES 1459 


In general terms, and apart from size, a mammalian parasite whose 
third and fourth pairs of legs do not project beyond the abdominal edge 
will be a sarcopt; one with ambulacral suckers attached to the ends of 
the limbs by the shortest of pedicles a choriopt; and one with a long 
three-jointed pedicle between the end of the leg and the ambulacral 
suckers a psoropt. 

Microscopic D1iagNnosis.—With the above facts in mind, the 
microscopic diagnosis should entail little orno difficulty when the parasite 
is found. This latter point is, however, not always easy of achievement. 
The clinical features will be of some guide in taking the material for 
examination. The first step is the inspection of the edge of the lesion 
with the naked eye. In the various psoroptic manges (of the horse, ox, 
sheep, goat, and rabbit’s ear), and in the case of the auricular mite of 
the dog and cat, the parasite can often be seen actively at work at the 
borders of the affected areas. This is especially so during the warmer 
months of the year. Should this fail, a little of the scab may be elevated, 
and the skin examined through a pocket-lens or watchmaker’s eyeglass. 
Failing this, a little of the scab, hair, or wool, as the case may be, can be 
removed from the edge of the lesion and warmed in a Petri dish, and 
examined under a 2 inch lens. If no parasites have been detected 
by any of these means, then active scabs must be removed, freed from 
hair or wool, and dropped into a Petri dish and covered by a 10 per cent. 
solution of caustic potash. After a time, varying from ten to fifteen 
minutes to the same number of hours, the mites can be sought for whilst 
still in the dish under the 2 inch lens. If still unsuccessful, a small 
piece of this soaked material may be examined under the low power 
whilst pressed between two slides. Ova which were surrounded by 
débris are often brought into view by this method. The parasites of 
leg, ear, and psoroptic mange are usually easily found in a dish of caustic 
potash solution, but scrapings to yield the sarcopt must be taken deeply— 
almost until the skin exudes lymph—and after the caustic potash soaking 
the examination should be made between two slides. 

Insurnious Errects.—There is no doubt that these mites are the 
sole cause of several contagious skin diseases which receive different 
names in various parts of the country. Itch, sweet itch, Norwegian itch, 
scabies, riff, duke, fiddle, scab, and mange are the most important ver- . 
nacular terms. The importance of the diseases 1s that many animals are 
often affected—viz., sheep scab and horses in war-time—and that the 
means adopted to control contagion often interfere seriously with market 
prices or transport. The severity of the injurious effects depends, 
amongst other things, upon the season of the year—being more marked 


1460 SYSTEM OF VETERINARY MEDICINE 


in winter and tending to disappear spontaneously in summer. The 
psoropts appear capable of producing the most irritant saliva, the sarcopts 
come next, and the chorioptes last. The sarcopt bores its way into the 
epidermis, and in the galleries so formed the ovigerous female deposits 
her eggs, and the larvee which ensue make for the surface. The burrowing © 
habit of this genus make the cure of the disease they cause very difficult. 
The psoropts live on the skin, they are larger than the sarcopts, and in 
the horse may lead a more or less non-pathogenic existence in the regions 
of the tail and mane during the summer months. The chorioptes inhabit 
the superficial parts of the various extremities, such as the digits, ears, 
and base of the tail. 

The various domesticated mammals are lable to invasion by one, 
two, or even three kinds of mange mite. We have seen a horse affected 
with three forms of itch at the same time. 

GENERAL Remarks on Symproms.—As a result of the mite’s bite a 
series of changes takes place in the skin. There is exudation, followed 
by incrustation, increased temperature, redness of the part, loss of hair, 
increase of superficial epithelium and of the thickness of the skin. 

The degree of exudation varies with the parasite present and the 
thickness of the host’s skin; some thin-skinned cart-horses may be so 
affected by the psoropt as to be best described as suffering from acute 
mange. Secondary effusion is due to the biting and friction resorted to 
by the affected animals. As a result of the irritation and effusion there 
is scab-formation and thickening of the skin. In the horse and ox, the 
soft parts, such as the neck, are thrown up into folds, whilst the skin 
covering the digits may increase greatly in thickness. The heightened 
colour is only visible on a light-coloured skin, such as that of the sheep. 
It is due to the irritation and secondary rubbing or biting; the extra 
warmth is explained in a similar manner. The loss of hair or wool results 
from the diseased process around the follicles, rubbing, biting, and pulling 
in the case of sheep. The actual irritation varies according to the species 
and disposition of the host, the parasite present, and the time of day. 
This latter point probably depends on the difference in temperature of 
housed animals at night and day; the pruritus is most marked and intense 
at night. 

GENERAL REMARKS ON TREATMENT.—No matter what form of mange 
exists upon any of the animals which come under veterinary supervision, 
there are several broad principles which must be acted upon. In the 
first place it is essential to remove all material which may hide any of the 
acari. The actual lesions themselves are to be washed in some softening 
and scab-raising solution, such as carbonate of soda or potash. In many 


PARASITES AND PARASITIC DISEASES 1461 


animals the removal of the hair from all over the body is desirable; 
especially is this so where the mite is known to be a migratory one. Not 
only does such show up small lesions, but it also causes less medicant to 
be used, and so prevents toxic and other sequel. The substitution of 
clothing for the lost coat is not to be recommended, as it uses up dressings 
and may predispose to reinfection. Depending on the dressing used and 
the season of the year, an attempt should then be made to dress the 
animal all over with an acaricide of such a strength as to destroy the 
parasites and render their eggs unfertile without damaging the host’s skin. 
This is difficult to achieve. A great number of the dressings applied, save 
in the case of animals capable of being dipped, are much too strong. A 
quarter or half the body may be dressed at a time. In other cases, where 
there is a localised area of the disease, this may be dressed with the 
prescribed acaricide, and the whole body then washed with some milder 
preparation. The importance of applying the dressing all over the body 
cannot be too strongly urged in those manges affecting the trunk generally. 
In most animals exercise is always an important item, and under it may 
be included grooming, etc. After a period varying from four to ten days 
further dressings will be necessary. The life-history of the causal acarus 
will be an important guide upon this point. It. often happens that 
dressings are applied much too frequently. Three dressings are often 
sufficient. Good hygiene and careful attention to the food are always 
necessary. A discussion upon the various acarides and their properties 
would be out of place here, as there are so many of them. Similar remarks 
apply to the vehicles used—viz., whether or not the dressings dpa be 
in watery or oily solution. 

GreneRaL Remarks on Controu.—Affected animals are always a 
source of danger to others, so that isolation must be strictly carried out. 
The place recently occupied must then be thoroughly cleansed, scrubbed, 
and gone over with the spirit-lamp. No portion must be missed. Walls 
can be whitewashed or distempered. The painter’s lamp is a very 
efficient acaricide. It is, however, often replaced by a suitable disin- 
fectant. If the animal is allowed to remain in its old habitation whilst 
under treatment, reinfection is possible. All articles of little value 
which have come into contact with the patient should be burnt, and those 
of worth must be thoroughly soaked in a disinfectant harmless to them. 
The further an outbreak is gone into, the more are the possibilities of 
infection brought to light. One has only to reflect on show-benches in 
the case of dogs, grooming-tools, rugs, and even men’s coats on horses, 
and pens for sheep, to realise the many ways in which the acari can be 
spread. All such channels have to be scrupulously guarded against. 


1462 SYSTEM OF VETERINARY MEDICINE 


During treatment the isolation box should be rendered non-infective, and 
after cure the animal kept there for some time. In-contact animals 
should be treated in order to obviate the risk of infection. 

An important point where dead animals are concerned 1s the fact that 
the mites soon tend to leave their host as it cools. An affected carcass 
should therefore be removed soon after death; and if it becomes necessary 
to slaughter an animal, this must be done if possible at the knackery or 
away from stables. 

SEASONAL OCCURRENCE.—As winter approaches, nearly all the manges 
become more prevalent. Especially is this so in the case of horses, sheep, 
cats, and fowls. Many are the explanations put forward to account for 
this, but what holds good for one animal does not apply to another. In 
the horse the long winter coat is said to be a predisposing cause, but 
the sheep’s fleece does not vary a great deal. In this animal the lessened 
grass-supply and aggregation into markets are put forward by some as 
factors which cause an increase in the number of cases. None of these 
reasons, however, apply to the cat and fowl. It seems probable that a 
proper explanation depends upon a number of these factors, together 
with important points in the bionomics of the host and parasite, at present 
not well understood. Many causes of spontaneous cure of mange with 
the approach of summer have been recorded. 

The following is a list of the most important mange mites: 


Sarcoptes scabiet hominis. Cnemidocoptes levis columbe. 
se 99 Megus. ; Psoroptes communis equi. 
ea » bovis. a B bovis. 
>» camel. ae 3 ovis. 
of 9 OVS. a . capre. 
» > ~»— Capre. oa cunicult. 
a rep Chorioptes symbiotes equi. 
p » canis. Ke Hy bovis. 
7 » cuniculi. 6 Fs ovis. 
furonis. 3 2 capre. 
N otcedres aor cati. a cuniculi. 
» cuniculi. Otodectes cynotis canis. 
Cnemidocoptes mutans. es COLT: 
. levis galline. 93 >» furonis. 


It is proposed to consider here under separate headings the following 
forms of mange—viz.: (1) Sarcoptic, (2) Notcedric, (3) Psoroptic, 
(4) Chorioptic, and (5) Otodectic. Important as the Cnemidocoptes are 
to poultry-keepers, scaly leg and depluming scabies of poultry cannot be 
discussed owing to lack of space. 


PARASITES AND PARASITIC DISEASES 1463 


(A) Sarcoptic Mange. 


This is due to Sarcoptes scabiet and its varieties. Man, the horse, ox, 
camel, sheep, goat, pig, dog, rabbit, and ferret, are all liable to its ravages. 
From this list we may exclude for descriptive purposes the camel, as the 
disease in that animal is somewhat similar to that of the ox; the sheep, 
as the lesions are confined to the head; the rabbit, which rarely comes 
under the veterinarian’s care—the lesions, however, start on the head; 
and, lastly, the ferret, the sarcoptic mange of which is usually described 
as “foot rot.” In this animal the plantar surface of the digits, then the 
tail and the head are the parts usually affected. Although a variety of 
sarcopt has been described for each host, the parasite of one species often 
passes to another, where it usually produces an affection which, although 
more or less marked at the onset, usually disappears spontaneously. 
Thus Sarcoptes scabiei equi has been found on the ass, mule, ox, and 
_ even man; the goat’s parasite may also affect the horse, ox, sheep, pig, 
and man. In a similar way several of the varieties may pass to one, two, 
or three hosts, and in most cases man is liable to their attacks. 

The boring habit of this species makes it always a serious disease, 
and often difficult to treat in a satisfactory manner. 

1. Sarcoptic Mange of the Horse.—Of the three equine manges this is 
the rarest; probably about 5 per cent. of the reported cases belong to this 
variety. There seems to be a great variation in the parts of the body 
that may be affected. This probably depends on the method of infection. 
If this is by means of saddles or collars, then the upper parts of the body 
will show early lesions. Contrary to the experience of others, the parts 
that we have found to be most frequently affected have been the sub- 
maxillary space, tracheal region, brisket and belly. In these places the 
skin is thin and well suited for the boring habits of the sarcopt. 

Symptoms.—The earliest symptoms will be rubbing, biting, kicking, 
swishing of the tail, and perhaps pulling on the head-chain or rope. 
The hair upon the affected areas may become stained, wet, and elevated 
from the effects of the teeth. The woodwork of the stall may even show 
ravages of the teeth. Rubbing on the withers with the finger-tips often 

‘causes rapid movements of the lips and extension of the neck, these 
being expressive of a pleasing sensation. When the recently affected skin 
is examined closely, disseminated papules and vesicles will be seen; then 
these become small bare patches. By increasing in number and joining 
up, they give rise to larger hairless areas. The bare spots are at first 
scaly, but scab formation and heaping up of epithelium soon occurs. 
Depending on the extent and age of the disease, coupled with the amount 


1464 SYSTEM OF VETERINARY MEDICINE 


of rubbing and biting, the skin now shows sores, and later there is thicken- 
ing and ridge formation. After six weeks of uninterrupted progress the 
extent of the disease is very wide, and such an animal soon begins to lose 
flesh. ) 

Diacenosis depends upon the discovery of the Sarcoptes scabiet equi, — 
but this is not always easy. The diseases with which it is likely to be — 
confounded are psoroptic mange, an extension of chorioptic scabies along 
the chest, lousiness, acariasis due to Dermanyssus galline (see p. 1440), 
and eczema. Although the differentiation will in doubtful cases be 
made by means of the microscope, the coexistence of any two of these 
diseases must not be lost sight of. The difficulty of demonstrating the 
equine sarcopt makes the distinction of this condition from a constitu- 
tional one no easy matter. The clinical characters, contagiousness, and 
history, have to be relied upon in such a case. 

TREATMENT.—There are a great number of parasiticides in use against 
the sarcopt, and likewise many systems of treatment. 

The following is taken from Blenkinsop’s article in Wallis Hoare’s 
‘ Veterinary Therapeutics.” In many cases a cure is brought about by 
two courses of dressings. We, however, always prefer to use train oil 
in the first formula, and to dress half the body at a time with that 
dressing. 

“The affected animals should be closely clipped, the hair on the legs as 
well as that on the body being removed, and the manes hogged. This 
should be done in a loose-box, and all the hair carefully collected and 
burnt. The patients should now be dressed all over with— 

Sulphur .. rai ee pants 
Lard, vaseline, train oil, or fish oil .. ..° 4 parts. 

‘The following day the horse’s skin will, if this mixture has been 
properly applied, present a uniform yellow colour. The patient should 
now be lunged daily until the skin acts, and then the dressing should be 
well rubbed in with the hand. 

“On the sixth day the animal should be thoroughly dressed with the 
following mixture: 

Paraffin or kerosene oil sit . .. $tol pint. 
Soap solution Fri oF Sipe leezallonp 

“This preparation is made by adding 1 pound of soft-soap or Sunlight 
soap to 1 gallon of warm water, and simmering over a slow fire until the 
soap is dissolved; then remove from the fire, add the kerosene oil, and 
stir until the oil mixes thoroughly with the soap solution and the whole 
becomes of a creamy consistency. 


PARASITES AND PARASITIC DISEASES 1465 


“On the seventh day wash thoroughly with plenty of warm water, in 
order to remove the whole of the sulphur dressing. While this is being 
done the box or stall should be thoroughly disinfected with a powerful 
blow-lamp flame, the floor, walls, manger, etc., being all most carefully 
flamed. The most useful lamp for this purpose is a brazier’s lamp, 
giving a 12-inch flame, and holding about 1 quart of petroleum. 
During the time the animals are under treatment no bedding should be 
allowed. 

“On the eighth day the sulphur dressing should be reapplied, and the 
former treatment continued. On the thirteenth day the kerosene oil 
emulsion should be applied, and the patient thoroughly washed on the 
fourteenth day, when the stable should be again thoroughly disinfected 
with the blow-lamp. 

“Treatment for three weeks, or three separate courses of dressing, will 
almost invariably result in a radical cure; but it is absolutely necessary 
for success that everything should be carried out in a most thorough and 
systematic manner. 

“ After the third dressing the patient should be placed under observa- 
tion for at least three weeks, and should be looked upon with suspicion 
for three months. In rare instances it may be necessary to repeat the 
treatment; but this is generally only necessary when either the first 
course of treatment has not been thoroughly carried out or the animal has 
become reinfected. 

“ Horse-rugs, attendants’ clothes and hands, brushes, harness, shafts, 
and poles of carts, stables, etc., transmit the parasite, and require careful 
attention. Clothing, blankets, numnahs, etc., should be passed through 
the disinfecting chamber of the nearest hospital or infirmary. Soap and 
water is the best means of cleaning the men’s hands. Grooming-brushes, 
curry-combs, and horse-clippers should be dipped in kerosene oil imme- 
diately after use. The kerosene oil and soap emulsion, if made with 
soft-soap and of the strength of 1 pint kerosene oil to 2 quarts soap 
solution, is very convenient for dressing the leather-work of harness, 
head-stalls, etc. 

“ Animals isolated for observation after an apparent cure should not 
be dressed in any way unless they again show symptoms of mange, when 
they should be treated as fresh cases of the disease. 

“Special attention should be paid to the diet and grooming of horses 
which have been recently under treatment for mange. Animals should 
be liberally fed on easily digested food, both while under treatment and 
for some time after they have been cured. When procurable, green 
forage should be given, and, if possible, animals should be grazed for 


1466 SYSTEM OF VETERINARY MEDICINE 


several hours daily. In the winter the frequent administration of small 
doses of sulphate of magnesia will be found most beneficial. 

“Horses which have been in contact with others suffering from mange 
should be thoroughly dressed with the kerosene oil emulsion. This 
should be washed off on the following day with warm water, and the - 
treatment repeated after a week’s interval. : 

‘Success in the eradication of mange from a stud depends on the 
intelligence and care employed in carrying out the treatment of affected 
and in-contact animals. It will be found economical both in time and 
money to work in a thorough and systematic manner as soon as the 
disease has been accurately diagnosed; otherwise treatment is almost 
sure to result in failure.” 

Probably the time-honoured dressing of black sulphur, potassium 
carbonate, oil of tar, and train oil is quite good provided the tar and 
oil are applied so that they do not cause blistering. 

LeGisLation.—In the United Kingdom this form of mange is included 
under the Parasitic Mange Order of 1911 of the Board of Agriculture and 
Fisheries. 

2. Sarcoptic Mange of the Ox.—Most textbooks point to the rarity of 
this affection, but recently recorded observations show that amongst 
housed and town cattle it is far from rare in winter-time in this country. 

Symptoms.—There is marked rubbing of the affected parts and great 
uneasiness; especially is this so in warm cowsheds. ‘The pruritus is 
severe, although the lesions at the onset show little tendency to spread 
beyond certain limits. The parts most often affected are the root of the 
tail and the hinder aspect of the mammary gland. If neglected and — 
after a prolonged period it may spread along the back to the withers, 
neck, and dewlap. Affected areas gradually become hairless, covered 
with scab, corrugated, and the skin thickened. In many cases there is 
marked falling off in the milk. Attendants often complain of mange-like 
eruptions on the forearm. Grooming and the use of the udder-cloth 
seem responsible for the spread of the disease. 

Diacnosis.—This is usually not difficult, because a scraping taken 
at such depth as to cause the appearance of a little yellow serum-like 
liquid will almost certainly contain plenty of sarcopts. The disease is 
likely to be mistaken for the other manges, from which it must be 
distinguished by the characters of the causal mite. 

TREATMENT.—AlIl the details of complete isolation must be carried 
out, as much of the scab removed as possible, and a dressing composed 
of a harmless oil or fat 4 parts and sulphur 1 part applied. Due respect 
will have to be paid to the contamination of the milk by the drugs em- 


PARASITES AND PARASITIC DISEASES 1467 


ployed. After two dressings at intervals of five or six days, with an 
intermediate wash, the animal should be treated all over with a 24 per 
cent. watery solution of creolin. 

3. Sarcoptic Mange of the Goat.—This is the common form of skin 
disease among goats. In European countries where the goat population 
is considerable, such as in Switzerland, it causes much loss. It appears 
to give rise to a severe form of scabies on man. 

Symptoms.—The disease commences on the head, as in sheep, but 
differs from “‘black nose”’ of this animal by its tendency to spread. Gradu- 
ally it attacks the neck, back, sides, udder, and finally the limbs. The 
hair falls off, and from the rubbing, scratching, and biting, the lesions 
become very aggravated. The parasite is easily found in the thick 
encrustations. The irritation appears to be so great as to cause, when 
extensive, rapid loss of flesh, and in some cases death. 

TREATMENT.—The coat should be removed, and if only a few animals 
are affected, dipping should not be resorted to, because goats do not 
stand bathing well, and are also rather intractable. When dipping is 
carried out, the methods described under Sheep Scab may be adopted. 
For isolated cases daily application of creolin lniment for a few days 
until the scabs loosen is recommended. This dressing consists of creolin 
1 part, spirit 1 part, green soap 8 parts. 

4. Sarcoptic Mange of the Pig.—Although not a common affection of 
the pig, mange is occasionally encountered. It is caused by Sarcoptes 
scabiet suis, but there has been described, from the pig’s ear, a very small 
sarcopt thought to be another variety of this species—viz., parvula. 

Symproms.—There is violent pruritus, which is manifested by fre- 
quent scratching with the hind-legs and rubbing of the body against near 
objects. Various portions of the trunk may be brought into contact 
with the floor of the styes. In a short while the natural sarcopt lesions 
are masked by injuries inflicted by the animal itself. The parts usually 
affected are the ears, around the eyes, the withers, the armpits, and 
inside the thighs. From these regions most other parts of the body may 
become infected. Affected areas become red, and the hair falls out. 
Behind the ears papules are seen, and in older cases these may be found 
on the abdomen, where they are hard and as largeasa pea. Later the skin 
becomes hot and thickened. Wrinkling is seen on the lower aspect of the 
abdomen and inside the thighs ; when the whole body becomes affected, the 
skin appears as if covered with a light-coloured powder. This has been 
observed by Berry and Miiller, and results from the accumulation of 
epidermal cells and secretion into crusts or scabs. After lengthy periods 
of infection, emaciation becomes marked, and death may ensue. The 


1468 SYSTEM OF VETERINARY MEDICINE 


porcine sarcopt is one of the easiest to demonstrate, and can often be — 
seen with the naked eye in glass tubes containing scrapings. 

TREATMENT.—It is customary in many cases of infectious conditions 
in pigs to slaughter out; but in this disease, if of any duration, the animals 
do not make good market prices. Treatment is therefore advisable. — 
The complete removal of all scurf is difficult, but can be facilitated by 
an application of lard twenty-four hours before soap, soda, water, and the 
scrubbing-brush are used. A preparation of sulphur 1 part and oil or 
lard 4 parts can then be applied at intervals of a couple of days. The 
necessity for so frequent an application arises from the thickness of the 
erust formation. 

5. Sarcoptic Mange of the Dog.— In towns this disease is quite common, 
more so, indeed, than is generally recognised, inasmuch as the parasite is 
most difficult to find. Owners of affected animals often allow them to 
come into close contact with other dogs. Oft-times diplomacy demands 
that a case be diagnosed as eczema and yet treated with parasiticides. 
These two items, coupled with breeding and bartering establishments, are — 
important factors in the dissemination of the disease. In addition to 
the dog, the canine variety of the sarcopt of scabies may also affect man, 
the pig, and horse. In this latter animal the disease is only of a transient 
nature. The dog itself may occasionally be infected by another mange 
mite, the small cat sarcopt (Notadres minor cati). | | 

Symptoms.—tThe first part to be affected is nearly always the head— 
on the muzzle, eyebrows, or ears—then it appears on the chest, elbows, 
belly, and paws. Later the croup may show lesions, and in about a month — 
or six weeks the whole body is likely to be invaded. Spreading in this _ 
way on the animal suggests infection from playmates in the first instance, 
and then, infecting the paws by scratching the primary area, the disease 
is carried to other parts of the body. Depending on the type of animal 
and length of coat possessed by it, the clinical picture will vary some- 
what, but in all cases there is the usual sarcopt lesion—viz., a reddish 
area, which becomes papular, then vesicular, and rarely pustular. 
Scratching may leave large moist areas in evidence; at other times the 
epidermal desquamation is marked and the mange is quite dry. After 
exercise, or when sitting near the fire, the irritation becomes more marked, 
as also does the peculiar smell of mice which often comes from affected 
dogs. The irritation always causes a great amount of scratching, rub- 
bing, and biting of the affected parts, which often become greatly injured 
thereby. 

Diacnosis.—The difficulty of finding the causal parasite often renders 
a definite diagnosis most difficult, but the gradual extension of the disease, 


PARASITES AND PARASITIC DISEASES 1469 


coupled with the intense pruritus, are important guides in the absence of 
the sarcopt. When micro-organisms gain access to the damaged part, 
the lesion is likely to simulate that of eczema. In this case, however, the 
area 1s usually more circumscribed, confined to certain areas, such as the 
back and loins, and covered by brownish crusts. Some cases of lousiness, 
follicular mange, and harvest-bug infestation, may closely resemble 
sarcoptic mange. They can then only be distinguished from it by the 
discovery of their respective parasites. There is no doubt that a great 
number of early cases of mange are treated as eczema, and a great number 
of them recover. 

TREATMENT.—Isolation of the animal and thorough disinfection of 
the kennel and its belongings should first be carried out. In long-haired 
breeds clipping is to be recommended, despite the unsightly appearance 
which results from it. The animal is then washed with soap and warm 
water. Friction will remove much scab. After thoroughly drying, the 
antipsoric dressing is applied. If this is toxic or likely to cause irritation 
of the mouth or internal organs, a muzzle should be applied. A useful 
prescription is: Creolin 1 part, soft-soap 1 part, and spirit 8 parts. The 
quantity of the latter can be decreased for cases of small extent. In 
animals widely affected about one-fourth of the body should be dressed 
each day, after which bathing will be necessary. For house dogs and 
early cases, Siedamgrotsky used the following application with great 
success: 


Naphthalin Ae i ie; .. 1 part. 
Vaseline .. om re Lp .. 5 parts. 
Oil of thyme ue of ie .. 8&drops. 
Oil of lavender .. Rs a Aras y 


In all cases great attention should be paid to the paws, which dis- 
seminate the disease. A liniment of black sulphur in cotton-seed oil 
(1 to 8), to which a little oil of turpentine and oil of tar have been added, 
is spoken well of by Stent. Numerous writers condemn the use of 
stimulants or irritants on the skin of the dog, and some point to the 
intense pruritus set up by even small quantities of turpentine. 


(B) Notcedric Mange. 


Manges of this type are due to mites belonging to the genus Notedres, 
which closely resembles that of Sarcoptes. The disease is therefore often 
spoken of as the sarcoptic form. The cat and the rabbit are the two 
animals commonly affected; the latter rodent is, however, also attacked 
by a true sarcopt—Sarcoptes scabier cumculr. 


LATO 3 SYSTEM OF VETERINARY MEDICINE 


Notcedric Mange of the Cat.—This is the commonest parasitic 
affection of the cat, and is due to Notedres minor cati. Raillet has shown 
that the disease is transmissible to man, the horse, dog, and rabbit. 
In outbreaks of mange amongst horses the cat is often blamed for intro- 
ducing the disease; but in many cases that have come under my notice 
the disease of the cat has been the one now under consideration, whilst 
that of the horse has been psoroptic mange. 

Animals which live apart from man’s habitations seem most liable 
to be affected; no doubt the predisposing causes are the adverse circum- 
stances and increased chances of infection to which they are exposed. 

Symproms.—The minute lesions are somewhat similar to those of 
sarcoptic mange. Gallery formations in the epidermis are rare, but 
nest-like cavities are found containing the ovigerous female. The head 
and nape of the neck are usually the only parts attacked, although in 
old and neglected cases the disease may spread along the back over the 
entire body and on the paws. There is, at first, scratching of the parts, 
then the hair appears to become thin, falls out, and finally a great quantity 
of dandruff appears. After this the skin becomes thickened and covered 
with scab, even up to $ inch in thickness. There is marked wrinkling, 
and soon the animal looks miserable, loses much flesh, and often dies. 

Diaenosis.—Lhe condition is not likely to be mistaken for any 
other affection, and the parasite is very easy of detection. 

TREATMENT.—When an early diagnosis has been made, this presents 
little difficulty. After removing as much scab as possible with a warm 
solution of washing-soda, a dressing of sulphur.1 part and lard 5 parts _ 
should be applied every other day. There are many other good dressings, © 
but the difficulty of preventing the animal from licking the dressing 
from off its paws makes it advisable to use a simple and non-toxic one. 
If the skin has become very wrinkled, deeply covered with scab, and the 
animal is in poor condition, death is likely to ensue from marasmus 
before any headway has been made, despite the best of feeding, which 
must always be offered. 


(C) Psoroptic Mange. 


The manges of this type are due to Psoroptes communis and its varieties 
or subspecies. ‘The animals liable to its attacks are the horse, ox, sheep, 
goat, and rabbit, A case of this scabies in the dog has been recorded 
by Hebrant and Antoine, and they suggest that the affection originated 
from the ear of a rabbit, as the patient was a sporting one; the constant 
dark coloration of Psoroptes communis cunicult should have allowed 


PARASITES AND PARASITIC DISEASES 1471 


them to have been certain on that pomt. The psoropts live on the 
surface of the skin, at the edges of their lesions, and under the scab they 
_ produce; they do not show such a tendency as the sarcopts to produce 
lesions on other than their definite hosts. The horse parasite causes 
irritation on man, and if he be repeatedly infected, slight lesions may 
result, but they soon disappear. Apparently the horse may infect the 
rabbit. The variety found on this animal may affect the horse, and 
possibly also, as previously remarked, the dog. From an economic 
point of view, the sheep and horse are the most important sufferers from 
this malady. The goat, when affected, shows an otacariasis; so does the 
rabbit; and as the symptoms and treatment are very much the same in 
these two animals, only one will be dealt with. The affection of cattle is 
somewhat similar in its predilection seats to sarcoptic mange of the ox 
(see p. 1466), save that the superficial habitat of the causal parasite makes 
it more easy of diagnosis and cure. The treatment is practically the 
same as in the horse. Clipping is, however, rarely carried out, and the 
necessity for dressing the whole of the body does not seem to be so neces- 
sary. In this country at least the ox is not often affected. The animals 
to be considered are therefore the horse, sheep, and rabbit. 

1. Psoroptic Mange of the Horse.—Psoroptic is the usual form of 
mange met with on the horse’s body. It is due to Psoroptes communis 
equi, which parasite also produces disease on the ass and mule, and has 
been found on the rabbit. Probably 95 per cent. of the reported cases 
belong to this type. When enclosed on the skin of man, it can produce 
a pruritus, but no cases of clinical interest have been reported. 

Symproms.—The manifestations of the disease are very much the 
same as in sarcoptic acariasis. They are, if anything, a little more in- 
tense. The parts of the body which are attacked are, however, quite 
different. Usually the disease commences at those places covered by 
the strongest hairs, such as the upper aspects of the side of the neck, 
the withers, the back, croup, and root of the tail. At these points it 
sometimes remains as a small circumscribed area, partly devoid of hair 
and covered with scab. In other cases a great number of small discrete 
bare patches appear on the neck and sides. Sometimes the irritation is 
so marked that in a couple of days an animal may show a great number 
of almost raw abrasions over the body. These result from rubbing and 
biting. The undisturbed lesion is nearly always a moist one; the vesicle 
resulting from the mite’s bite exudes, and the serous-like fluid forms, 
with the epithelial products, a scab. The progress of the disease after a 
certain stage is more or less slow; but a neglected case may show extensive 
areas covered by a scab somewhat moist in consistency. | 


1472 SYSTEM OF VETERINARY MEDICINE 


Dragnosis.—This is usually easy in animals whose skins have not 
been subjected to violent home remedies, and even in these the parasites 
can often be found in débris taken from the root of the tail. The micro- 
scope will distinguish it from the other parasitic affections, but the 
coexistence of other forms of mange must not be lost sight of. Lousiness 
is often an accompaniment of this mange. Rapid movement of the lips 
when the animal is scratched on the withers, although a useful test, must 
not be regarded as diagnostic. Cases arise in which the diagnosis is 
complete save for the discovery of the parasite. It would here seem wise 
to run no risks, and such a doubtful diagnosis should be safeguarded by 
treatment of an antiparasitic nature. 

TREATMENT.—Generally speaking, this is much easier than the sarcoptic 
form, but it often fails because the areas around the primary lesions only 
are treated. The animal must first be clipped all over, the scales and 
scabs completely removed, and an antiparasitic dressing then applied to 
the whole body. The chief point to be borne in mind is the prevention 
of further damage to the already irritated skin. A great number of the 
oils used as bases of the dressing either do this or leave a varnish-like layer, 
and so prevent the cutaneous functions. According to the dressing used, 
the whole body will be completely or half covered at a time. Bearing 
in mind that two dippings, with an interval of ten days, is recognised as 
sufficient to cure scab in sheep, the dressing will not be applied too often. 
Exercise, feeding, and attention to the stall and fittings should be carried 
out as previously described under Sarcoptic Mange. The oil and soap 
dressings mentioned on p. 1464 can be used. A mixture of sulphur and ~ 
train oil (1 to 5) is quite good. It can be repeated in about five days. — 
Many of the coal-tar preparations in common use can be safely employed, 
as can a number of the prescriptions used against sheep scab. Watery 
applications or repeated washings are, however, not to be advised. Even 
after the application of an oil-and-sulphur dressing, friction to the skin 
by means of a duster or whisp seems very much better than washing. 

PREVENTION.—Psoroptic mange is liable to recur on the treated 
animal unless every portion of the skin has been satisfactorily dressed. 
Second and third outbreaks in the same stock often occur if all the 
animals are not treated. In such cases the crevices and cracks on the 
woodwork of the stables are blamed; but there is strong evidence to 
show that many animals harbour the psoropt without showing symp- 
toms. It is upon these that the disease appears, or spreads from them 
to other animals. Such latent cases are no doubt responsible for many 
of the outbreaks among animals which appear to have no chances of 
infection from other sources. 


PARASITES AND PARASITIC DISE ASES 1473 


LEGISLATION.—The Parasitic Mange Order of 1911 of the Board of 
Agriculture and Fisheries includes this variety of mange. 

2. Psoroptic Mange of the Sheep.—tIn sheep this disease is usually 
spoken of as “scab.” ‘It is even to-day the cause of great loss and 
inconvenience. In many of the Colonies it has, by stringent regulations, 
been completely stamped out. There were over three hundred outbreaks 
in England and Wales during 1912. 

SymMproms.—During port and market inspection the following 
phenomena will be noticed: A small area of fleece will be ruffled and 
appear as if it had been sucked. It is consequently whiter than the 
rest of the wool. A similar appearance, however, may be brought about 
by the irritation set up by the ked (Melophagus ovinus). A small portion 
of fleece may be pulled out about an inch or s0, or the animal may have 
a little in the angle of the mouth. Animals rub themselves frequently 
against any accessible object, and may be seen to elevate the nose and 
move the lips rapidly. The same effect may be brought about by rubbing 
the back with the fingers. If the fleece is parted and the surface of the 
skin felt with the tip of the finger, a small, hard pimple will be apparent, 

giving one the impression of a very small shot under the skin. On 
examination with a lens, the parasite or parasites will often be seen. 
The papule resulting from the bite has a red area around it, and, turning 
into a yellow shade, becomes a vesicle. Hxudation over a patch the size 
of a threepenny piece now takes place, the serous-like material coagulates, 
and, with epithelial detritus, forms a scab. When exudation is taking 
place, a dirty patch of wool may be observed. The more numerous 
the acari, the larger the area affected. The irritation is now more 
marked, the fleece is pulled, rubbed, and falls. Bare patches become 
visible. 

According to the season of the year and the condition of the host, 
the parasites now increase in numbers, the disease extends rapidly, the 
scab becomes much thicker, and the fleece falls out in lumps. The parts 
usually affected at the onset of the symptoms are the upper regions of 
- the trunk, such as the croup, back, and withers. From these seats the 
lesions extend in advanced cases to the neck and sides. Neglected cases 
lose a great deal of wool, and become very unsightly and emaciated. In 
young animals the disease is often severe. When shorn, the diseased 
areas present parchment-like crusts upon a tumefied skin. Shearing 
seems to lessen the activity of the acari. Like the other varieties, 
Psoroptes communis ovis has a marked seasonal occurrence, being much 
more active in the cold than warm seasons of the year. 


Dracnosis.—The psoropts can usually be found where the disease is 
VOL. II. 93 


1474 SYSTEM OF VETERINARY MEDICINE 


active, in fresh lesions, or at the edges of old and scab-covered areas. 
The process of examining the fleece of a suspected animal is tedious, 
and whilst it is easy to certify in many cases that the animal has the 
disease, it is often most difficult to say that this is not so. The same 
applies to a flock. It is often necessary to use the caustic potash method 
already described. The disease is likely to be mistaken for rain-scab, 
which is sometimes seen suddenly in most members of a flock after ex- 
cessive rains. The lack of irritation, nature of the lesions, and absence 
of psoropts are the most important points in differentiation. When too 
strong dips have been used, a drug dermatitis,results; in these cases there 
is a layer of epithelium fastened around the roots of the wool which has 
separated from the highly coloured skin lying beneath it. The irritation 
produced by ticks, keds, and lice will be distinguished from scab by the 
presence of the parasites. Delafond mentioned an inflammation of the 
sebaceous glands which resembled scab. It appears to be rare, and the 
absence of the parasite from the bad smelling and very moist lesions 
separates the two diseases. 

TREATMENT.—Dipping is now recognised as the only reliable means 
to cure diseased animals and to protect in-contact ones from the infection 
to which they have been exposed. Salving, pouring, and any other methods — 
of hand application, which are quite good for black nose (the sarcoptic 
form of scab), have been blamed for spreading the disease. Under 
Article 18 of the Sheep Scab Order of 1905, all dips used in this country 
have to be approved of by the Board of Agriculture and Fisheries. Pro- 
prietary articles which have been so approved of contain statements to — 
that effect on the outside of the package. At present there are 507 ~ 
recognised dips. 

When the manufactured dips are used, the instructions given must 
be carefully carried out. It is usual to shear all the sheep to be dipped 
and locate them on one part of the farm for about a fortnight, after which 
they are all dipped, and then redipped in ten days. They are then 
turned on to another part of the farm. The solution should be ata 
temperature of about 100° to 101° F., and the animals should be kept 
in them for the prescribed time. The head is usually immersed once, 
the eyes being closed by the man at the head. Care has to be exercised 
with rams and pregnant ewes. In dips containing poisons the animals 
must be allowed to drain on a grass-free yard. Attention must be paid 
to the removal of excreta, and great care used in the addition of fresh 
dips, so that the correct strength is maintained. Baths in common use 
are the hand bath, swim bath, and cage bath. The hand bath is made 
of wood or galvanised iron, and is 4 feet long, 1 foot 9 inches wide, and 


PARASITES AND PARASITIC DISEASES 1475 


4 feet deep. The animal is held upside down in the dip by its legs and 
head. Although it is cheap and inextravagant in material used, it is 
_ often dangerous to the men and animals. A modified form consists of 
a wooden bath 6 feet long, 2 feet 6 inches wide, and 2 feet 3 inches deep. 
From the middle of the length an inclined floor with cross bars allows 
the animal to walk up into a dripping-pen. The swim bath consists of a 
trough with sloping ends. It is 33 feet long at the top, 20 feet 6 inches 
at the bottom, 5 feet deep, and 1 foot 8 inches wide. The bottom is not 
so wide as the top. After passing through the dip, the animals walk into 
a draining-pen. The drippings regain the bath. In the cage bath the 
animal walks into a cage, which is lowered by means of a windlass into the 
dip-containing bath. After being raised, it passes into a dripping-pen. 
By this means the sheep are scarcely handled at all. Large permanent 
dipping plants are in use in countries where sheep breeding forms the 
staple industry. 

The following are three dips approved of by the Board of Agriculture 
and Fisheries for 100 gallons of bath: 

a. Lime and Sulphur.—Mix 25 pounds of flowers of sulphur with 
124 pounds of good quick-lime. Triturate the mixture with water until 
a smooth cream without lumps is obtained. Transfer this to a boiler 
capable of boiling 20 gallons, bring the volume of the cream to 20 gallons 
by the addition of water, boil and stir during half an hour.” The liquid 
should now be of a dark red colour; if yellowish, continue the boiling 
until the dark red colour is obtained, keeping the volume at 20 gallons. 
After the liquid has cooled, decant it from any small quantity of insoluble 
residue, and make up the volume to 100 gallons with water. 

b. Carbolic Acid and Soft Soap.—Dissolve 5 pounds of good soft soap 
with gentle warming in 3 quarts of liquid carbolic acid (containing not 
less than 97 per cent. of real tar acid). Mix the liquid with enough water 
to make 100 gallons. 

c. Tobacco and Sulphur.—Steep 35 pounds of finely ground tobacco 
(offal tobacco) in 21 gallons of water for four days. Strain off the liquid, 
and remove the last portions of the extract by pressing the residual 
tobacco. Mix the whole extract, and to it add 10 pounds of flowers of 
sulphur. Stir the mixture well to secure an even admixture, and make 
up the total bulk to 100 gallons with water. 

The period of immersion in these dips should not be less than half a 


minute. 
The Bureau of Animal Industry of the United States gives the following 


prescriptions: 


1476 SYSTEM OF VETERINARY MEDICINE 


1. Flowers of sulphur uM .. 383 pounds. 
Unslaked ime .. ae .. 11 pounds. 
Water .. fe hy: .. 100 gallons (U.S.). 
2. Flowers of sulphur aN .. 24 pounds. 
Unslaked lime... ie .. 8 pounds. 
Water .. a BS .. 100 gallons (U.8.). 
3. Nicotine ies et .. 4 pounds. 
Flowers of sulphur i, .. 16 pounds. 
Water .. ae Rf .- 100 gallons (U.8.). 


On the Continent of Europe many dips are known and used, but a 
number of them are modifications of the foregoing. Amongst these may 
be mentioned those of Walz, Gerlach, Zindel, Tessier and Matthieu, 
Eberhard, Fowler, and Viborg. Many of the latter contain arsenic, a 
drug which is now not so much in favour as formerly. In Germany, 
shorn animals are rubbed on several successive days with creolin liniment 
(creolin 1 part, spirit 1 part, and green soap 8 parts), and then twice 
dipped in a 24 per cent. watery solution of creolin, the interval being of 
seven days’ duration. Many bodies allied to the coal-tar disinfectants 
are also used as sheep dips. 

Proprietary dips are extensively used here and in the Colonies on 
account of the ease with which they are made up. Against nearly every 
dip some disadvantage can be urged; they must, however, be efficient 
against the acarl. Some may be toxic to the animals and dippers— 
arsenic; others may injure the fleece—sulphur and lime; and yet others 
cause an appreciable loss of flesh, or set-back, and in this direction carbolic | 
acid and tobacco dips are the most important. Properly prepared and — 
used, the lime and sulphur dips appear to have the least disadvantages. 

LEGISLATION.—Sheep scab is a scheduled disease. Apparently the 
sarcopt and choriopt forms are also included in the Orders relating to 
scab. Compared with the psoroptic form, the other two varieties are, 
however, not important. The Diseases of Animals Act, 1903, The Sheep 
Scab Order of 1905, The Sheep Scab (Compulsory Dipping Areas) Order 
of 1906, The Sheep Scab (Regulation of Movement) Order of 1906, and 
the Sheep Scab Order of 1910 are the chief legislative measures against 
the disease. 

3. Psoroptic Mange of the Rabbit——As has been previously remarked, 
both the goat and rabbit suffer from an otacariasis due to their respective 
varieties of psoropt. The symptoms, lesions, and treatment are very 
much the same in each case. In the goat the disease is not common, 
but amongst rabbits, especially tame animals, it is far from rare. 

Symptroms.—Affected animals shake their heads, carry the ears low, 


PARASITES AND PARASITIC DISEASES 1477 


and scratch them with the hind-legs. On examination, the diseased 
process is found to be confined to the conchal cartilage. At the bottom 
of this is a soft grey mass, which gradually fills the organ and becomes 
dryer and crust-like as the exterior is reached. If removed, the under- 
lying tissue is found to be red, the epithelium gone, and to be discharging 
a sero-sanguinolent or pus-like fluid. The ear becomes swollen, painful, 
and hot. After a time the animal loses flesh. Rarely equilibrium is 
interfered with. . 

Diacnosis.—The parasites are usually present in great numbers, and 
can easily be seen with the naked eye on account of their dark colour. 

TREATMENT.—As the parasites confine their attacks to the ear, a local 
dressing is nearly always efficacious. The ear is first carefully cleared 
of all material by means of cotton-wool, forceps, and weak soap solution. 
A great number of parasites are removed in this process. The abraded 
surface is protected by a little of some bland oil. When the cavity has 
been emptied, a liniment composed of the following agents can be applied 
three times during fourteen days: 


Tincture of opium Hf py italipart: 
Oil of turpentine .. es yids part 
Phenol .. sll - .. 2 parts. 
Glycerine NY ee .. 100 parts. 


(D) Chorioptic Mange. 


Apparently all the forms of this mange on the various animals are 
due to several varieties of the same species. This acariasis is often 
spoken of as symbiotic mange. The animals that may be affected are 
the horse, ox, sheep, goat, and rabbit, but, with the exception of the 
first mentioned, none are really important. On the ox, the disease has a 
similar distribution to that of sarcoptic mange. It is, however, often 
confined to the root of the tail and anal fosse. The ovine form closely 
resembles leg itch of the horse. In the rabbit the ear is affected, as in 
psoroptic otacariasis, but it is not a common condition. The goat 
choriopt has been recorded from the regions along the spine and from 
the pasterns. In all cases the lesion is a superficial one, as the parasite 
lives on the skin, and its attacks are less severe than those of the psoropt. 
Man is occasionally attacked by the bovine form, but the acari do not 
appear to pass from one species to another, and, indeed, the spread of 
the disease on an individual is often slow, as is the transmission from 
animal to animal. 

Chorioptic Mange of the Horse.—This is a very common disease of 
the limbs of horses, and acquires importance not so much on account of 


1478 SYSTEM OF VETERINARY MEDICINE 


the lesions themselves, but from the injuries which result from attempts 
to remove the irritation. Treads, kicks, and severe jarring of the limbs 
are often so caused. Itchy legged horses become bad to shoe, and many 
regard the equine choriopt as an important predisposing factor in the 
etiology of grease. 

Symproms.—The chief manifestations are: rapid stamping of the 
hind-limbs, especially when these are handled, rubbing against the 
opposite member, and violent biting. The hind-liimbs are most often 
affected, and the disease starts at the pasterns and fetlocks, and later 
gains the hocks and knees. More rarely the lower aspect of the chest, 
and even the stifle and croup, are affected. The progress is slow, and 
in the end the hair falls out, and epithelial proliferation occurs. Rarely 
there is apparently no loss of hair, but the leg becomes thickened and a 
fine granular material falls out of the hair if the limb is briskly brushed. 
It is most common in cart-horses, and has a marked seasonal occurrence, 
being more manifest in winter, with a tendency towards the spontaneous 
cure In summer. 

Dracnosis.—The situation of the lesions are sufficient for this purpose, 
and the parasite is easily found. The fact that the choriopt may rarely 
exist on the chest and croup is important, as this form is not included 
under any legislative measure, and confusion with the psoroptic mange 
and this abnormally high lesion is possible. 

TREATMENT.—Clipping, rapid friction by means of the brush, and 
washing-soda, soap and water to remove the scales, should be followed 
by any of the mild anti-psoric liniments or even coal-tar disinfectants. 
Sulphur 1 part, to train oil 4 parts, is quite efficacious. A cure is — 
usually effected by three weekly courses of treatment. 

PREVENTION.—This will follow general lines, but need not be so 
complete; probably separate brushes and isolation of the patient after 
destruction of all the removed hair and bedding will be all that is required. 


(EK) Otodectic Mange. 


As has been previously remarked, the Otodectes closely resemble the 
Chorioptes, differing only in essential details of structures in the females. 
They occur in the ears of the dog, cat, and ferret, where they produce 
an otacariasis. Varieties from each of these species are recognised. 
They, however, appear to be capable of transmission in the two first- 
mentioned hosts. The disease presents very similar clinical pictures in 
all three animals, and that of the dog only will be described. 

Otodectic Mange in the Dog.—This form is known by a number of 
synonyms, such as parasitic canker of the ear, parasitic otorrhea, 


PARASITES AND PARASITIC DISEASES 1479 


otacariasis, auricular acariasis, and symbiotic acariasis of the ear. The 
presence of the parasite in cases of otorrhcea is extremely common, and 
it has been estimated that 75 per cent. of such cases in the dog are of 
parasitic origin, and even more in long-haired cats. 

Symproms.—At first the animals scratch their ears and shake their 
heads, and this is often made more manifest when the sufferer becomes 
heated. Occasionally hematoma of the flap results from repeated 
bruisings. Nervous symptoms have been noted on the Continent, but 
they appear to be very rare. After prolonged irritation, the head is 
carried on one side and equilibrium is interfered with. On examination, 
the disease is usually found to have been in existence for some time, the 
flap may be tender to the touch, and the internal parts of the ear hot and 
inflamed. The entrance to the auditory canal contains a varying amount 
of dark brown cerumen, which forms a scab. When removed, the under 
surface is soft, sticky, and hghter in colour than the exposed portion. 
In neglected cases the discharge increases, and the odour given off becomes 
very Offensive. The entrance to the auditory canal may be almost 
occluded by the thickened lining of the ear. Crenated flap may also 
result from long-continued irritation. Ulceration of the internal aspect 
of the ear occurs in old-standing cases. 

Diaenosis.—In recent cases the parasite can often be seen as minute 
white spots actively moving about over the hairs and cavities of the 
conchal cartilage without many noticeable lesions. Later on, when not 
visible by means of the hand-lens, the cerumen will usually contain 
parasites. Abroad, where symptoms of a nervous nature are said to 
occur, this condition has to be distinguished from epilepsy, fits resulting 
from worms and teething, and even rabies. Apparently the most im- 
portant differentiation is from non-parasitic otorrhcea, in order to prevent 
its spread. 

TREATMENT.—In many cases this is most difficult, and demands the 
strictest attention to detail. After thorough cleansing, Stent recommends 
the application, at intervals varying with the gravity of the case, of 
boracic acid ointment to which 5 per cent. of carbolic acid has been 
added. He speaks well of tannoform in daily dressings for chronic cases 
with ulceration. Nocard had good results with a liniment composed of 
naphthol 1 part, ether 2 parts, and olive oil 10 parts. The ether penetrates 
any unremoved wax. The lotion is kept in stoppered bottles, and applied 
daily, care being taken to prevent evaporation of the ether for a while. 
Livesey has had good results with 1 part of perchloride of mercury in 
250 parts of water, to which a little glycerine has been added. He recom- 
- mends also the apparently drastic measures of applying a pledget soaked in 
tincture of iodine on three weekly occasions. Hebrant and Antoine have 


1480 SYSTEM OF VETERINARY MEDICINE 


recently obtained good results by the employment of a dressing com- 
posed of glycerin 100 parts and tincture of iodine 10 parts. Many 
other parasiticides have been employed. Sulphur liniment is quite a 
good application. 


PREVENTION.—The usual general principles concerning acarus-caused © 


diseases will have to be enforced, but the possibility of inter-communica- 
bility of the mites between the dog and cat must not be lost sight of. 


BIBLIOGRAPHY. 


Annual Report of the Proceedings under the Diseases of Animals Acts, etc., for 
1912. 

Berry: Outbreak of Sarcoptic Mange in Pigs. Journal of Comparative Path- 
ology, vol. xix., 1906, p. 301. 

BLENKINSOP: The Treatment of Sarcoptic Mange in Horses and Mules. Veter- 
inary Therapeutics, second edition, 1906, p. 711, by E. Wallis Hoare. 

Cranston-Low: An Investigation into Scabies in Laboratory Animals. Journal 
of Pathology and Bacteriology, vol. xv., 191], p. 333. 

GARNETT: Auricular Acariasis. Journal of Comparative Pathology and Thera- 
peutics, vol. xvii., 1904, p. 105. 

GoopaLu: About Acarina. Veterinary Journal, 1912, pp. 107, 170, and 224. 

HANDBOOK: Diseases of Animals Acts, 1906. 

HEBRANT ET ANTOINE: Un cas de Gale Psoroptique chez le Chien. Annal de 
Méd. Vét., December, 1907, p. 696. 

HEBRANT ET ANTOINE : Parasitic Otitis in the Cat. Veterinary Journal, 1913, 

. 537. 

J ea of the Board of Agriculture and Fisheries. London, 1908. 

LivesEy: Notes on Some Problems of Everyday Dog Practice. Veterinary Record, 
vol. xxv., 1913, p. 455. 

Mzrenin: Les Parasites Articulés. Paris, 1895. 

NEUMANN: Parasites and Parasitic Diseases of the Domesticated Animals. 
London, 1905. 

NeEveEv-LEMarRE: Parasitologie des Animaux Domestiques. Paris, 1912. 

PILLERS: Sarcoptic Scabies of Bovines. Veterinary Journal, 1909, p. 434. 

PILLERS: Short Note on the Prevalence of Bovine Sarcoptic Scabies. Veterinary 
Journal, 1912, p. 251. 

PILLERS: The Treatment of Psoroptic Mange of the Horse. Veterinary Record, 
vol. xxvi., p. 20. 

RAILLET: Traité de Zoologie Médicale et Agricole. Paris, 1895. 

Sheep Dipping. Leaflet 145, Board of Agriculture and Fisheries. London, 1908. 

Sheep Scab, United States Department of Agriculture. Farmers’ Bulletin 159. 
Washington, 1903. 

Sheep Scab. Leaflet 61, Board of Agriculture and Fisheries. London, 1906. 

STOCKMAN AND BreRry: The Psoroptes communis ovis: Some Observations on Ova 
and Ovipositing. Journal of Comparative Pathology and Therapeutics, 
vol. xxvi., p. 45. 

STOCKMAN: Some Points in the Epizootiology of Sheep Scab in Relation to 
Eradification. Journal of Comparative Pathology and Therapeutics, vol. xxiii., 
p- 303. 


Taytor: On the Prevalence of Bovine Sarcoptic Mange. Veterinary Journal, 
1912, p. 324. 


i i 


PARASITES AND PARASITIC DISEASES 1481 


THE LEECHES. 


These animals belong to the subkingdom Annelida, class Hirudinea. 
As a group, they lead a varying existence. Many live in salt water 
and others in soft. As temporary parasites they may be found on 
mammals, birds, and fishes. They have a segmented body, with no 
lateral appendages such as the earth-worms possess. The internal seg- 
mentation usually corresponds to sets of external rings. The body 1s 
capable of great extension, and when in this condition resembles a flat- 
tened worm, but when contracted it is ovoid. There are two suckers, 
by which locomotion is accomplished, one anteriorly (the oral), and the 
other posteriorly (the anal). The latter is usually much the larger. In the 
oral sucker are placed the piercing mouth-parts. Leeches are herma- 
phroditic; the eggs are laid in damp soil and are enclosed in a cocoon. 
When these parasites attack animals they become engorged with blood 
up to five times their former size. Several genera deserve brief mention 
—viz.: Hirudo, Limnatis, Hemadipsa, Protoclepsis, Hemiclepsis, and 
Pontobdella. Hirudo previously furnished in great numbers those species 
which were therapeutically employed—viz., the medicinal leech. 
H. medicinalis L., the green leech, H. officinalis Moq-Tand., and the 
trout leech, H. troctina Johnson. 

Inmnatis nilotica (Savigny).—This species is common in Southern 
Kurope, North Africa, and parts of Asia. It is from 8 to 10 centimetres 
long and 1:5 centimetres broad. The colour varies greatly; some speci- 
mens are greenish-brown. Several varieties have been described. It 
inhabits streams and pools, attacking most mammals, and even man. 
Great confusion has arisen with this and another species—viz., Hamopis 
sanguisuga Berg. They are both known as horse leeches, but the teeth 
of the latter cannot pierce the skin. H. sanguisuga lives in semi-stagnant 
streams and pools in this country. It feeds upon small aquatic verte- 
brates. From India I have received a large Limnatis taken from the 
nose of a dog. 

Hemapidsa ceylanica (de Blainville).—This is a terrestrial form from 
Ceylon, where it lives in fields, damp woods, and under leaves. It is 
about 2°5 centimetres long and very thin, and causes great annoyance 
to the limbs of animals and travellers. 

Protoclepsis tessellata (Miller) is commonly parasitic on water fowl, 
Hemiclepsis marginata (Miller) is found on fish, as are also Pusciola 
geometra (L.) and Pontobdella muricata. 

Insunious Errects. There is not a group of parasites concerning 


1482 SYSTEM OF VETERINARY MEDICINE 


which views so divergent concerning their baneful effects have been held. 
The assertions of the older naturalists that a few leeches would kill a 
horse have been rightly condemned in recent times by pointing the fact 
that in certain districts most animals harbour great numbers of them. 
In this country at least they are unimportant. In Vol. I., p. 1116, of 
this work mention is made of the fact that these parasites transmit 
important protozoan parasites of fishes. 

Formerly leeches were extensively used to extract blood from patients. 
Raillet says that in Paris during 1840 the Central Pharmacy purchased 
828,000 leeches, whilst in 1873 this figure had fallen to 52,000. The 
areas from which blood was to be drawn were usually moistened with a 
little blood, and the leech applied to the exact place in a test-tube or 
similar receptacle. The parasites, when fully engorged, dropped off in 
about an hour, after which the blood-flow was either arrested or kept up 
as the case required. Leech-culture was once extensively practised in 
France. In animals, the parts usually attacked are the natural orifices 
and the cavities leading from them, such as the mouth, nostrils, pharynx, 
larynx, trachea, conjunctiva, vagina, and even the cesophagus of birds. 
The latter may also be attacked on the body. Animals become affected 
with the aquatic forms when drinking. In some countries such as 
Algeria, serious losses amongst cattle, camels, and horses may be traced 
to leech infection. 

Symproms.—The bite usually leaves a tri-radiate lesion, and, depend- 
ing upon the number of parasites present and the parts affected, varying 
symptoms are shown. If repeatedly attacked, horses become weak and — 
anemic, with loss of appetite and all their attendant manifestations. — 
Often there is hemorrhage whilst the animals are at work. In the ali- 
mentary canal of the leech blood will remain non-coagulated for a con- 
siderable period. When the nasal cavities, larynx, or trachea, are the. 
seat of the parasites, various respiratory inconveniences will be shown. 
Deaths from dyspnoea have been recorded. In rare cases nearly 200 
specimens have been removed from the larynx of one host on post-mortem 
examination. 

RemeEpIAL Mrasures.—Visible parasites should be removed by the 
forceps or scissors. When situated in the nasal or oral cavities, attempts 
should be made to dislodge them by means of a whalebone with a padded 
end. This may be soaked in various irritant solutions, such as vinegar or 
alum solution. 

As a means of prevention, drainage should be carried out if the leech 
is a mud lover, or, better still, animals should not be allowed to drink 
water which is likely to harbour the parasites. When on the march, a 


PARASITES AND PARASITIC DISHASES 1483 


nose-bag of fine wire gauze has been recommended to be worn in the act 
of drinking. The natural enemies of leeches, such as eels and other fish, 
should be encouraged in infected waters. 


BIBLIOGRAPHY. 


Harpine, W. A.: A Revision of the British Leeches. Parasitology, vol. iii., 
1910, p. 180. (With a good bibliography.) 

Harpine, W. A.: Note on a Gnathobdellid Leech from Angola. Parasitology, 
vol. i., 1908,-p. 186. 

MASTERMAN, EK. W. G.: Hirudinea as Human Parasites in Palestine. Parasi- 
tology, vol. i., 1908, p. 182. 

RAILLET, A.: Traité de Zoologie Médicale et Agricole. Paris, 1895. 


THE BLADDER WORMS. 


Many of the larval forms of the Cestodes which attack the domes- 
ticated animals are known by this name, the explanation being the 
shape of the cyst, coupled with its always containing a liquid. They are 
the immature forms of tapeworms. Many of them were known and given 
specific names before the researches of Von Siebold, Kuchenmeister, 
Leuckart, and others had shown that they were stages in the life-cycle 
of animals with such a different external appearance. This explains the 
fact that these cystic forms still go by specific names quite different 
from the adult. 

The arrangement of the various parts of these bladder worms allows 
them to be divided into several groups, of which the following are the 
most important: 


1. Cysticercus. 4. Cysticercoid. 
2. Coenurus. 5. Cryptocystis. 
3. Echinococcus. 6. Plerocercoid. 


The last three, so far as disease production is concerned, are not of 
great importance. The cysticercoids are usually of small dimensions, 
and have their caudal vesicles poorly developed. The cryptocystis and 














Cysticercus. Host. cree tren | Host. 
C. cellulose ie Pig, dog, and man Tenia solium Man 
C. bovis me i T’. saginata Y 
C. tenuicollis is Ox, sheep, pig T'. marginata Dog 
C. ovis eh wt Sheep T’, ovis % 
C. pisiformis Es Rabbit and hare T. serrata ae 
C.tarandi .. te Reindeer T. krabber A 
C. fasciolaris .. | Rat and mouse T'. crassicollis Cat 











1484 SYSTEM OF VETERINARY MEDICINE 


plerocercoid are really false cysts, as they are solid; the former has a _ 
rounded body with a tail, and the latter is elongated. 

The cysticerci possess an outer membrane, enclosing a single head, 
and a varying amount of fluid in the cavity. When ingested, each cyst 
can therefore give rise to only one tapeworm. They vary in size from 
that of a pea to a fowl’s egg. 

The ccenurus cyst consists of a single cavity containing several poten- 
tial tapeworm heads, so that a great number of adults arise in the intestines 
of a host after the ingestion of a ccenurus. 











Coenurus. Host. | A el ace Host. 
C. cerebralis ue Sheep, ox, and goat Tenia cenurus Dog 
C. serialis .. .. | Rabbit T’. serialis Dog 














Cysts with the structure of an echinococcus have a number of other 
cystic bodies projecting from their walls, and these contain many scolices. 
Thus this form has many heads and several cavities. 





. Corresponding 
Echinococcus. Host. Tapeworm. Host. 
E. polymorphus .. | Horse, ox, sheep, | T'@nia echinococcus Dog 
pig, dog, and man | 
E. alveolaris an | 1’. echinococcus var, Dog 
alveolaris 














The various cysts of these three groups produce their injurious effects 
by travelling through the animal to their predilection seats, by their 
pressure upon important structures, by rupturing, by carrving micro- 
organisms, and by being present in great numbers. The diseases caused 
by each are termed respectively Cysticercosis, Coenurosis, and Echino- 
coccosis. 

(A) Cysticercosis. 


" This group of diseases receives different names according to the 
species of parasite present and the animal affected. Thus, in cattle 
C. bovis produces measles, as does C. cellulose in swine, whilst C. tenui- 
collis in the abdominal cavity of slaughtered animals is generally called 
** water-bags.” 

1. Due to Cysticercus cellulosee—The cyst is elliptical, measuring 
from 6 to 20 millimetres long, and 5 to 12 millimetres broad, and con- 
taining a small white body, which projects into the cavity. When the 


PARASITES AND PARASITIC DISEASES 1485 


vesicle is ruptured, and the head examined under the low-power lens, it 
will be found to be furnished with a double row of about thirty hooks 
and four suckers, all possessing the characters of the head of Tenia 
solium L. 

ANIMALS AFFECTED.—The usual host is the pig. In this country, 
masley pigs are not common, but they are occasionally met with. In 
Kuropean States the disease is not so common as formerly. Several 
cases are on record of infection of the dog, the cysts having been found 
under the skin, in the muscle, brain, and internal organs. It has rarely 
been seen in the cat. Man is also sometimes affected. In the pig, 
as with most other cysts, there is formed a covering to the parasite com- 
posed of a thin connective-tissue layer. The most common seats are the 
shoulders, neck, tongue, intercostal and psoz muscles. In badly infested 
cases, most of the muscles of the body may be affected, even the heart. 
Usually, the internal organs are free from infection. 

MetHop or Inrection.—Swine are infected by the ingestion of eggs 
of Tenia.solium from human excreta, which may reach the pig in in- 
numerable ways in country districts. The course of the embryo after 
the action of the gastric juices upon the egg is variously stated. Some 
imagine it reaches the general circulation by the thoracic duct, others 
that it bores directly through the stomach wall to its predilection seats. 
It is possible that from the stomach wall the embryo gains the portal 
vein, then, passing through the liver, reaches the heart, and then the 
general circulation. On becoming arrested in muscular tissue, the cyst 
soon develops. | 

Symptoms.—In most cases the animal is only found to be 
affected at the slaughter-house. If the tongue is affected, the cysticerci 
may be felt under the mucous membrane, but in other cases nothing 
positive can be ascertained. Some authors have noticed increased sensi- 
bility of the snout, whilst others have described various pictures of brain 
Symptoms. 

Diacnosis.— The éntra vitam diagnosis is only possible when cysts 
can be seen or felt under accessible mucous membranes. In meat inspec- 
tion the cysts are brought to light by incision of susceptible muscles. 
If the exposed muscles have had the larvee removed, small cavities will 
be noticeable, and the suspicion can be confirmed by fresh incisions. 
There are other muscular lesions which simulate cysticercosis, such as 
sarcocysts and concretions. 

Meat Inspection.—Infected carcasses should be completely con- 
demned, as by the ingestion of live cysts in uncooked pork human beings 
are likely to become affected with the armed tapeworm, Tenia solium. 





1486 SYSTEM OF VETERINARY MEDICINE 


Young pigs are most often infected. The cyst takes about three months 
to become full-sized. They eventually die, and become calcified. The 
temperature required to kill the cysts is 50° C., and it has been shown 
that a large roasted infected joint may even be capable of giving rise to 
the worm in man. ® 

RemepiaL Mrasures.—There is no satisfactory treatment in the 
living animal. Infected meat should be destroyed without trying to kill 
the parasite, and so render it innocuous. The prevention of primary 
infection of the pig from human excreta containing the tapeworm’s eggs 
can only be effected by the construction of proper accommodation for the 
defecation of farm and other hands. Even to-day in country districts 
streams or manure-heaps are used for this purpose, and if the culprit is 
a worm-bearer, swine cysticercosis 1s likely to result. Human excreta 
should be treated with disinfectants or caustics before it is used as 
manure. , 

2. Due to Cysticercus bovis.—This cyst is usually an elliptical 
vesicle from 1 to 6 millimetres long, and about 3 millimetres broad, with 
a small white spot indicating the invaginated head. On rupture of the 
vesicle, the head presents four suckers and a central pit—points which 
distinguish it from the armed measle of the pig. 

ANIMALS AFFECTED.—The ox is the only animal harbouring this 
parasite. It is rare in this country, but must occur, as the adult tape- 
worm, Tenia'saginata (Goeze), is sometimes recorded from man. It is 
usually found in the muscles of mastication, especially the pterygoids, 
rarely in the heart, and more rarely in the tongue and neck muscles. In 
a few cases it has been generalised in the muscles. In countries where 
incision and reflection of the pterygoid muscles is practised in routine meat 
inspection, bovine measles may be detected in one-five-hundredth of 
the animals examined. It is found in France, Germany, and other 
European States. 

Metuop oF InFection.—This is similar to that of the preceding cyst, 
the eggs being derived from the unarmed tapeworm of man, Tenia sagi- 
nata. The chances of infection to bovines in some of our colonies is 
great. This has been noticed in India, where cattle drinking-water has 
been contaminated by human excreta. 

Symproms.—These are practically never shown by the living animal. 
A routine examination of the masseter region of slaughtered cattle leads 
to its detection at the abattoir. 

Meat Inspection.—The parasite is important on account of its 
giving rise, when eaten alive, to tapeworm in man. The larva is thought 
to reach full size in about six weeks, and to live for about eight months 


PARASITES AND PARASITIC DISEASES 1487 


only, after which they become calcified, giving rise to dry measles, as is 
_ seen in the case of the pig. Animals of all ages appear to be liable to the 

disease. The parasite is slightly easier to kill by heat than the pork 
measle, 48° C. being required for that purpose. Affected carcasses should 
be condemned. 

REMEDIAL MeEAsurEs.—These must follow on the lines indicated 
under Cysticercus cellulose. 

3. Due to Cysticercus tenuicollis.—C. tenwicollis is one of the 
largest of cysticerci. The caudal vesicle is very large, varying in size 
from a walnut up to even that of a hen’s egg. It is commonly called a 
“water bleb,”’ or “‘ bladder.” The neck is very long and thin, thus giving 
rise to the cyst’s specific name. The anatomical details of the head 
resemble those of Tenia marginata Batsch, of which it is the hydatid 
stage. 

ANIMALS AFFECTED.—The most common hosts are the ox, sheep, 
pig, and goat. It appears from one or two records that man has rarely 
been affected; still rarer are records from the cat and horse. The camel 
and a few other wild ruminants in captivity have also been found to 
harbour the cyst. The usual seats are the peritoneal or pleural cavities, 
where it is attached to various structures, especially the liver. In a few 
authenticated cases the immature cyst has been found in the muscles of 
sheep. 

Meruop or Inrection.—After passing from the stomach, the hooked 
embryo gains the liver, and may leave traces of its journey in the form 
of small channels. The other aspects of this parasite are unimportant. 
They are usually removed by the meat inspector, and the chief item in 
prophylaxis is to see that they are not given to dogs, in whose intestines 
they would become adult tapeworms. 

4. Due to Oysticercus ovis—On naked eye examination, the sheep 
measle closely resembles C. cellulos@, with which it has long been con- 
fused. Although Cobbold first differentiated the two cysts many years 
ago, it has remained for Ransom recently to definitely prove the existence 
of a muscle cysticercus in the sheep. It is oval in shape, and varies from 
3°5 by 2 millimetres to 9 by 4 millimetres in diameter. The head is 
armed, and is invaginated from the wall of the caudal vesicle at about 
midway between the ends. In the pork measle the head arises at the 
end of the bladder. The cyst wall is thin, and has small projections on 
its surface. It is the larval stage of T@nia ovis (Cobb) of the dog. 

ANIMALS AFFECTED.—The sheep is the only important host, although 
the goat has also been found to harbour the cyst in its heart. The 
cysts are usually few in number, and are most often encountered in the 


1488 SYSTEM OF VETERINARY MEDICINE 


heart and diaphragm; they also occur in the muscles of mastication and 
tongue. Other muscles may also be affected. The geographical dis- 
tribution is wide. Cobbold first described the parasite in this country, 
and in America during 1912 approximately 20,000 sheep were found to 
be affected. Infection takes place by the ingestion of eggs from the | 
. feces of dogs infested with Tenia ovis. 

Meat InspEction.—There appears to be no reason why slightly 
infested carcasses should not be passed for food after the removal of the 
cyst, but badly invaded animals should be condemned.: The actual 
lesion closely resembles pork measles, but the parasite appears to undergo 
degeneration somewhat rapidly. It is possible that Cysticercus ovis is 
more prevalent in this country than records would suggest. 

5. Due to Cysticercus pisiformis.—This cyst is elliptical in shape, 
and about 10 to 12 millimetres long, the usual size being a little larger 
than a pea. The cavity contains the head suspended in a colourless 
fluid. The head closely resembles that of Tania serrata Goeze of the 
dog. 

ANIMALS AFFECTED.—The cysts are found in the peritoneal cavity of 
hares and rabbits, and rarely in that of the mouse. It is usually 
attached to the mesentery, or more correctly between its layers. Occa- 
sionally it is seen on the surface of the liver or even free in the cavity. 
The number of cysts present in each case varies. Usually a few only are 
seen, whilst in others the cysts, when removed from the affected animals, 
look very like a bunch of small grapes. 

Ingurnious HErrects.—The course of the parasite after ingestion of 
the egg is by way of the stomach and liver. In the latter organ it pro- 
duces a series of changes due to damage to vessels and microbic infec- 
tion. Dead rabbits may sometimes be found with these cysts in their 
peritoneal cavities, but there are usually other entozoa present in the 
intestines. Affected animals are often only detected when being gutted, 
and it may then be noticed that they are somewhat thinner than normally. 
Usually little importance is attached to their presence from a meat in- 
spection point of view. It appears probable that those cases in man- 
where the adult tapeworm (7. serrata) of this cyst has been stated to 
have been found are in reality misdeterminations. 

6. Due to Cysticercus tarandi—This form of measles is only of 
zoological importance. From the small cysticerci found in the muscles 
of captive reindeer Moniez raised his Tenia krabber of the dog. 

7. Due to Cysticercus fasciolaris.—C. fasciolaris is found chiefly in 
the livers of rats and mice, more rarely in field mice and bats. It differs 
considerably from other cysticerci. There is an invaginated head on its 


PARASITES AND PARASITIC DISEASES 1489 


anterior extremity, and this is followed by a segmented body, which ter- 
minates in a very small caudal vesicle. The larval stage thus closely 
resembles a tapeworm. The usual] length is about 5 to 10 centimetres. 
I have found it in about 10 per cent. of rats examined in stables where 


cats were kept. When ingested by the cat, the cyst gives rise to Tenia 
crassicollis Rud. 


(B) Ccenurosis. 


There are only two ccenuri of importance to the veterinarian. One 
afiects the nervous system of ruminants, where it produces a disease 
known variously as “ gid,” “sturdy,’’ “‘ staggers,” or “ turnsick ’”’; the 
other is found subcutaneously and intermuscularly in rodents, affected 
animals being often spoken of as “ bladdery.”’ 

1. Due to Coenurus cerebralis—The cyst varies in size from that 
of a pea up to a fowl’s egg. The wall is thin and transparent, and pro- 
jecting from the internal surface are a number of groups of heads. These 
latter may number some hundreds. They vary in size and length. 
Some may project into the colourless vesicular fluid for 2 to 4 milli- 
metres. 

ANIMALS AFFECTED.—The sheep 1s most often the host of this para- 
site, but it may be found in a great number of other ruminants, including 
the ox and goat. There appears to be no doubt that the horse is some- 
times attacked, but all the cases that have been recorded from man, the 
dog, pig, cat, and other animals, are thought to be very doubtful or 
erroneous. The usual seat is within the cranial cavity, but they 
have been found in the spinal cord. A few cases are on record from 
other situations. In England the disease does not appear to be so 
commonly met with as formerly. 

Metuop oF Inrection.—The disintegration of a ripe segment of 
Tenia cenurus Kuch on the pasture of sheep allows them to pick up 
the eggs. After passing the stomach, the hooked embryo is carried by 
the blood-stream to various parts of the body. Further development 
usually, however, only takes place in the brain. In early killed experi- 
mental animals traces of the parasite in a breaking-down condition have 
been found in other regions. | 

Symptoms.—The clinical picture as seen in the sheep will be men- 
tioned, and from it must be gathered those of the disease in the other 
animals. The disease is prevalent after a wet spring, and manifests 
itself most often in winter. 

Acute and chronic forms are recognised. In the former, the number 


of small cysts in the cranium is considerable, and traces of them may be 
VOL. Il. 94 


1490 SYSTEM OF VETERINARY MEDICINE 


found as small greenish bladders on the cortex of the cerebral hemispheres, 
but they may also be in the base of the brain. Apart from the recogni- 
tion of an acute and chronic form, each case passes through an acute 
stage before manifesting the usual picture of gid. Some are so severely 
affected as to die, whilst others, owing to the conditions under which 
they are kept, are not noticed to be ailing. 

In the first stage, shortly after infection, and due to the arrival of 
the hooked embryo in the brain, there is shown general brain disorder, 
such as increased nervousness and erratic movements without any ap- 
parent cause. There may be dulness and separation from the flock. 
These symptoms are associated with cerebro-meningitis. If the parasites 
are few, little may be noticed, whereas considerable numbers may lead 
to death at this stage in about five days after showing inflammatory 
symptoms of the eyes and head generally. 

After this stage there is usually a period in which no, or only a few, 
symptoms are shown. This may last for about three to seven months, 
depending upon the position and rate of development of the cyst. 
Affected sheep are at first difficult to herd, persistently leaving the flock, 
and running away from it when chased. Whilst the flock are grazing, 
the affected animal will be executing various movements, which are 
repeated. Turning in a circle is often seen, the diameter becoming 
smaller sometimes until the animal falls. The direction in which the 
animal-turns 1s often an indication of the situation of the cyst. Often 
when in the cerebrum, the movement is towards the side affected. After 
grazing for a short while a giddy sheep may start off for a few yards 
and then commence eating again. Sometimes the head is swung between 
the fore-legs in a staggering manner. In some cases the head is held to 
one side, either raised or lowered. More rarely it is raised over the back, 
and the animal then falls backwards. Often the head is rested against 
some object or upon the ground. In those cases described as “‘ pivoters,”” 
the body is revolved around one limb, which remains fixed. HExamina- 
tion of the outer region of the head by percussion may be useful, but it: 
is only in advanced cases that there is deformity and softening over the 
frontal and parietal bones. This latter shows all degrees, from simple 
pitting to fluctuation. 

When the cysts are in the cord, paralysis of the hind-limbs has been 
noted. With the progress of the disease, food is taken erratically and 
sparingly, so that the animal gradually becomes emaciated. Towards 
the end of the disease affected sheep lie on the ground in a lifeless 
manner. | 

Diaenosis.—In the first stages of the disease distinction has to be 


PARASITES AND PARASITIC DISEASES 1491 


made from sunstroke and meningitis. The atmospheric conditions pre- 
vailing, the history of the farm, and the usual value of an affected sheep, 
allow these distinctions to be made if an expectant attitude is adopted. 
In the typical stage the most important. differentiations will be from 
(Estrus ovis infection, loco-weed poisoning, accidents, tumour of the 
brain, and the presence of echinococcus cysts. In “ grub in the head ” 
there is always a discharge from the nostril, and the movements as in 
vid are not seen. Rarely the diseases may coexist. In loco-weed 
poisoning, the sheep are nervous and erratic, but there is no repetition 
of the same actions as in sturdy. Locoed animals tend to recover when 
put on fresh pasture. The presence of the plant and the fact that a 
number of animals are showing similar symptoms are important items. 
In accidents, tumour, and echinococcosis of the cranium, the question of 
diagnosis would be best settled by definite evidence at post-mortem 
examination, which procedure the suspicion of these conditions would 
warrant. I have on several occasions searched the brains of sheep for- 
warded to me by veterinarians, who stated that in life there were definite 
gid symptoms, without finding the slightest evidence of parasites. 
TREATMENT.—Where the disease is not prevalent, probably the best 
course to adopt is to slaughter an affected animal. Medicinal treatment 
is of no avajl. In cases that circle, operative measures prove satisfac- 
tory in about half the cases treated. It is not to be recommended when 
the symptoms suggest that the cyst is not on the upper aspect’ of the 
brain. In circling animals, the cyst is usually superficially situated in 
the side of the brain turned to the centre of the circle. In “ pivoters,” 
the parasite is usually deeply placed, and often when the head is depressed, 
the parasite is in the frontal lobe. The seat of operation may be indi- 
cated by a softening or bulging. If these give no indication, firm pres- 
sure by the thumb on the cranial bones above the cyst may cause the 
animal to start violently. Local anesthesia should be employed, after 
removing all the hair or wool from the part and thoroughly disinfect- 
ing. A V-shaped incision is made in the skin, the skull trephined, and 
a cruciate incision made in the dura mater. At this point the cyst should 
appear in the wound. It can then be gradually emptied of its fluid, and 
removed by the forceps. If the skull wound is not exactly over the cyst, 
careful exploration by means of the finger can be carried out, and the 
parasite removed by means of the forceps. After the arrestation of 
hemorrhage, the cavity is washed out, the V-flap stitched on one side, 
and the wound treated antiseptically. The trocar and cannula some- 
times substitute trepanation. After puncture, the cyst may protrude 
through the operation hole, and thus be removed by means of forceps. 


1492 SYSTEM OF VETERINARY MEDICINE 


These instruments are, however, more satisfactorily used in conjunction 
with the trephine if the parasite is a little way from the operation 
wound. 

PropuyLactic Mreasures.—Attention has in the first place to be 
directed to the host of the adult tapeworm—viz., the dog. The numbers 
of the useful animals should be kept down as low as possible, and stray — 
dogs should be destroyed. Dogs employed on infected farms should be 
periodically subjected to detention and dosing with a reliable teniafuge, 
and any tapeworms thus obtained should be examined for the presence 
of Tenia cenurus, and then burnt. The cysts removed by operation 
should also be burnt. The heads removed from affected sheep which 
have died or been slaughtered should be split open, and examined for 
ccenuri, and then carefully burnt. Although no definite cases are on 
record of other wild carnivora harbouring T. cenurus, this point should 
not be lost sight of. 

2. Due to Coenurus serialis——The cyst is usually very similar in size 
and structure to Cenurus cerebralis, but its scolices resemble that of its 
parent tapeworm, Tenia serialis Baillet. It, however, is capable of 
producing internally or externally daughter cysts, which may contain 
heads. The external daughter cysts usually remain attached to the 
parent cyst by a pedicle, but the internal ones may become free-swimming 
in the vesicular fluid. 

ANIMALS AFFECTED.— In this country this cyst 1s very prevalent. 
Especially have I found it so in Lincolnshire rabbits. It occurs chiefly 
in rabbits, although the hare and squirrel also rarely harbour the para- 
site. Records of it from the horse and goat appear to be doubtful. 
The usual seat is in the intermuscular and subcutaneous tissue of the 
back, loins, and hind-limbs, but it may occur in other parts of the 
body. 

Meat Inspectrion.—Affected rabbits are usually termed “ bladdery,” 
and their presence is indicated by large ege-like subcutaneous elevations. 
Rabbit-catchers usually puncture the cyst when basketing their produce. 
In inspecting the animals the hand should be carefully drawn from head 
to tail when the animal has been paunched. In this way, unpunctured 
cysts will be felt as fluctuating elevations, and drained ones will be 
evidenced by a balsas due to muscular atrophy. Superticially 
placed “ punctured cysts ” can only be detected by skinning. 

PROPHYLAXIS.—This will, where it is attempted, follow on exactly 
the same lines as laid down for the gid parasite, save that attention will 
be directed against the bladdery rabbit, the dog infected with 7. serialis, 
and any wild carnivora that may possibly harbour the adult worm. 


PARASITES AND PARASITIC DISEASES 1493 


(C) Echinococcosis. 


1. Due to Echinococcus polymorphus.—The most common cestode cyst 
found in the domesticated animals is undoubtedly E. polymorphus Dies- 
ing. It is often spoken of as E. veterinorum Rud. The parasite itself 
varies greatly in size and structure. Usually it is surrounded by a 
strong fibrous capsule derived from the organ upon which it is parasitic 
(pseudo -cyst). Underneath this is the outer wall of the hydatid 
(ecto - cyst), which is lined by a germinal layer (endo - cyst). 
This usually gives rise to a number of proligerous vesicles or broad 
capsules, and each of these contains a number of tapeworm heads. 
This arrangement is one of the simplest met with, but there are many 
others. In some cases the primary cyst is sterile, and although increasing 
greatly in size, does not give rise to any other structures. In addition 
to the broad capsules, some primary cysts give rise to complete daughter 
cysts, from which may arise granddaughter cysts. These developments 
may, in the case of daughter or granddaughter cysts, take place exogen- 
ously or endogenously. The secondary cysts are usually developed from 
small areas of germinal membrane in the substance of the outer covering 
of the cyst. The vesicular liquid is usually sterile, and contains, amongst 
other bodies, salt and a toxalbumin. The normal evolution may be 
regarded as following one or other of the above possible methods, but it 
has been shown by Dévé that it is possible for a scolex or head to give 
rise directly to an echinococcus if the cyst wall becomes ruptured. Thus 
the cycle may be completed in the intermediate host, and without the 
usual intervention of the adult tapeworm. The size of the various cysts 
ranges from a marble up to that of a child’s head. They are often as 
large as a goose’s egg. Reviewing the above facts, it will be seen that 
a single ovum may ultimately give rise to several thousands of potential 
tapeworm heads. 

ANIMALS AFFECTED.—There are, indeed, few species of animals that 
are altogether free from infection by this cyst. The ox, sheep, pig, 
horse, and goat often harbour it. More rarely it is seen in the dog, cat, 
and even domesticated birds. In some countries man is very often 
infested. Many wild mammals, especially ruminants, have from time to: 
time been shown to be invaded. In its distribution it is very wide, 
being seen practically in all countries. Broadly speaking, there are few 
tissues that escape infection. In most animals the liver is the usual 
seat. In the ox infested organs weighing over 150 pounds have been 
recorded, and even 1 hundredweight in the case of the pig. The horse 
most often shows hepatic lesions. The next organ to become invaded is 


1494 SYSTEM OF VETERINARY MEDICINE 


the lung, and it is commonly affected in the ox, sheep, pig, and horse. 
Hydatid disease of the heart is most frequently met with in the ox. It 
is, however, not common in this situation. Occasionally it has been 
found in the bones of cattle and horses. Several cases are on record 
from the brain, muscles, spleen, kidney, lymphatic glands, uterus, and — 
even udder. In the latter organ the appearance has closely resembled 
tuberculosis (Jackson Young). 

Metuop oF Inrection.—The ingested egg of Tenia echinococcus Von 
Sieb. follows the same course as has been mentioned for the eggs of 
other tapeworms. Having gained the portal vein, many embryos will be 
arrested in the liver. Should they escape the capillaries there, they will 
be carried through the heart to the lungs, where arrestation is likely 
again to take place. Passing from here into the general circulation, 
almost any organ is likely to become invaded. It is not known for 
certain how long an echinococcus may live, but in visible situations they 
have been known to persist for over thirty years. Often, however, long 
before this they die, and undergo changes. Their fluid and capsules 
become thicker, and finally calcification sets in. | 

Symproms.—With a parasite varying so extensively in its size and 
position, it is only natural that the symptoms presented should be 
obscure. As a matter of practice, in the clinical examination of organs 
such as the liver and lungs, the presence of an echinococcus may be 
suggested by percussion, palpation, or auscultation. In some cases 
rectal examination may lead to diagnosis. Although slight derange- 
ments resulting from loss of tissue of certain organs may be occasionally 
noticed, it is wonderful to what extent an animal may be found to be 
affected on post-mortem examination without having lost much flesh or 
shown any important symptoms when alive. Rupture of the cyst wall 
which allows the escape of fluid into the pleural and peritoneal cavities 
is regarded by some authorities to be the cause of certain rashes in 
man. 

Diaenosis.—Although not made of general use, it has been shown 
that the serum of affected animals contains specific antibodies, which can 
_be demonstrated by the complement fixation test. Precipitins are also 
present, and a marked reaction can usually be obtained. These must be 
regarded as valuable means in diagnosis. 

Meat Inspection.—It is customary only to condemn affected organs. 
Little else is really necessary, the adult worm not being found in man. 

TREATMENT.—There is no satisfactory treatment. In some cases 
surgical removal may be possible. | 

PropHyLactic Mrasures.—The extent to which hydatid disease is 


PARASITES AND PARASITIC DISEASES 1495 


found in England suggests that the adult tenia—viz., T. echinococcus— 
must be more prevalent than records show. As a matter of fact, 
notices of the finding the worm in the alimentary canal of the dog here 
are very rare indeed. The dog, dingo, jackal, wolf, and cat are known 
to be harbourers of the adult worm. All condemned hydatid-containing 
viscera should therefore be kept from these animals, and knackeries 
forbidden to allow stray animals access to their premises. In countries 
where dogs are numerous, such as Iceland, India, and Australia, the 
disease is extremely common in cattle, and even man. 

2. Due to Echinococcus alveolaris.— Echinococcus cysts of this 
type are rare in the domesticated animals. They are large, and made 
up of a great number of cysts of small size. When cut into, the 
surface presents a honeycomb appearance. The tapeworm resulting 
from these cysts closely resembles T. echinococcus, differing from it only 
in the size and number of its hooks and structures of the uterus. Its 
egos, however, always give rise to alveolar echinococci. The adult worm 
is regarded by Posselt to be a variety of the above species—viz., 7’. echino- 


coccus var. alveolaris. 
BIBLIOGRAPHY. 


Braun: Animal Parasites of Man. (L. W.Sambon.) London, 1906. 

CosBpBoLD: Parasites: A Treatise of the Entozoa of Man and Animals. London, 
1879. 

Divi: De l’Echinococcese. Paris. 1901. 

Dévé: Echinococcose Multiloculaire de Beeuf et Echinococcose Alveolaire Humaine, 
Comptes Rendus de la Société de Biologie, October, 1905. 

Hatu: The Gid Parasite and Allied Species of the Cestode Genus Multiceps. 
Bulletin 125, Bureau of Animal] Industry, United States Department of Agri- 
culture, 1910. 

Hau: Methods for the Eradication of Gid. Circular 165, Bureau of Animal 
Industry, United States Department of Agriculture, 1901. 

Martin: Echinococcosis in the Domesticated Animals. Journal of Comparative 
Pathology and Therapeutics, vol. xx., 1907. 

Neveu-LemarreE: Parasitologie des Animaux Domestiques. Paris, 1913. 

OsteRTAG: Handbook of Meat Inspection. (E. V. Wilcox.) London, 1913. 

PuaB: Miinchener Tierarztliche Wochenschrift, February 15, 1910. 

RAILuET: Traité de Zoologie Médicale et Agricole. Paris, 1895. 

Ransom: Cysticercus Ovis the Cause of Tapeworm Cysts in Mutton, Journal oi 
Agricultural Research, Department of Agriculture, Washington, U.S.A., vol. i., 
1913, p..15. 

Weinsaee: Sero-Diagnostic de |’Echinococcose. Annales de |’Institut Pasteur. 
July, 1909. 

Youna: Veterinary Record, No. 1,276, December 12, 1912, p. 369. 


THE TAPEWORMS. 


These parasites are so called on account of their resemblance to a 
piece of tape. They belong to the class Cestoda of the subkingdom 
Platyhelminthes (flat-worms). Their further classification has not yet 


1496 SYSTEM OF VETERINARY MEDICINE 


been definitely accepted. They vary considerably in size and length. 
The whole worm (strobile) is furnished anteriorly with a head or scolex, 
and this is followed by a number of segments, each of which must be 
regarded as a complete individual. The colour is usually some shade of 
white. The head is modified to fasten the parasite to the wall of the 
organ wherein it is found. For this purpose it is usually provided with 
four suckers, and in some cases groove-like suckers, known as “‘ bothria.” 
Hooks or hooklets are also present in some species, which are then said to 
be armed. Most of the tapeworms found in herbivora are unarmed. The 
size, shape, number, and disposition of the hooks are important features 
in classification. They are usually centrally placed, and may be on the 
circumference of a contractile organ—the rostellum. Immediately 
behind the head is the neck. It is made up of young segments. In 
some cases the head is large, and well marked off from the neck, but in 
others a small head may surmount a broad neck. The number of seg- 
ments varies from four in T'enia echinococcus to great numbers in many 
of the longer species. The segments near the neck are usually oblong 
across the length of the strobile, those near the middle square, whilst the 
posterior ones are oblong from before to behind. In some cases the 
antero-posterior aspect of the segment is like the edge of leaf, the greatest 
measurement of the segment then being across the worm. The anterior 
border of a segment is usually narrower than the posterior, and thus 
easily joins the segment in front of it. 

Bundles of muscle fibres are present in each segment. The terminal 
segments are shed at intervals either singly or in small groups, and they 
may often be seen moving upon voided excreta. There is a nervous 
system running from the head through all the segments. Hach segment 
contains both male and female generative organs. The male organs 
usually appear first in segments some distance from the neck. These 
organs consist of a number of testes, which are united by vessels leading 
to the vas deferens, seminal vesicle, and penis, and open at the genital 
pore, which is either placed centrally or on the lateral border of the seg- 
ments. The female organs open in the same place. They usually con- 
sist of vagina, uterus, oviduct, ovaries, vitelline glands, and their ducts. 
Some segments possess a genital pore on each lateral border, in other 
cases the single pore opens on alternative segments. After fertilization, 
the terminal segments undergo changes due to the uterus and its contents 
occupying practically the whole space. Such segments, when about to 
be shed, are sometimes called “‘ mature” or “ripe.” Great numbers of 
egos are usually produced. 


Lire-History.—Copulation takes place in a number of ways. It 1s 


PARASITES AND PARASITIC DISEASES 1497 


possible in the same segment, same strobile, or between different worms. 
After fertilisation, the egg acquires two enveloping layers and six hook- 
lets, and so becomes an oncosphere. Although not strictly correct, this 
structure is often termed the “eggs.” Leaving the segment after this 
has been shed and disintegrated, they become free in the faeces or upon 
the soil, and so gain in multitudinous ways the mouths of man and 
animals. Having reached the stomach, the embryos become free, and 
pass to their various predilection seats in a manner already described 
under the section upon Bladder Worms (p. 1483). The resulting cystic 
stage varies in structure according to the species. When the great 
number of eggs that a segment may contain, the great number of seg- 
ments comprised in each worm, and the life of the worm are taken into 
consideration, it will be seen that the chances of maintaining the numbers 
of such parasites is quite in accordance with the difficulties that an egg 
has to contend with in reaching a suitable host. 

InguRnious Errects.—All the domesticated animals (with the excep- 
tion of the pig) and birds are lable to tapeworm attacks. The damage 
produced by them varies from slight inconvenience in the case of dogs 
slightly affected up to extensive losses in badly infested lambs. In the 
horse and ox these worms do not usually give rise to serious losses. 
Young cats may occasionally suffer death from tenia infection. The 
presence of tapeworms, however, sometimes leads to serious consequences, 
such as penetration of the bowel wall, and even impaction. The impor- 
‘tance of tapeworms in animals is also due to the fact that the eggs given 
off from some of them give rise to cysts which are fatal to man, and 
injurious or even fatal to the other domesticated animals. 

Propuyiactic Mrasurges.—A great number of tapeworms still re- 
quire to have their life-histories discovered, Especially is this so amongst 
those infesting the horse, ox, and sheep. With these animals, stringent 
isolation and destruction of feeces would therefore be required in any 
campaign against the worms. In some of the other animals, however, 
the administration of a reliable teeniafuge to the final host and prevent- 
ing its contact with the bearer of the cyst will suffice to eradicate the 
parasite. These two points must always be aimed at. The actual 
measures will vary according to the habits of the intermediate host. It 
has been shown that flies may act as transporters of tenia eggs, and this 
fact must not be lost sight of. 

GENERA CONSIDERED.—In the widest sense the tapeworms (Cestoda) 
are divided into several groups. The Bothriocephaloidea contains the 
family Dibothriocephalide, and the Cyclophyllidea includes the family 
Teeniide. The former family contains genus Dibothriocephalus, and the 


1498 SYSTEM OF VETERINARY MEDICINE 


latter all the important parasitic cestodes of the domesticated animals— 
viz., Tenia, Moniezia, Stilesia, Thysanosoma, Anoplocephala, Dipylidium 
and Mesocestoides. 


1. Tapeworms of the Horse. 


The horse harbours three tapeworms, all belonging to the same genus. 
They usually appear to give rise to no important symptoms, although 
unthriftiness and anemia, and more rarely outbreaks where death has 
occurred, have been noticed. Rupture of the intestinal wall has in a 
few cases, however, been associated with their presence. The life- 
history of each is unknown. 

Anaplocephala perfoliata (Goeze) is from 20 to 70 millimetres long, — 
and from 4 to 10 millimetres broad. The head, which is large and un- 
armed, possesses four suckers, and is set upon a broad neck, and from it 
project backwards four cephalic lobes. The segments are piled upon one 
another, like leaves of a closed book, and are thus very short in an antero- 
posterior direction. In outline the shorter specimens resemble the fluke, 
whilst longer forms are about the same breadth all the way down. This 
worm is usually found in the cecum, and sometimes in the colon. In 
this country it is most commonly met with in pit ponies. Cobbold and 
Lloyd noted its presence in Welsh mountain ponies. 

Anoplocephala mamillana (Mehlis).—This species 1s about 6 to 30 milh- 
metres long, and up to 5 millimetres broad. The small head has the 
suckers laterally placed, and they open by longitudinal slits. It is occa- 
sionally met with in this country, and inhabits the lower reaches of the 
small intestine. 

Anoplocephala plicata (Zeder)—This worm is from 10 to 80 milli- | 
metres long, and 5 to 20 millimetres broad. The head is large, bemg 
from 4 to 6 millimetres wide, with well-marked suckers. The strobile 
gradually increases in breadth towards its middle third, and then tapers 
again, resembling a cigar. This feature and the absence of cephalic 
lobes distinguish it from A. perfoliata. It is a rare worm, but is usually 
found in the small intestine. Several varieties of both A. perfolsata and 
A. plicata have been described from time to time. 

TREATMENT.—The rarity of these parasites has given little oppor- 
tunity for observation upon the value of the various anthelmintics. 
Amongst those most usually prescribed, however, are a dose of aloes, 
followed daily by powders containing 2 drachms of antimony potassium | 
tartrate, or a dose of oil of turpentine in linseed oil. 


PARASITES AND PARASITIC DISEASES 1499 


2. Tapeworms of Ruminants. 


A great number of teenie belonging to several genera are known to 
infest the ox, sheep, and goat. So far as the ox is concerned, they are 
not thought to produce disease of any economic importance, although 
digestive disturbances, emaciation, and anzmia have been recorded. 
The goat does not occupy such an important place in British agriculture 
as the sheep. Most of the following remarks will therefore be directed 
towards that animal. All the genera possess neither rostellum nor hooks, 
and their life-histories are unknown. In Moniezia the uterus and genital 
pores are duplicated; in Thysanosoma the uterus is transverse and simple, 
and the genital pores are duplicated; whilst in Stilesia the uterus is trans- 
verse, the genital pores open on alternate segments, and the body is 
2 to 4 millimetres broad. Although their normal habitat is the small 
intestine, some species, such as Thysanosoma actinioides, gain access 
to the liver, and there cause important lesions. 


Parasite. Host. 
Moniezia expansa .. 25 i .. Ox, sheep, goat. 
$3 planissima se x .> Ox, sheep: 
3 denticulata oe - .. Ox, sheep. 
as alba Al eA a .. Ox, sheep. 
S trigonophora ba! ie J. Sheep: 
+ nudlicollis .. ay a 1. Sheep. 
4 benedent .. as . .. Ox, sheep. 
= neumanni .. oe - .. Sheep. 
sy vogtt ed HIG oe “aa Sheep: 
7 capre - > xe ie Oat, 
Stilesia globipunctata ie te .. Sheep. 
- centripunctata a a: .. (Sheep. 
Physanosoma ovilla (T. giardt) be .. Sheep. 
¥ actinioides .. oe .. sheep. 


The above table shows that the ox harbours five tapeworms, the 
sheep thirteen, and the goat two. By far the most important and com- 
mon worm in this country is M. expansa. It is this species that veterin- 
arians are called upon to treat in lambs. Many of the other species, 
however, are often to be found withit. 

Moniezia expansa (Rud.).—-This worm may attain a length of 4 metres. 
The head, which is small and round, is provided with four suckers with 
slit-like orifices. The neck is thread-like, but gradually flattens out. 
The segments are broader than they are long throughout the strobile, 
and the terminal ones reach to nearly 20 millimetres in breadth. 

Symptoms.—Lambs are most often attacked, and when only a few 
worms are present, there are few outward manifestations of their presence ; 
but when the bowels contain great numbers, serious losses are occasioned. 


1500 SYSTEM OF VETERINARY MEDICINE 


Such enzodétics have been recorded from various parts of England. In 
some cases the feeces dropped in market-pens or pastures are completely 
white with segments or disintegrated portions of the parasites and 
mucus. Winter lambs usually show signs of infection in late spring or 
early summer. The disease generally commences in an obscure manner. 
There is pallor of the skin and mucous membranes, the wool loses its 
natural feel, and the animals do not do well, in spite of their appetite, 
which remains good. Digestive disturbance in the form of loss of rumina- 
tion, tympanites, sometimes constipation occurs, and at others the passage 
of moist feeces containing the portions of the worms and mucus is seen. 
Later, emaciation becomes more marked, the animals show little tendency 
to move about, become affected with marked diarrhcea, and finally die 
with grave anemia. 

D1acnosis.—This rests upon a clinical picture similar to the above 
in a number of animals, together with the demonstration of the presence 
of the worm, either in the feces or in the small intestine of a killed or 
recently dead animal. 

InsuRious Errrects.—In animals which show symptoms, but recover, 
there is a marked “set-back” in flesh and fat. Affected animals are 
also more liable to other diseases, especially parasitic infections. Great 
losses, however, often occur through actual deaths. 

TREATMENT.—If this is carried out during the first stages of the 
disease, a great deal can often be achieved. The animals should be 
removed from infected pastures, and given a dose of castor oil (3il.-iv.). — 
After this has acted, powdered areca-nut in 31.-ii. doses according to the 
size of the animal in bran or pulped roots should be given. An olea- 
ginous purgative completes the course of treatment. Two doses of 
kamala (3i.) suspended in water at an interval of four hours are strongly 
recommended by Hartmann. Good results have been obtained with 
15 grains of naphthalin twice daily for a week, and followed by a dose of 
Glauber salts. 

Other agents used are picric acid and its sodium salt, extract of 
male shield fern, oil of turpentine, and tansy-root, the latter in 2 to 
3 drachm doses daily for a week in food, preceded and followed by a 
purgative. 

PropHyLaxis.—In the absence of any definite knowledge of the life- 
histories of these tapeworms, infected pastures should be pastured by 
animals not likely to be affected by these worms. The feces containing 
tenia segments must not be allowed to be scattered about. Resting, 
ploughing, and surtace dressing of tainted pastures with salt, lime, or 
iron sulphate also deserve consideration. Some practitioners claim to 


PARASITES AND PARASITIC DISEASES 1501 


have had great success in preventive measures by administering in the 
food of all the animals likely to become infected a powder containing 
various anthelmintics. They suggest that such a procedure renders the 
alimentary canal an unsuitable ground forthe worm’s development. 


3. Tapeworms of the Dog. 


The dog harbours a number of important tapeworms belonging to 
the genera Tena, Dipylidium, Dibothriocephalus, and Mesocestoides. 
Only the former two are, however, common. 

Dibothriocephalus latus (L.) may measure several metres long, but it 
is only common in districts where dogs have access to fish, some species 
of which harbour the cystic stage—a plerocercoid. It is usually a para- 
site of the human small bowel. Other species are D. cordatus (Leuck.) 
and D. fuscus (Krabb.). | 

Mesocestoides lineatus (Goeze) somewhat resembles Dipylidium cani- 
num, but it is unarmed, and the genital pore is mesially placed. It 
varies in length, reaching to 2 metres, but it is rare in this country. 

Excluding the above parasites and Tenia balaniceps Hall, T. brawn 
Setti, 7. brachysoma Setti, and T. krabbez Moniez, which was bred from 
Cysticercus tarandi of the reindeer, the following is a list of commoner 
canine tapeworms and their larval stages: 





Species. 


Cyst. 


Host. 





Tenia serrata .. 
>» marginata 
»» ovis 
3.  CNUTUS 
»  serialis .. 
»  echinococcus 








Cysticercus pisiformis 
; tenuicollis 
rh ovis 

Cenurus cerebralis 

a) serialis 


, | Echinococcus polymorphus 
Dipylidium caninum .. 


| 
} 


Cryptocystis trichodectis 





Rabbit 

Ox, sheep, and pig 
Sheep 

Sheep and ox 
Rabbit 

Most mammals 
Dog-louse and flea 





The normal habitat of these worms is the small bowel, but they are 


sometimes seen in the stomach. D. caninum is probably the commonest 
form met with, and next to it comes 7. serrata. With regard to the 
others, the findings of different observers do not agree. From a great 
number of post-mortem examinations in different parts cf England, I 
am led to believe that 7. sertalis runs the last-mentioned very close, and 
that T. marginata, T. cenurus, and T. echinococcus are rare. 
tainly occur. 


They cer- 
The latter worm is likely to be passed over on account 
of its size, and the larger forms are erroneously specified if the micro- 
scope is not used. A brief outline of the life-histories will be gathered 


1502 SYSTEM OF VETERINARY MEDICINE 


from the foregoing table and a reference to the section on Bladder Worms 
(p. 1483). . 

_ Tena serrata Goeze (TL. pistformis) is from 0°5 to 1 metre long. The 
head has a double row of hooklets, of which there are about forty. 
The large ones have a straight handle, and the small ones a bifid guard. 
The ripe segments have the posterior border broader than the anterior, 
giving rise to a somewhat serrated appearance. They are about 13 mill- 
metres long and 5 millimetres broad. The genital pore is usually on 
alternating segments, and prominent. The central trunk of the uterus 
gives rise to eight or ten lateral branches on each side. 

Tenia marginata Batsch (T. hydatigena).—This is the longest dog 
tapeworm, being from 1°5 to 2 metres in length. The head, which is about 
the same breadth as the neck, has a double row of hooklets, usually about 
forty in number. The handle of the large ones is wavy, and the guard of 
the small ones single. Mature segments are 15 millimetres long, and 5 to 
7 millimetres broad, with a slightly salient genital pore. The uterus 
has five to eight ramified lateral branches on each side of the central — 
trunk. 

Tena ovis (Cobbold) is from 45 to 100 centimetres in length. The 

head, which is a little wider than the neck, carries twenty-four to thirty- 
six hooks, arranged in a double crown, the large ones alternating with 
the small. The guard of the small hooks is enlarged, but not bifid. — 
Ripe segments measure 3 to 15 millimetres in length, and 4 to 6 milli- 
metres in breadth, and have a convex lateral border. The central uterine 
trunk has twenty to twenty-five lateral branches. This species has been 
bred from Cysticercus ovis by Ransom. It somewhat resembles the worm 
just described. 
Tenia cenurus Kuch. is usually about 50 centimetres long. The 
head, which is broader than the neck, has a double row of hooklets on 
the rostellum. There are about thirty in all. The handle of larger 
ones is about the same length as the blade; the guard of the small ones 
is entire, and the handle is curved in the reverse direction to the blade. 
The ripe segments are 10 millimetres long, and 3 millimetres broad. The 
median trunk of the uterus gives off eighteen to twenty-six slightly 
ramified branches on each side. This is the gid tapeworm. . 

Tenia serialis Baillet is from 50 to 60 centimetres long, and some- 
what resembles the former, save that most structures are slightly smaller, 
and the guard of the small hooklets is bifid. 

Tenia echinococcus Von Sieb.—This small tenia measures only about 
4 millimetres long. It is usually composed of three or four segments, 
the last of which contain eggs and constitutes most of the strobile.  — 


PARASITES AND PARASITIC DISEASES 1503 


Dipylidium caninum (L.) (Tenia cucumerina) varies from 10 to 40 
centimetres in leneth. The head is small, and has four rows of hooklets 
on its rostellum. The segments are roughly Ble a cucumber-seed in 
shape, and have two genital pores. 

Recent research has in some cases modified the above nomenclature. 
As an example, it may be mentioned that Hall has shown that 7. cenurus 
and T. serialis should be known as Multiceps multiceps (Leske) and 
M. serialis (Gervais) respectively. 

Symproms.—The presence of a few worms may give rise to no un- 
toward symptoms, save the appearance of their segments on the feces 
of the host. This is the most important symptom when other disturb- 
ances are shown. The history of the dog, or, where possible, an examina- 
tion of the voided segments, is of great value. Thus, if 7. cenurus or 
T. serialis are present, the animal is likely to harbour a great number 
of worms from the ingestion of a many-headed ccenurus. With 7. ser- 
rata there are likely to be a few tenia present from the eating of a group 
of small cysticerci from the rabbit, and 7. marginata may be present in 
twos or threes. For similar reasons 7’, echinococcus 1s always, when 
present, in great numbers. There are usually signs of intestinal catarrh. 
The appetite is variable, and there may be emaciation with general 
unthriftiness, listlessness, restlessness, and irritability. There may be 
itching of the anal region. The discovery of portions of the parasite or 
its eggs is nearly always possible. Affected animals often rub their noses 
against the ground. 

Masses of tapeworms in the stomach often give rise to repeated 
vomitions, which may be followed by death. Other accidents, such as 
penetration of the bowel wall, give rise to symptoms of peritoneal pain. 
T. echinococcus causes a severe enteritis, the pain of which has been said 
to produce symptoms resembling rabies. 

TREATMENT.—It is always most satisfactory to prepare the patient 
before giving a teenifuge. For a day or so previous to the administra- 
tion only a little milk is offered, and a purgative given in the form of 
calomel or a little magnesium sulphate. On the following morning 
freshly powdered areca-nut (gr. x. to Ix.), combined with extract of male 
shield fern (Mx.-xv.) should be given in a little fresh butter. Exercise 
in a loose box is allowed, but no food. In a few hours a further purga- 
tive, such as a dose of castor oil, should be given. This course of treat- 
ment is to be repeated in a couple of days, and the animal watched by 
its owner for the appearance of fresh segments derived from heads which 
may have remained attached to the mucous membrane of the bowel. 
The disadvantage of areca-nut is its tendency to cause vomition, but 


1504 SYSTEM OF VETERINARY MEDICINE 


there are several proprietary preparations of it made up in liquid or 
capsule form in order to overcome this difficulty. As showing the efficacy 
of Tenaline, one of these preparations, T. D. Young records the case of 
an Irish terrier which had mi. of it per pound body-weight, after the use 
of a purgative and a fluid diet, and which passed after twenty minutes 
enough tapeworms to fill a pudding-bowl. On careful examination, 
eighty-one Tenia serrata were counted. 

Other useful drugs are pelletierine tannate (gr. v.-xv.), kumala (gr. xv.- 
xxx.), and brayerin (gr. xv.-l.). 

PRopHYyLAxis.—This has for the most part been indicated under 
a previous section. In the case of Dipylidium caninum, however, atten- 
tion will have to be paid to the host’s skin, because its cyst (Crytocystis 
trichodectes) is found in the dog-louse (T'richodectes latus) and dog-flea 
(Ctenocephalus canis). 


4. Tapeworms of the Cat. 


The cat is invaded by a number of tenis, which are also found in the 
dog—viz., Dipylidium caninum, Tania echinococcus, Mesocestoides linea- 
tus, and Dibothriocephalus latus. In addition, it may harbour Tenia cras- 
sicolis Rud. This worm is usually from 20 to 60 centimetres long. 
The head has a double row of hooklets, the number of which varies 
greatly between thirty and fifty. The suckers are prominent, the neck 
is broad, the last few terminal segments are very long when compared 
with those in front of them. They are 8 to 10 millimetres long, and 
6 millimetres broad. The cystic stage (Cysticercus fasciolaris) is found 
in the liver of rats and mice. 

Symproms.—The presence of a few D. caninum does not usually give 
rise to any definite symptoms, but 7’. crassicollis may, and often does, 
cause death. In an outbreak several young animals went dull, sleepy, 
and refused all food; later they became completely ignorant of what was 
going on close to them, and died with marked diarrhcea. Post-mortem 
examination revealed in each case numbers of these tapeworms in the 
stomach and small bowel. Both structures were greatly inflamed. Older 
animals are not usually so severely affected, and they escaped in this 
outbreak, although some were shown to harbour the worm. 

TREATMENT.—This should be on similar lines to that of the dog, due 
consideration being given to the doses employed. ) 


PARASITES AND PARASITIC DISEASES 1505 


5. Tapeworms of the Rabbit. 


During the investigation of teeniasis of sheep or lambs it often happens 
that the wild rabbits of their pastures are also extensively affected with 
tapeworms. None of them, however, belong to the same genera as those 


of the sheep. 
BIBLIOGRAPHY. 


CoBBOLD: Parasites: A Treatise on the Entozoa of Man and Animals. London, 
1879. 

Hau: The Gid Parasite and Allied Species of the Cestode Genus Multiceps. 
United States Department of Agriculture, Bureau of Animal Industry, 
Bulletin 125. 

Haut: Methods for the Eradication of Gid. United States Department of Agri- 
culture, Bureau of Anima] Industry, Circular 165. 

PiInLeRS: Some Common Forms of the Equine Perfoliate Tapeworm (Anoplo- 
cephala perfoliata Goeze). Veterinary Journal, vol. xviii., 1911, p. 521. 

RAILLET: Traité de Zoologie Médicale et Agricole. Paris, 1895. 

Ransom: Cysticercus ovis the Cause of Tapeworm Cysts in Mutton. Journal of 
Agricultural Research, Department of Agriculture. vol. i., p.15, Washington, 
U.S.A., 1913. 

STILES AND HASSALL: Revision of the Adult Cestodes of Cattle, Sheep, and Allied 

' Animals. Bureau of Animal Industry, United States Department of Agriculture. 
Washington, 1893. 
Youne: Tenia serrata. Veterinary Record, vol. xxv., p. 575. 


THE FLUKE, OR SUCKER WORMS. 


These worms constitute the second division of the Platyhelminthes— 
viz., the Trematoda. They vary in size, and are usually leaf-like, although 
some are barrel-shaped and others conical. They derive their first 
common name from their shape, and the second from the suckers which 
they possess. They are not segmented, and the alimentary canal has no 
anus. In broad terms, their structure resembles the tapeworm segment. 
Most of the species are hermaphroditic, but in some—a rare feature—the 
sexes are separate: As parasites of the domesticated animals, they are 
not nearly so numerous as the round or tape worms, but more so than the 
hooked worms. Unlike the teenie, they have a varied habitat, being 
found in the liver, pancreas, lungs, bloodvessels, stomach, and bowels of 
various mammals. 

InsuRious Errects.—Although not so numerous in parasitic species 
as other groups, they are, nevertheless, very important. In England 
alone the liver fluke (Fasciola hepatica) has, at different periods, been 
responsible for enormous losses amongst sheep. In some cases, forms 
pathogenic to man are also found in the domesticated animals. This is 


so with Schistosomum japonicum. The liver fluke takes up blood from 
VOL. II. 95 


1506 SYSTEM OF VETERINARY MEDICINE 


the wall of the biliary canals, and schistosome eggs set up cystitis and 
enteritis. 

Lire-History.—This is very complex in the parasitic forms, and 
requires an intermediate host, which is often an invertebrate. In a great 


number of cases the complete evolution has yet to be worked out. The 


life-cycle of Fasciola hepatica given on p. 1509 may be taken as an example 
of the life-history of the group. 

Parasitic Famities.—The most important genera are contained in 
the Fasciolide, Schistosomide, Paramphistomide, and Holostomide. 
The former contains several genera, of which Fasciola, Fasciolopsts, 
Dicrocelium, Clonorchis, Metorchis, Opisthorchis, Paragonimus, Echinos- 
tomum, and Heterophyes, are important. The Schistosomide and Holos- 
tomide contain the genera Schistosomum and Holostomum respectively. 
The Paramphistomide includes Paramphistomum, Gastrodiscus, Pseudo- 
discus, Gastrothylax, and Homalogaster. 


1. Trematodes of the Horse. 


These number seven—viz., Fasciola hepatica, F. magna, Gastrodiscus 
agyptiacus, G. secundus, Pseudodiscus collinsi, P. stanleyi, and Schisto- 
somum indicum. 

Fasciola hepatica L.— The liver fluke is flat and leaf-like. The 
outline is oval, broad in front, but narrowing towards the posterior 
extremity, which is blunt. The head, which projects from the anterior 
extremity, is conical, and carries at its tip the small and rounded anterior 
or oral sucker. The posterior sucker is situated on the ventral surface 
some distance from the head. It is large and triangular in shape, and 
in front of it is the genital pore. The body is covered with small spines. 
The colour varies considerably from a pale slate to light brown shade; 
often the outer portions of the body are darker than the area they sur- 
round. The length varies from 18 to 30 millimetres, and the breadth 
from 10 to 13 millimetres at its widest part. It is a rare parasite of the 
biliary canals of the horse in this country, but is seen more often in the 
ass. In the great epizodtics of distomiasis which have often been ex- 
perienced in this country equines have not been appreciably infected. 

Fasciola magna, described on p. 1507, is recorded as having occurred 
in the horse. | | 

Gastrodiscus cegyptiacus (Cobbold) has its body disc-shaped, the ventral 
surface being concave and studded with a great number of closely packed 
papille. The dorsal surface is convex and plain. From it projects the 
head, and this is terminated by a small sucker. The colour is usually 





PARASITES AND PARASITIC DISEASES 1507 


light red. The entire length is about 16 millimetres, and the breadth 
10 millimetres. This species inhabits the large bowel of the horse in 
India and Egypt. Itis usually fastened to the mucous membrane by the 
caudal sucker. 

Gastrodiscus secundus Looss closely resembles the foregoing species, 
but it is much smaller. Specimens have been recorded from India. 
It inhabits the large bowel. 

Pseudodiscus collinst (Cobbold) and P. stanleyz (Cobbold) are two rose- 
red amphistome-like trematodes found attached to the mucous membrane 
of the large bowel of the horse in tropical countries. They may be 
present in great numbers, and are often associated with nematode 
parasites. The former worm is about 5 millimetres long and 2°5 milli- 
metres broad, and the latter 8 millimetres long and 6 millimetres broad. 

With the exception of the fluke, we know little of the life-histories of 
the above species, and, apart from their association with the term 
““masuri,” we are not well informed as to the symptoms they provoke 
or the treatment necessary to expel them, although their presence is 
often serious. 

_ Schistosomum indicum Montg. is a rare Asiatic equine parasite. 


2. Trematodes of the Ox. 


In addition to Fasciola hepatica, which is a common liver parasite in 
this country, the ox harbours a number of important flukes. 

Fasciola magna (Bassi) is somewhat similar to the liver fluke, but is 
longer and much broader. The length varies from 30 to 35 millimetres, 
and the breadth from 20 to 30 millimetres. It is most prevalent in 
America, where it is usually found encysted in the lungs, and less often 
in the liver and small bowel. 

Fasciola gigantea (Cobbold) has a well-developed head, and is very 
long and narrow. It attains even 70 millimetres in length, and only 
3 to 5 millimetres in breadth. Like the other members of this genus, it 
is found in the liver, and is an exotic form. Other species are F. angusta 
(Raillet) and F. egyptiaca Looss. 

The effects of these parasites will be fully considered under the next 
section. Generally speaking, however, very little derangement in health 
is seen in the ox, save in extensive infections of young animals. On post- 
mortem examination, the liver is found to be enlarged and fibrous, and 
the distended bile-ducts are made very apparent by their yellowish-white 
colour and increased size. They are spoken of as “pipy livers” by 
butchers, and affected organs are condemned in meat inspection. 


1508 SYSTEM OF VETERINARY MEDICINE 


Dicrocelium lanceatum (Stiles and Hassall)—The lancet fluke is 
flattened and transparent, thus allowing the dark-coloured internal organs 
to be seen. It varies from 8 to 10 millimetres in length, and from 1°5 to 
2°5 millimetres broad. The life-history is similar to that of the liver 
fluke, the intermediary mollusc being a species of Planorbis—viz., P. mar- — 
ginatus. Although common in Europe and many other countries, this 
fluke does not appear to have been found in England. Its normal habitat 
is the liver. 

Eurytrema pancreaticum (Raillet). — This species measures from 
8 to 10 millimetres long and 5 millimetres broad. The posterior extremity 
carries a slight prolongation or tail. It has been found in the pancreas 
of cattle from Cochin China and Japan. 

Paramphistomum cervt (Zeder)—This amphistome is somewhat 
conical in shape, with a ventral curvature. It is red in colour. The 
length is 10 to 13 millimetres, and the breadth at the posterior extremity 
about 3 millimetres. It appears to be common in a number of hot 
countries, and is found attached to the mucous membrane of the rumen. 
This worm is apparently of slight economic importance, although some 
writers have credited it with causing many deaths. Looss has shown 
that this species passes through a complicated life cycle with stages 
similar to those in the evolution of the liver fluke. Another species, 
P. explanatum Creplin, occurs in the liver and gall-bladder. 

Schistosomum bovis (Sonsino).—Unlike most trematodes, this genus 
has the sexes separate. The male is white, and has the oral and ventral 
suckers close together. The sides of the body are reflected inwards, so 
as to form a groove in which the smaller female is carried. 

The female is much narrower than the male, and as it is also longer 
(14 to 20 millimetres), the anteridr and posterior extremities remain un- 
clasped by the male, which measures about 11 to 14 millimetres in length 
and 1 millimetre broad. The adult parasite is found in the portal and 
other internal veins of the ox in Egypt. The eggs, laid in the blood, 
pass to certain capillaries, such as those of the bladder and rectum, and, 
passing through the wall of the viscus, give rise to symptoms. The egg 
has a swollen central portion, with pointed poles. After gaining the 
exterior, a ciliated embryo is liberated. Although the rest of the life- 
history is unknown, it appears that infection takes place by ingestion. 

Schistosomum bomfordi Montg., an allied species, has been found in 
the ox in France. | 

Schistosomiasis or bilharziosis is manifested chiefly by symptoms 
appertaining to the bladder. These are due to the eggs, and not the 
adult parasite. Hematuria is usually the first alteration in health; then 


PARASITES AND PARASITIC DISEASES 1509 


there is pain in the loins and urino-genital tract. The urine is at first 
markedly blood-stained, but later becomes clearer, and often products 
from the inflamed bladder, such as pus containing eggs, are passed at 
the termination of urination. In man, the ova often form a nucleus for 
vesical calculi. When the terminal rectal vessels are attacked, there is 
diarrhoea with dysentery. ’ 

Homalogaster philippinensis Stiles and Gold.—All members of genus 
Homalogaster have a flattened body and a large terminal posterior sucker. 
The ventral surface of the body is covered with numerous papille. The 
above species is about 8 millimetres long and 5 millimetres broad, and 
was found attached to the mucous membrane of the large bowel of the 
ox in Manilla. 

H. periert is also found in the ox. In countries where the ox is 
replaced by some of its close relatives, such as the gour, gayal, banting, 
zebu, yak, and bufialo, these may harbour many of the above species, 
different species of the same genera, or even species of genera not found 
in the ox. Among the latter may be mentioned the many species of 
Gastrothylax, conical-shaped trematodes, with a large posterior sucker at 
the base. 


3. Trematodes of the Sheep. 


The sheep harbours, under almost similar conditions to the ox, the 
following sucker worms: Fasciola hepatica, F. cegyptica, F. magna, 
F. gigantea, Dicrocelium lanceatum, Paramplistomum cervi, and Schisto- 
somum bovis. 

By far the most important of these are F. hepatica and D. lanceatum. 
Abroad, they are often associated in the production of fluke disease, but 
here the former parasite is responsible for the lesions. 

Lire-History oF THE Liver FLuxre.—A great number of eggs (30,000 
to 40,000) are laid by a single fluke. These are deposited in the bile- 
ducts, and, passing into the intestines, reach the exterior with the faeces. 
In from three to six weeks a ciliated embryo hatches out, and if this comes 
into contact with a small species of fresh-water snail (Lomnea trunca- 
jula), it bores to the pulmonary cavity. If the intermediate host is not 
soon found, the ciliated embryo dies. Many perforate more solid struc- 
tures in the snail, but they usually do not develop further. A further 
change within the snail gives rise to a sporocyst. From this may 
originate other sporocysts, usually two. The sporocyst contains redi@ 
(six or eight). These, when ready, leave their parent structure by 
passing through its wall, which closes up, and other rediz are developed. 
The redia leaves the pulmonary cavity, and makes for the snail’s hepatic 


1510 SYSTEM OF VETERINARY MEDICINE 


organ, where it grows, and in summer gives rise to daughter rediew, but 
in winter to cercarie (fifteen to twenty). 

The daughter redi# may contain another generation of redice or cer- 
caries. It is stated that there may be four series of secondary redie. 
The cercaria, having escaped from its parent, bores through the snail and 
reaches the exterior. By means of its tail, it swims in stream-water or 
that upon the damp pasture, and finally becomes encysted on blades of 
vegetation. Having been eaten in this condition, it loses its covering 
and tail, and gains the duodenum and bile-duct, to become adult in the 
biliary canals in about six weeks. The life of the adult is thought to be 
about a year’s duration. 

In countries where LZ. truncatula is exotic, and the fluke abounds, 
other molluscs act as the intermediate bearer. Immense numbers of 
eggs never reach their final host, but the number of eggs produced and 
the consequent multiplication of each egg make the porsibilities, of at 
least a few becoming adult, very great. 

If all the eggs of a single fluke became adult, the result would be 
approximately 9,000,000 to 12,000,000 individuals. 

Synonyms.—The disease is known by a number of local names, such 
as “rot,” “ liver rot,” “‘ bain,” and “‘ fluke disease.”” The correct name 
is fascioliasis, but distomiasis and distomatosis are also used. In 
France, the terms fove douvé, douwvette, and bouteille, and in Germany 
Leberfaule and Leberegelseuche, are employed. 

PREVALENCE.—The disease is world-wide. In England, great numbers 
of sheep are annually affected. Widespread epizodtics are not so preva- 
lent as formerly, when every ten years or so saw periodic increases in the 
annual loss. Low-lying counties often experience severe outbreaks. 
During 1902 and 1904 a great many animals in the West of England 
were affected. Our sheep-producing Colonies have suffered extensively. 
Neumann states that in 1891 an Australian sheep-farmer lost 10,000 
sheep. Wet seasons, extensive flooding of pasture, marsh and undrained 
land, are all suitable for the completion of the life-cycle of the fluke, and 
are thus important factors in the spread of the disease. Young animals 
are usually most severely affected, together with animals reduced in 
condition from a variety of causes. The disease is usually most marked 
during the late autumn, winter, and spring; but climatic and atmospheric 
conditions may influence this. The method of prehension in the sheep 
renders it more liable to take in the encysted cercarie from the lower 
portions of blades of grass. Parrot-mouthed sheep, which cannot graze 
so closely, are said to often escape infection. 

Symproms.—In its early stages, the disease is most difficult to detect. 


PARASITES AND PARASITIC DISEASES 1511 


Experienced shepherds, however, can distinguish fluky sheep from 
sound ones by the feel across the loins. Instead of being hard and firm, — 
infected sheep feel as if the underlying tissue were cedematous. Not 
everyone, however, can rely upon this measure. In late autumn, when 
infection often takes place, sheep show few symptoms, on account of 
their then usually good condition. There is, however, douleur when the 
animals are handled. It is stated that the first effects of the fluke are 
to improve the general condition by their stimulating effect on the liver. 
In a couple of months there is variation in the appetite, increased thirst, 
loss of flesh, and a lessened degree of activity. The wool is drier, and 
leaves the skin easily. There is a variable temperature. The sclerotic 
portion of the eyeball appears bluish, and the conjunctiva cedematous 
and swollen; but a jaundiced condition of the membrane is rare. The 
eyelids may appear swollen. The abdomen and chest walls become 
cedematous, whilst anemia and weakness are now increasing. The loss 
of flesh gives the animal’s dorsal spines special prominence, and this is 
often called “razor-backed.” The submaxillary region may become 
_@dematous, giving a bottle-like appearance, and this disappears on 
exercise, or when the head is held up for some time. Diarrhoea becomes 
marked, the feeces contain eggs of the fluke. They are oval (0°13 by 0:08 
millimetre), with a flat lid, and are of a brownish colour. Dropsy ap- 
pears in the abdomen and chest, the former being manifested by a pen- 
dulous abdomen and a hollowing of the back, and the latter by laboured 
respirations. In-lamb ewes may abort, and in those which carry the 
lambs for the full term the foetal membranes and fluids are watery and 
contain bubbles. The duration and severity of the symptoms depend 
upon the condition of the sheep, the severity of infection, and pastural 
surroundings. Death generally takes place quietly and without con- 
vulsive movements. 

Lestons.—In the early stages of the disease the liver is enlarged and 
congested, the bile slightly reddened, and perihepatitis is seen. Later, this 
becomes more marked, and an appreciable amount of peritoneal fluid is 
present. The biliary canals are inflamed, enlarged, and contain a vary- 
ing number of parasites and their ova. Often they can be demonstrated 
in all portions of the liver or section. In advanced cases the red blood- 
cell count falls very considerably. The liver becomes firm and cirrhotic, 
with rounded edges. The gall-ducts stand out as dull white cords, and 
contain casts, flukes, and thick dark-coloured bile. There are present 
general signs of emaciation and cedema of the tissues. 

Dracnosis.—Although the symptoms shown are not actually diag- 
nostic, their association with a number of animals grazing on low-lying 


1512 SYSTEM OF VETERINARY MEDICINE 


pasture should be of great value. The microscopic examination of feces, 
after suspension and washing in normal saline and filtering, should reveal 
the characteristic ova. More often than not a recently dead animal is 
available for post-mortem examination. 

CURATIVE TREATMENT.—At present no preparation can be relied upon 
to kull the flukes in the liver. Even if this were possible, the lesions 
present when symptoms are shown appear to be of such a character as 
to have a permanent effect on the animal’s health. Raillet, Moussu, and 
Henry, after experiments on affected sheep, recommend the administra- 
tion of m Ixxxv. of ethereal extract of male shield fern on four occasions. 
The disadvantage of this drug is its tendency to produce tympany and 
anesthesia. 

Affected animals are to be well fed, and plenty of salt allowed. 

Many other drugs have been tried, amongst them are sulphate of iron 
and naphthalin. Emaciated and weakly sheep are usually killed off, 
and moderately affected animals moved from infected pastures and given 
a rich diet, with vegetable and mineral tonics: 

B  Sodii chlor. 


Pulvy. gentian. rad. 
Pulv. ferri sulph. 


aa 4 pounds. 
“e ee 1 pound. 
M. ft. pulv. 
This powder is mixed with about 40 pounds of finely crushed cake or 
meal (barley, wheat, oat, maize, etc.), and about 4 pint given to each 
sheep daily. 

PROPHYLAXIS.—In districts where liver rot is widespread, and low- 
lying pastures which are liable to become flooded, prevail, sheep-grazing 
is often a risky undertaking. The lack of reliable therapeutic measures 
renders prevention very important. Thorough drainage of the land is a 
first essential, and in conjunction with it the surface should be dressed 
with lime or salt, 400 pounds of each to the acre. The former has the 
disadvantage of becoming converted into an inactive carbonate. Raillet, 
Moussu, and Henry, recommend sulphate of iron (264 to 440 pounds per 
acre). In addition to its preventive effects, it has a manurial value. 

Where these measures cannot be carried out, horses can be turned 
on to infected land. Some of the small wild animals, such as hares and 
rabbits, sometimes become infected, and so disseminate the ova. The 
cultivation of the natural enemies of Limnea has been followed by a 
great reduction in fluke prevalence in countries where the disease is 
associated with overflowing rivers. 

If infection takes place from the drinking-water, the animals should 
be made to drink from one source, which should contain salt (vi. to the 
gallon). 


PARASITES AND PARASITIC DISEASES 1513 


In order that sheep may better resist invasion, salt blocks can be 
posted in the pastures, and a mixture somewhat similar to the one men- 
tioned under Treatment given periodically. Care must be used in the 
selection of store stock, in order to prevent infected sheep gaining access 
to non-infected pastures. In various parts of the German Empire pur- 
chased sheep are accompanied by a warranty covering from fourteen to 
forty-two days. 

In overstocked fields, the chances of infection are greater than in 
sparsely populated pastures, on account of the closeness to which the 
grass is eaten. 

All practicable means should be adopted to prevent the spread of 
ova on pastures. Dead animals should therefore be buried in lime, and 
dogs not allowed to eat any infected organs. 

Mzat Inspection.—Affected organs are condemned, and the condi- 
tion of the carcass is judged on general principles. 


4. Trematodes of the Pig.. 


Clinically speaking, the flukes of the pig are not important, and 
especially is this true with regard to England. In the East, however, it 
is known to harbour a number of species which may affect man. Fasciola 
hepatica and Dicrocelium lanceatum are occasionally met with in the 
liver.. Gastrodiscus homims Lew and McConn has been found in the 
intestines of Asiatic swine. 

Fasciolopsis buski (Lank).—A large fluke from the intestines of man, 
which measures 24 to 37 millimetres, and even more, in length, and 5 to 
12 millimetres in breadth, has also been found in the intestines of Asiatic 
pigs. 

Clonorchis sinensis (Cobb), also parasitic in the liver and gall-bladder 
of man, the cat, and dog, is said to occur in the pig. 

By far the most important porcine fluke is Paragonimus westermanna 
(Kerb), the lung fluke. It is oval in shape, and measures 8 to 10 milli- 
metres in length, and 4 to 6 millimetres in diameter. The oral sucker is 
just below the anterior extremity, and the posterior one is situated just 
within the anterior half of the length. There are minute spines on the 
cutis. The eggs are brownish-yellow in colour, and measure 80 to 100 u 
in length. It is a parasite of man in China, Japan, Formosa, and Corea, 
where it causes parasitic hemophysts. It has been found in the lungs of 
the tiger, cat, dog, and pig. In the latter animal it was recognised 
during meat inspection by Payne in America. The parasites are usually 
enclosed in cysts 12 to 36 millimetres in diameter on the surface of the 
lung, or sometimes situated more deeply. Usually two flukes occur in a 


1514 SYSTEM OF VETERINARY MEDICINE 


cyst, together with a chocolate-coloured fluid. In man, the disease com- 
mences with a cough. A reddish-coloured sputum is brought up, and 
this contains the eggs. The symptoms increase until the case somewhat 
resembles phthisis and its hemorrhages. 

Various observers have recorded the presence of small distomes 
(Agamodistomum suis) from the muscular tissues of the pig. They 
resemble trinchina spots, and are sometimes mistaken for sarcospores. 
Such parasites have been found most often in the diaphragm and 
laryngeal muscles, where they are placed between the fibres. On being 
warmed, movements may be shown. Stiles has connected some of 
these forms with the species just described. ) 


5. Trematodes of the Dog and Cat. 


There are a number of small flukes of the domesticated carnivora 
which are for the most part exotic, and of little clinical importance. 
The following table shows the most common of these parasites, together 
with their hosts and habitats. Quite a number of them will be seen to 
affect man. In this way they become extremely important, especially 
to tropical medical and veterinary officers. 














Parasite. Host. Habitat. 
Paragonimus westermanni .. a ay, Dog, cat, man Lungs 
Schistosomum japonicum .. ze; Be as of Prater Portal vein 
Metorchis truncatus .. Z ae ‘e So ees Liver 
M.albidus .. AA mh e. .. | Dog, cat oe 
Opisthorchis noverca +3 bi = ope BARE a) a 
O.felineus .. nes Bb " 7 Caceres - 
Clonorchis sinensis .. NG - Ne Dog, cat, man f 
Heterophyes heterophyes A Small intestine 


oe Tat 99 39 
Echinostomum perfoliatum .. be .. | Dog, cat bes sy 
H. trigonocephalum .. oy a ite >» > » 
Hemistomum alatum ee os 43 » 9 » 





Metorchis, Opisthorchis, and Clonorchis all possess the characters of 
their family, the Fasciolide, and have no cirrus pouch. In the former, 
the testes are rounded; in the second, lobulated; and in the last, ramified. 

Paragonimus westermanne has already been referred to in the last 
section. It occurs in Japan and America, and has been found under the 
parietal pleura. Schistosomum japonicum Katsur is differentiated from 
the bovine schistosome by its smaller size and rounded ova. It has been 
recorded from Singapore and Japan. 

Metorchis truncatus (Rud.) measures about 2 millimetres in length. 
The anterior extremity is attenuated, and the posterior truncated. There 


PARASITES AND PARASITIC DISEASES 1515 


are oral and ventral suckers, the latter being situated in about the middle 
of the body. The cuticle is covered with small spines. Although the 
life-history is unknown, animals appear to become infected from fish. 
M. albidus (Braun) is a somewhat larger and differently shaped 
species, which does not appear to have been recorded from man. It 
occurs in Central Europe. 

Opistorchis noverca Braun is from 9 to 12 millimetres long, and 2°5 
millimetres broad, lancet-shaped, and covered with spines. The oral 
sucker is terminal, the ventral one lies close to it, and is smaller than the 
former. This species occurs in several parts of India. Another species, 
O. felineus (Rivolta), which measures from 7 to 18° millimetres in 
length, occurs in Japan and most European countries, especially Prussia. 

Clonorchis sinensis (Cobb.) measures from 13 to 19 millimetres in 
length, and 3 to 4 millimetres broad. The flattened body has the anterior 
extremity attenuated and the posterior one rounded. There are no 
spines. It has been found chiefly in Japan, China, and India, and appears 
to be most common in the former country. 

Heterophyes heterophyes (Von Sieb.) is about 2 millimetres long and 
1 millimetre broad. It is roughly pear-shaped in outline, and the anterior 
portion is covered with small spines. The genital pore is likewise sur- 
rounded by spines. On account of its smallness, it often escapes detec- 
tion, but has been found in man, dogs, and cats in Egypt by Looss, and 
also in Japan and China. It is sometimes present in great numbers. 

Echinostomum perfolatum Ratz and FE. trigonocephalum Rud. are 
two small and rare intestinal trematodes, whose anterior suckers are 
furnished with or surrounded by bodies with spines. Hemistomum alatum 
(Goeze), another small intestinal fluke, 3 to 6 millimetres in length, 
although common in the fox and wolf, is unimportant in the dog. Gener- 
ally speaking, the trematodes, parasitic in the intestine of the dog and 
cat, give rise to little or no disturbance in health. Occasionally, how- 
ever, those found in the liver, especially if present in great numbers, 
produce lesions such as thickening and dilatation of the bile-ducts. 


BIBLIOGRAPHY. 


Braun: Animal Parasites of Man. London, 1906. 

Law: Veterinary Medicine, vol. v. Ithaca, 1909. 

NEUMANN: Parasites and Parasitic Diseases of the Domesticated Animals. London, 
1905. 

NeEvevu-LEMAIRE: Parasitologie Humaine. Paris, 1908. 

RAILLETT, Mousso, AND HENRy: (1) Essais sur la Prophylaxie de la Distomatose; 
(2) Essais de Traitement de la Distomatose; Comptes Rendus de la Société de 
Biologie. Séance 18 Mars, 1911. 

THomas: The Life-History of the Liver Fluke and the Prevention of Rot. 
Veterinarian, 1883. 


1516 SYSTEM OF VETERINARY MEDICINE 


THE HOOKED WORMS. 


These parasites are a division of the subkingdoms Nemathelminthes; 
they, however, have no alimentary canal, and the anterior extremity 
carries a protractile organ which is furnished with a number of hooklets; 
hence the name of the class into which they are placed—Acanthocephala, 
or hooked worms. In many other respects they more or less resemble 
the Nematoda. There are two families—viz., Gigantorhynchide and 
Kchinorhynchide, which contain parasites of the domesticated animals, 
and each has but one genus—Gigantorhynchus and Echinorhynchus. 

Gigantorhynchus hirudinaceus (Pallas).—The male is from 6 to 9 centi- 
metres in length, whilst the female is roughly three times these dimen- 
sions. The body, which is usually of a whitish-pink hue, is transversely 
striated. There is a short proboscis on the anterior extremity, furnished 
with five or six rows of small hooks. It is a common parasite of the pig 
and wild boar, and is found in the United States, France and other 
European countries. The normal habitat is the small intestine, and it 
seems to prefer the duodenum. Occasional records show that it may 
occur in man. It may be free in the lumen of the viscus, but is usually 
attached to the mucous membrane by its hooklets. It may penetrate 
this membrane and even reach the submucosa and inner muscular layer. 
The presence of the attached worm may be evident on the peritoneal 
surface of the bowel by small elevations. 

Lire-History.—The ova, which possess three envelopes, pass out 
with the feeces on to the ground, where they are taken in by the larva 
of a beetle—viz., the cockchafer (Melolontha vulgaris). This larva takes 
about three years to complete its life-history, a considerable period of 
which is occupied by an active larval stage. In the alimentary canal of the 
intermediate host the envelopes are lost, the embryos gain the abdominal 
walls of the beetle larva, and become encysted. In this state they may 
remain whilst the insect completes its life-cycle. If the larva, pupa, or 
adult is then ingested by the pig, the adult worm soon appears in its intes- 
tines. A number of other organisms have been shown to act as inter- 
mediate hosts for this worm. Among these may be mentioned Cetonra 
aurata—another beetle whose life-cycle occupies three years, and also 
the May bug (Lachnosterna arcuata). The last species occurs in America, 
where it takes the place of the cockchafer. 

Symproms.—The symptoms shown by affected animals differ little 
from those seen in other forms of intestinal helminthiasis in swine. 
Similar remarks apply to treatment. On account of the micro-organisms 
which gain access to the bowel wall at the points where the worm is 


PARASITES AND PARASITIC DISEASES 1517 


attached, a fatal enteritis may be set up. Records show that occasion- 
ally penetration of the bowel wall may take place, and thus give rise to 
peritonitis. Badly infested intestines are rendered useless for the manu- 
facture of sausage-skins. 

PREVENTIVE Measures have for their chief aim the housing of in- 
fected swine and reduction of the numbers of the intermediate hosts. 
The latter is difficult on account of the number of species concerned and 
their habits. 

Echinorhynchus.—The members of this genus are much smaller than 
the above-described species, and usually inhabit the intestine of ducks 
and allied birds. Species have, however, been described from the dog 
and rabbit. 


THE ROUND WORMS. 


With rare exceptions, members of the class Nematoda of the sub- 
kingdom Nemathelminthes are elongated, nonsegmented organisms, 
with a complete alimentary canal and separate sexes. They vary 
greatly in size, from several centimetres to microscopic dimensions. 
The alimentary canal usually consists of a mouth, cesophagus, intestine, 
and anus. The food taken differs in the various groups—sometimes it is 
ingesta, at others, cells from the mucous membranes of the bowel, and at 
others blood. The reproductive organs vary in the different groups, 
and, together with the mouth-parts, are extremely important in classi- 
fication. In the male the organs are usually single, consisting of a 
thread-like testicle, which gradually merges into vas deferens, seminal 
vesicle, and ejaculatory duct, by which it opens into the posterior por- 
tion of the gut at the anal orifice. The external genitalia usually con- 
sist of the spicules and the caudal bursa. In some groups the bursa 
is not present—non-bursata ; in others is is fully developed—bursata 
vera ; and, again, other species are included in the pseudo-bursata. The 
typical bursa has the following structure: If the male is placed on its 
ventral surface, the caudal pouch is seen to be made up of three lobes— 
two lateral and one dorsal. In outline they may resemble the inverted 
club of playing-cards. These lobes are supported by ribs or rays, of 
which, according to Looss’s terminology, there are five systems. Com- 
mencing at the lateral lobe, near its anterior border are two rays, which 
constitute the ventral system, the anterior one being the ventro-ventral, 
and the next the latero-ventral ray. Behind these is the lateral system, 
which is composed of three rays. These from before backwards are 
termed the externo-lateral, medio-lateral, and ‘postero-lateral. These rays 
are designated right or left, according to the lateral lobe to which they 


1518 SYSTEM OF VETERINARY MEDICINE 


belong. The dorsal lobe is supported by the dorsal system, which has a 
similar structure on each side of its middle line. An externo-dorsal ray 
usually enters the lateral lobe, and behind this is a termino-dorsal ray. 
The disposition and structure of these lobes and their rays are of great 
importance in assigning a species to its proper position. The dis- 
position and size of the spicules are likewise important factors in 
classification. 

In the female there are usually present paired reproductive organs. 
The thread-like ovaries gradually become oviducts and uteri, and these 
unite to form a single vagina which opens at various points in the body 
length by the vulva. The females are usually larger than the males. 

Lirs - History.—After copulation, eggs or embryos are brought 
forth (oviparous or ovoviviparous). From this point the life-cycle varies 
in the different genera. In the majority of cases no intermediate host 
appears to be necessary; the immature form gains the mouth of the host 
after a series of changes in the outer world, and the adult form appears 
in the alimentary canal. In some cases the immature forms enter the 
skin and ultimately reach the bowel. In other groups the interference 
of an insect is necessary, whilst in rarer instances the mammalian bearer 
becomes the intermediate host, and has to be itself ingested for the 
completion of the life-cycle. 

GENERAL RemarKs.—There are very few tissues of the body which 
at times may not be invaded by nematodes, so that it is almost impos- 
sible to generalise on symptomatology. In a number of cases, however, 
the presence of helminthes is suggested by a gradual loss of flesh, with 
corresponding unthriftiness, anemia, and weakness. In practice any 
such picture should cause an examination for them to be made. If the 
actual worm cannot be demonstrated, its ova can often be found in the 
patient’s faeces. When in the lungs and bronchi, there is pneumonia and 
bronchitis, whilst in the muscles pain may be shown; lameness is seen 
when the tendons are the seat of parasites, and large species in the blood 
become arrested in the heart. 

Similar remarks are applicable to remedial measures. In addition 
to the remote situation of some of the parasites, in many cases the damage 
produced by the time symptoms are shown is so great that recovery is 
often problematical, were all the worms at once killed. Even if recovery 
is brought about, young animals may have suffered such a set-back as to 
be greatly reduced in value or utility. Although a great number of 
drugs possessing anthelmintic properties are in use, only a few of them 
have a very decided action. In a number of cases all that can be 
done is to prevent further infection, and by a generous diet to im- 


PARASITES AND PARASITIC DISEASES 1519 


prove the patient’s general health until the infection shall have been 
thrown off. 

The prophylactic measures applicable to the various species and 
their hosts are best considered in dealing with the individual parasites. 

Parasitic GENERA.—The classification of the nematodes has not 
been definitely settled, and there is much confusion with regard to 
families, subfamilies, and genera. Of the latter there are approxi- 
mately between fifty and sixty represented in the list of parasites of the 
domesticated mammals. This number is constantly being increased as 
old genera are split up and new ones are discovered. Some of them are 
rich in species, and others contain a single form. In all, the actual species 
number some hundreds, and their great importance cannot be over- 
estimated. The following are some of the most important genera: 


Anchylostomum. Gsophagodontus. 
Arduenna. sophagostomum. 
Ascaris. Ollulanus. 
Belascaris. Oncocerca. 
Bunostomum. Ostertagia. 

*Capillaria. Oxyuris. 
Chabertia. Physocephalus. 
Cooperia. Probsmayria. 
Crassisoma. Pierocephalus. 
Cylicostomum. Rhabditis. 
Cylindropharynx. Setaria. 
Dermofilaria. Simondsia. 
Dictyocaulus. *Spiroptera. 
Dioctophyme. Stephanurus. 
Dracunculus. Strongyloides. 
Filaria. Strongylus. 
Gaigeria. Synthetocaulus. 
Globocephalus. Thelazia. 
Gnathostomum. Toxascaris. 
Gongylonema. Trichinella. 
Gyalocephalus. *Trichosomum. 

* Habronema. Trichostrongylus. 
Hemonchus. Trichuris. 
Hemostrongylus. Triodontophorus. 
Metastrongylus. Uncinaria. 
Nematodirus. 


In the following pages the various species will be considered as they 
affect different systems of the various animals. 
1. Helminthiasis of the Respiratory Organs. 


2. Helminthiasis of the Alimentary Canal. 
8 Helminthiasis of the Muscular and other Tissues. 


t..,* Possibly some of the above terms are co-generic, and the more recent will 
require suppression when this has been satisfactorily demonstrated. 


1520 SYSTEM OF VETERINARY MEDICINE 


(A) Helminthiasis of the Respiratory Organs. 


Practically all the domesticated mammals are at times liable to 
invasion by worms which affect either the bronchi or lungs. Often 
amongst young animals large numbers are attacked and losses are great. 
The following list gives the most important respiratory worms, their hosts, 
and habitats. 











Species. Host. Habitat. 
Dictyocaulus arnfieldi .. .. | Horse, ass Bronchi, bronchioles. 
D.vivvparus .. 55 ret x e ws 
D. filaria at ei .. | Sheep, goat, camel i ay 
Metastrongylusapri... mibig i < 
M. brevivaginatus Sy i . ” 
Synthetocaulus rufescens .. | Sheep, goat Lungs. 
S. capillaris “A i _ a 
S. unci phorus ¥ A 
S. ocreatus a: -- | Shéép ? 
S. abstrusus ° es eo -Cat ¥ 
Heemostrongylus vasorum Soo a bYeyed Pulmonary artery. 











The four genera mentioned in the above table form a subfamily, 
the Metastrongyline, and the diseases which they produce are termed 
verminous bronchitis and verminous pneumonia, according as the para- 
sites are found in the bronchi or lung tissue. This distinction, however, 
is not always clinically true, because broncho-pneumonia or pneumonia 
is often present in bronchial infestations. The rays of the caudal bursa 
of the male are comparatively thick in all these genera, and the vulva 
is just in front of the anus in the female, with the exception of Dictyo- 
caulus, where it occupies a position roughly about midway between the 
two extremities. At the moment of laying, the egg contains a well- 
developed embryo in Metastrongylus and Dictyocaulus, whereas in 
Synthetocaulus and Hemostrongylus they are non-segmented. The only 
species requiring differentiation are the small worms of the sheep and 
goat, and the two large ones of the pig. 
 Dictyocaulus arnfieldi (Cobbold), (Strongylus arnfeldi Cobbold), varies 
considerably in length; the male is, however, usually 28 to 38 millimetres, 
and the female 44 to 55 millimetres long. In this country it is compara- 
tively rare in the horse, but occurs occasionally in the ass. 

D. viwiparus (Bloch), (Strongylus micrurus Mehlis)—The male is 
about 40 millimetres long, whilst the female measures from 60 to 80 milli- 
metres. It is a very common species in calves in most parts of England, 
and gives rise to “ husk ”’ or “ hoose.” 


PARASITES AND PARASITIC DISEASES 1521 


D. filaria (Rudolphi), (Strongylus filaria Rudolphi).—This is one of 
the largest of respiratory worms, the male attaining 80 millimetres, 
and the female even 100 millimetres, in length. At times it is 
common in sheep and lambs, on low lying pastures, and, associated 
with intestinal nematodes, is often responsible for important losses. It 
gives rise to a similar condition as the preceding species. 

Metastrongylus apri (Gmelin), (Strongylus apri Gmelin, and S. para- 
doxus Mehlis)—Male, 12 to 15 millimetres long, with two spicules, 
approximately 4 millimetres long, terminating in a single point; female, 
25 to 50 millimetres long. The vulva is just in front of the anus, and 
leads into a vagina, which is about 2 millimetres long. It is compara- 
tively common species in this country. 

M. brevivaginatus Raillet and Henry.—This species closely resembles 
the foregoing, and was formerly often mistaken for it. The vagina in 
the female is, however, only 0:5 millimetre long, and the spicules of the 
male are about 1:5 millimetres long. 

Synthetocaulus rufescens (Leuckart), (Strongylus rufescens Leuckart).— 
Compared with the previously mentioned species, this and, in fact, all, 
the members of this genus are very thin and hair-like. The male is 
approximately 20 to 30 millimetres long, whilst the female is a few 
millimetres longer. In addition to sheep, in which it is very common, 
it is said to occur in goats and domestic rabbits. 

S. capilaris (Miller) has been found in sheep and goats. Raillet and 
Henry have described two other species—S. uncvphorus from the goat 
and sheep, and S. ocreatus from Algerian sheep. A closely allied species, 
S. sagittatus (Miller), occurs in the lungs of the stag. 

S. abstrusus (Raillet), (Strongylus pusillus Miller) is a thread-like 
worm of the cat’s lung. The male is about 5 millimetres long, and the 
female reaches twice this length. It does not appear to be common in this 
country. It often occurs in animals affected with notcedric mange. 

Hemostrongylus vasorum (Raillet), (Strongylus vasorum Raillet).— 
The male is from 16 to 18 millimetres long, and the female is a little in 
excess of this. It is of reddish tint and longitudinally striated, but is 
not a common species. Strictly speaking, this parasite should not be 
included in this section, because it is found in the pulmonary artery of 
the dog. The lesions which its ova and embryos create are, however, 
situated in the lungs. 

OTHER SpecrEs.—In addition to the foregoing lung worms, a number 
of others need to be mentioned. In the dog there are occasionally seen 
at the junction of the bronchi with the trachea small elevations which 
contain a nematode, usually associated with the name of Osler. The 

VOL. IL. 96 


1522 SYSTEM OF VETERINARY MEDICINE 


male is about 5 millimetres long, and the female is twice that length. 
Occasionally Falarva ommitis may be found in the dog’s lung, and in the 
cat Oliulanus tricuspis also occurs. In the other animals parasites which 
have wandered from the normal habitat may also sometimes be found in 
the respiratory organs. 

Lire-History.—In nearly all the genera now under consideration a 
sreat deal yet remains to be known with regard to the life-cycle. In 
Metastrongylus the egg when laid contains an embryo, which soon hatches 
in the bronchi; after moulting, they gain the trachea, nasal cavities, and 
exterior, and in this state it possesses. marked powers of resistance. 
Similar remarks apply to Dictyocaulus. In Synthetocaulus the egg at 
birth is non-segmented, but, after further development, the embryo 
hatches in the air-spaces of the lungs. After reaching the exterior in 
the way mentioned above, the larva is capable of living in suitable 
media for considerable periods, and is likewise very resistant. The 
eggs of Hamostrongylus are deposited in the bloodvessels, and become 
arrested in the smaller arterioles of the lung. After hatching, the 
larvee gain the bronchi, and thus reach the exterior. The consequent 
development in the outer world of all four genera is not known for certain, 
neither is their mode of entry into the lungs. All that can be definitely 
said is that after a series of changes in the free stage, the parasites again 
reach their habitat. When the possible means of infection by some of 
the alimentary species are taken into consideration, it seems that these 
respiratory worms may have an indirect method of arriving at their goal. 
Anchylostomum caninum larve are known to penetrate the host’s skin; 
thus they gain the bloodvessels and become arrested in the lungs, whence 
they pass up the trachea and down the cesophagus to their usual habitat. 
It is therefore difficult to say exactly how susceptible animals become 
infected, although food and water are probably the sources in many cases. 
Low-lying and damp pastures are most liable to keep the disease going, 
whilst wet seasons favour the development of the worms on ordinary 
land. Swine which have always been housed are sometimes attacked. 

Young animals appear more liable to the attacks of Dzctyocaulus, 
whilst Synthetocaulus is usually found in older animals. Infection 
appears to take place usually in the autumn, but it is possible in spring 
and even early summer. 

Lestons.—These depend upon the number and species of parasite 
present, and the duration of the attack. In slight infections of Dictyo- 
caulus and Metastrongylus in horses, lambs, calves, and swine respec- 
tively, bronchitis and broncho-pneumonia are the most common changes. 
When the worms are more numerous, portions of lung tissue, supplied 


PARASITES AND PARASITIC DISEASES 1523 


by a blocked bronchus, become collapsed, and a lobular broncho-pneu- 
monia results. Worms may be present at the edges of the lungs. 
Synthetocaulus rufescens usually gives rise to a nodular pneumonia, the 
small nodules surrounding one of the parasites or its eggs. Such a con- 
dition is often referred to as pseudo-tuberculosis, on account of its 
resemblance to the tubercle. The lesions are uniform throughout the 
lung, and, on section, have a greenish line. Occasionally this species 
also causes a lobular pneumonia by the obstruction of a small bronchus; 
a diffuse pneumonia due to the eggs and larval forms is also recorded. 
The presence of helminthes in the respiratory organs and their effects 
upon the mucous membrane must always be regarded as a fruitful 
source of invasion by micro-organisms. The presence of small nodules of 
nematode origin in the bronchi of the dog have already been alluded to. 
Isolated parasites often show degenerative changes, and, later, become 
calcified. 

Symproms.—In the horse, goat, pig, dog, and cat, lung-worm disease 
does not, on account of its rarity and clinical unimportance, come promi- 
nently before the veterinarian. Apart from persistent symptoms of 
bronchitis, there is little to distinguish it. In the horse and goat the disease 
closely resembles that of calves; in the pig there is a similarity to the 
symptoms shown by sheep; whilst the dog and cat show frequent cough- 
ing, vomition, and gradual emaciation. If a number of animals of any 
species are affected, the possibility of the presence of lung worms should 
be taken into consideration, and a microscopic examination of the nasal 
discharge made, in which case ova, larve, and portions of adult worms 
may be demonstrated. Sheep and lambs which are low in condition are 
most liable to infection, and especially is this so if pastures are over- 
stocked. In a great number of cases the presence of other parasites, such 
as Fasciola hepatica in the liver, and Hemonchus contortus in the fourth 
stomach and small bowel, seems to favour invasion. A similar associa- 
tion has also been noted in other animals. 

The symptoms are usually shown about two months after infection, 
and although manifested at all times throughout the year, the disease 
is most often seen from February onwards. There is a bronchitis in a 
number of animals, and this gradually becomes more severe. The cough 
is at first hard, but becomes softer, and occurs in paroxysms. There is a 
frothy discharge from the nostrils. The temperature varies, but is not 
markedly high. When driven, the respiration is easily disturbed, the 
animals become easily fatigued, and rest with the head lowered and the 
mouth ajar. Auscultation may reveal greatly increased mucous rales. 
When alimentary worms are also present there is diarrhoea and conse- 


1524 SYSTEM OF VETERINARY MEDICINE 


quent soiling of the fleece. There is also loss of appetite, with depravity 
for the ingestion of abnormal materials; earth may be attempted, and 
rumination is irregular. After a varying period, affected animals become 
emaciated and anemic, as is shown by the conjunctiva. The wool loses 
its natural feel, becomes dry, and may be cast; the skin itself feels harsh 
and dry. With the progress of the disease, the cough and discharge are 
increased, and the latter contains clusters or portions of parasites. 
Death takes place from suffocation or marasmus. 

The above remarks apply chiefly to verminous bronchitis or broncho- 
pneumonia due to D. filaria, but S. rufescens often occurs with it. When 
the latter worm only is present, unless the invasion be very severe, 
hardly any symptoms are shown in older sheep save that of a cough. 
This becomes more frequent. Advanced cases may develop local pneu- 
monic foci, become emaciated, weak, and finally die. 

Dracnosis.—The disease now under consideration resembles a 
number of other conditions, such as bronchitis, broncho-pneumonia, 
pneumonia of young stock, pleuro-pneumonia, and even tuberculosis. 
The most important distinguishing features are that a number of young 
animals are attacked, that the temperature is not much elevated, and 
that consequently the general health is not at first much affected. When 
one of the affected animals is available for post-mortem examination, 
the demonstration of the parasites is easy. The same may be said when 
the material coughed up is plentiful. In other cases it may be necessary 
to search for mucus; this can usually be obtained from the throat by 
scraping with a long-handled spoon. The microscopic examination of 
sputum so obtained, especially after a recent attack of coughing, 1s most 
likely to show the presence of ova, larve, or broken portions of adult 
Worms. 

TREATMENT.—In former years antiseptic expectorants were often 
administered by way of the alimentary tract. A common formula was 
oil of turpentine in linseed oil. Later, fumigation was extensively 
practised, the principle being usually to generate a quantity of chlorine 
gas, sulphur, tar, or tobacco fumes in the upper part of a closed building 
containing the animals, and allowing it to gradually permeate the air- 
space. The irritant action of the gas caused the animals to cough up 
the bronchial mucus and the worms it contained. The animals were 
usually relieved from further treatment when their attendant could no 
longer remain in the building. Both of these treatments have now fallen 
into disrepute on*account of their disadvantages, and various forms of 
direct medication to the affected organs have supplanted them. The 
important hosts from a therapeutic point of view are young cattle and 


PARASITES AND PARASITIC DISEASES 1525 


sheep, and in the latter the death-rate may be from 5 to 50 per cent. of 
the affected animals. The principles to be aimed at are the immediate 
arrestation of further infection, the maintenance of general physical 
conditions, the destruction of the pulmonary and intestinal worms, and — 
the interruption of sequelae, such as pneumonia. The first of these 
items is dealt with under Prophylaxis, and good feeding on an easily 
digested nitrogenous diet will bring about a good physical condition. 
Tonics, both mineral and vegetable, can be added to any mixtures which 
may be offered to destroy intestinal worms if the infection should be a 
double one. This subject is discussed in a later section (p. 1544). It is 
stated that the addition of pulped onions to the feed is of material use. 
Although good results are said to have been obtained by pouring mix- 
- tures down the nostrils, intertracheal injections are more preferable. In 
calves a number of preparations may be used. The following are some 
of the most common: 


1. KR Ol. terebinth. ig s "i Slee ie 
Tinct. opii _ fe 3 rene Al. 
Acid. carbol. liq. .. M. i Ae Wx 
Ol. olive .. : : Ha Bue 


M. ft. injectio. Sig.: One dose. To be injected into the 
trachea every second or third day, according to the severity 
of the case, etc. 


gs conve ce o's) och tam pelea gaan 
SEL ect): sh MMM ete | rear 
M. ft. injectio. Sig.: 311. as a dose. 

3. K Ol. terebinth. #7) 4A PONY 
eee Hasan net. a ts | aa 3ul. 


Aque 7 Ee be se ) 
M. ft. injectio. Sig.: 3ss. as a dose. 
4. K Creosote At A ie AP NS 
ie et rect. a. ah : rf ecuestheate 


M. ft. injectio. Sig.: Dose about ili. to be vaporised into 
the trachea on three consecutive days. 


5. R Creolin :. i fe PT Ty cy. 
Ol. terebinth. eae} 
Ol. olivee RE 


M. ft. injectio. Sig.: 3ii.ss. daily for three days. 


1526 SYSTEM OF VETERINARY MEDICINE 


The injections have to be carried out with due respect to sepsis, 
thickness of the skin, and position of the patient’s head. The animals 
are usually housed. Opinions differ as to value of oily, watery, and 
vaporising injections. Resulting bronchitic and pneumonic foci 
should be treated as described under the sections dealing with these 
‘diseases. | 

For lambs or sheep similar treatment can be resorted to, due 
consideration being paid to dosage. Moussu recommends the 
following: 


Jodine .. seb icin ees ae ia laD Bete 
Potassium iodide ie ai -s 0 parts. 
Water .. gi en fs ee Uae 


This solution is mixed with equal parts of olive oil and of oil of tur- 
pentine. Dose 31.88. to 3ii.ss. 

An injection on two consecutive days will often greatly relieve the 
symptoms. Where a great number of animals are affected, intertrachea] 
injections are sometimes thought to be rather laborious, and the old 
inhalation method is resorted to. The heads are steamed over a large 
boiler containing large amounts of oil of turpentine. This can also be 
applied to calves; but, all things considered, the former deserves a 
preference. Spontaneous cures are not uncommon. 

Verminous pneumonia in sheep rarely comes under the veterinarian, 
Intratracheal injections may be tried, and sometimes fumigations are 
given. Little is likely to be achieved by attacking the nodular form of 
the disease. 

PROPHYLAXIS.—The absence of knowledge concerning a number of 
important points in the bionomics of this group of worms allows only 
the laying down of generalisation with regard to prevention. Most of 
these will be very similar to those already mentioned under Fascioliasis 
(p. 1512). It must not be lost sight of that the sputum may often be 
swallowed and the feeces thus become infected, as well as the coughed-up 
bronchial mucus. When affected animals are housed, all the discharges 
should therefore be destroyed, and attention given to the mangers. 
Organs containing worms should be burnt. At pasture, animals not 
liable to the attacks of the parasite in question may be turned on to the 
ground. 

Meat Inspection.—The usual procedure is to condemn affected 
organs, but in some cases the whole carcass may be deemed unsound on 
account of secondary and remote changes—e.g., emaciation or dropsical 
conditions. Records certainly point strongly to the probability of 


PARASITES AND PARASITIC DISEASES 1527 


infection of man by Metastrongylus apri. In sheep the nodules caused by 
Synthetocaulus rufescens have been mistaken by medical public health 
authorities for miliary tuberculosis. 


BIBLIOGRAPHY. 


Braun: Animal Parasites of Man. London, 1906. 
NEumMANN: A Treatise on the Parasites and Parasitic Diseases of the Domesti- 
; cated Animals. Macqueen. London, 1905. 

RAILLET AND HENRY: Sur les Variations des Strongles de l’Appareil Respiratoire 
des Mammifers. Comptes Rendus de la Société de Biologie. Tome Ixiii, 1907. 
No. 38, December 27, p. 751. 


(B) Helminthiasis of the Alimentary Canal. 


All the domesticated animals are liable to invasion of their digestive 
organs by round worms. In nearly all of them a number of the parasites 
produce important and oft-times fatal diseases. Generally speaking, the 
upper portions of the canal do not harbour very important species. The 
stomach, however, in most animals (abomasum in ruminants) is often 
the seat of extensive and fatal nematode lesions. The same applies to 
the small bowels, except:in the horse. In this animal the large bowels 
are most often affected. Certain groups of worms appear to cause little 
or no trouble, and the distinction of the known pathogenic forms then 
becomes important. This can often only be done by microscopic 
examination. The presence of ova in the feces is always suggestive, 
but they may be derived from a species which is thought to be harmless. 
Clinically, the horse, ox, and sheep are the most important hosts of 
round worms; the pig, dog, and cat, however, cannot be lightly passed 
over. The various aspects of worm infestation will be considered here 
under four headings—viz.: (1) The horse; (2) the ox and sheep; (3) the 
pig; and (4) the dog and cat. 


1. Round Worms of the Alimentary Canal of the Horse. 


In the following table are shown the most important round worms 
of the digestive apparatus, with their normal habitats. No distinction 
has been made between the various species of horse (Equus). 


Parasite, Habitat, 

Ascaris megalocephala .. ae .. Small intestine. 
Oxyuris curvula fe td .. Caecum, colon, and rectum. 

»  mastigodes 23 f" : 

.f poculatum ee : e ve + 

ss Stenuicauda >. as ue op ie a 
Trichinella spiralis... = .. Small intestine 
Trichostrongylus axet .. se .. Stomach. 


Probsmayria vivipara .. es some OLOnL. 


1528 SYSTEM OF VETERINARY MEDICINE 


Parasite. Habitat. 


Habronema muscee re si .- Stomach. 

i microstoma “3 4 
Gongylonema scutatum A ..  (Césophagus. 
Strongylus equinus a" be .. Cecum and colon. 

as edentatus .. ah ms a ote 
- vulgaris Le ee ap 4p m4 
Triodontophorus minor ise ae ‘, ‘5 
4 intermedius .. ae bs * 
a serratus as +3 
Cylicostomum tetracanthum .. ian O1L0n: 
Ms alveatum af sh " 
- auriculatum ae ‘ie - 
if bicoronatum He 47 if 
BS calicatum oe ae 3 
¥. catinatum be Ay AS 
33 coronatum rh 7 cs 
as elongatum ne 5” Be 
" labiatum he “se € 
Phe labratum as at i” 
x mettamt ¥ Ax $3 
a nassatum a aie x5 
5 poculatum As " op 
ae radiatum M ae +H 
Gsophagodontus robustus -. es Hi 
Gyalocephalus capitatus uF ae 3 
Cylindropharynsx brevicauda .. ae = 
is longicauda .. - a 


Ascaris megalocephala Cloq.—The large white worm, with its three 
lips, measures in the male from 15 to 25 centimetres long, whilst the 
female may exceed 35 centimetres. It is a very common inhabitant of 
the small intestine, usually in the first few feet. Although only small num- 
bers are most often present, enormous quantities are occasionally encoun- 
tered. We have collected 10 pounds from one animal on post-mortem 
examination. The eggs measure 90 to 100 wu in diameter, and after 
expulsion develop an embryo, which is capable of great resistance. On 
being ingested, the latter leaves the egg and becomesadult. This worm 
occurs in most of the equine species. 

Oxyuris curvula Rud.—This species, and other members of the 
genus, have a thin tapering tail. The female is from 4 to 5 centimetres 
long, and of a cream-like colour. The vulva is approximately 8 milli- 
metres from the anterior extremity. The male is comparatively rare, 
and measures from 9 to 12 millimetres long. The eggs are 90 uw long and 
40 u broad. 

Oxyuris mastigodes Nitz, closely resembles the foregoing species, but 
the tail is very much elongated, so much so that the females often attain 
a length of 12 to 14 centimetres. Forms of varying length are met with. 
They are common parasites, and are found throughout the large bowel 
of equines, and may even be seen at the anus, Other species are 


PARASITES AND PARASITIC DISEASES 1529 


O. poculum V. Linst. and O. tenwicauda V. Linst. The life-history is 
direct, as in the case of the large white worm. 

Trichinella spiralis (Owen).—The adult or intestinal form of this 
worm must sometimes occur in the horse’s small bowel, as this animal’s 
muscles are not exempt from its attacks. 

Trichostrongylus axet (Cobbold).—This small worm is described on 
p. 1540. It is not infrequently found in the stomach, where it gives rise 
to a gastritis very similar to that of ruminants. 

Probsmayria vivipara (Probs.).—The female only measures 2°5 milli- 
metres in length, and has a prominent lip. This minute species is often 
found in great numbers on and in the mucous membrane of the large 
intestine associated with other species. Little is definitely known con- 
cerning its pathoeni c role. 

| Habronema musce (Carter), (Spiroptera megastoma Rud.).—The male of 
this species measures about 8 to 10 millimetres, and the female 10 to 12 
millimetres, in length. The colour is white, and the mouth is furnished 
with four thick lips; there is a funnel-shaped pharynx. The posterior ex- 
tremity of the male is coiled. It is a common worm in elevations or 
tumours of the mucous membrane of the stomach of the horse in India. 
These tumours vary in size up to that of an egg, and the worms can be 
traced at the apex of the swelling. The female is ovoviviparous, and 
Ransom has shown that the life-cycle is completed through the house-fly 
Musca domestica. Thus Habronema musce, which was previously regarded 
as a fly parasite, is in reality a stage in the evolution of Spiroptera 
megastoma. 

Habronema microstoma (Rud.), (Spiroptera microstoma Rud.).—This 
species resembles the previously described worm, but is longer, the male 
being from 10 to 20 millimetres, and the female 12 to 26 millimetres. 
It is usually found free upon the surface of the stomach, or even attached 
to the mucous membrane. 

Gongylonema scutatum Miiller has been recorded from the epithelium 
of the cesophagus of the horse, but itis a rare parasite. Itis of a yellowish 
hue, and the male measures 4 to 5 centimetres in length, with a coiled 
tail, whilst the female is usually twice these dimensions. 

Strongylus equinus Miller (S. armatus Rud., Sclerostomum equinum 
De Blain).—The body is of a grey or brownish-grey hue. The mouth, 
which is widely open, is made tense by a number of chitinous rings, the 
innermost of which is furnished with a number of denticles. The buccal 
capsule is regularly ellipsoidal, and almost equally rounded at the anterior 
and posterior ends. There are four teeth. The male measures up to 
35 millimetres, and the caudal bursa has its median or dorsal lobe slightly 


1530 SYSTEM OF VETERINARY MEDICINE 


developed. The terminal dorsal ray is trifid. The female is from 40 to 
50 millimetres in length, the tail is obtuse, and the vulva is situated 
at about a quarter of the body’s length from the tip of the tail. Although 
apparently not common, this species does occur in the colon in this 
country. 

Strongylus edentatus (Looss).—This species resembles the one Just 
described; the head is, however, separated from the body by a distinct 
neck, and the worms are therefore somewhat pin-shaped. The diameter 
of the anterior opening of the buccal capsule is greater than that of the 
posterior, and there are no teeth. The male measures from 23 to 26 milli- 
metres in length, and the dorsal lobe is less developed. The female is 
from 33 to 36 millimetres long, and has a somewhat blunt tail. It is 
very common in most countries. 

Strongylus vulgaris (Looss) is somewhat similar to the above species, 
but is smaller. There are two teeth. The male measures approximately 
14 to 16 millimetres, and has the dorsal lobe triangular in shape. The 
female attains 24 millimetres in length. This also is a very common 
species. 

Cylicostomum tetracanthum (Mehlis), (Strongylus tetracanthus Mehlis, 
Sclerostomum tetracanthum Dies.).—The colour is reddish; the mouth is 
circular, and has a denticulated rim. There are six papille placed ex- 
teriorly to this. The mouth capsule is cylindrical. The male is about 
9 millimetres long. The dorsal lobe of the caudal bursa is large, and the 
termino-dorsal ray has three strong branches. The female is about 
11 millimetres long, and the vulva is situated a little in front of the anus. 
This is a common and important parasite of the cecum and colon of all 
equines, especially in grazing animals. A great number of other species 
of this genus are to be found in this and other countries. They vary 
considerably in length and details of structure. Many of them escape 
detection unless very careful search is made. Their names will be found 
in the list already given. C. auriculatum Looss is the longest, the male 
being 17 millimetres, and the female 26 millimetres; whilst C. labratum 
Looss and C. calicatum Looss are less than 8 millimetres long. 

Triodontophorus minor (Looss) somewhat resembles the group just 
considered. The dental armature is, however, composed of three pieces, 
which meet ata point. The body is transversely ridged. The edges of the 
bursa of the male are finely denticulated. The vulva is situated some way 
from the tail—one-seventh of the body-length. The male is approximately 
13 millimetres, and the female 14 millimetres, in length. Other species 
are T. serratus (Looss) and 7’. intermedius (Sweet). The former two 
Species are to be met with in the colon of the horse in this country. 


PARASITES AND PARASITIC DISEASES 1531 


(Esophagodontus robustus (Giles), a brownish-red worm, closely related 
to T'riodontophorus, has been described from India. The male has a 
bilobed bursa, and measures 13 millimetres in length. The female is 
about 22 millimetres long, and has the vulva just in front of the anus 
(1 millimetre). 

Gyalocephalus capitatus Looss also occurs here; but Cylindropharyna 
brevicauda Leiper and C. longicauda Leiper, from the zebra, have been 
recorded only from abroad. 

The members of the genera Triodontophorus, Strongylus, and Cylicos- 
tomum, especially the latter two, must be adjudged the most important 
of equine parasites; for, apart from being world-wide in their distribution, 
they attack many young animals, especially those at or recently returned 
from pasture. Some of them are found attached to the lumen of the 
bowel, others in or under the mucous membrane, and, again, others in the 
bloodvessels. : 

Lirr-History.—Although this is variously stated by different authori- 
ties, it is probably somewhat as follows. These remarks apply more 
particularly to Strongylus vulgaris. The egg when laid measures 90 u 
by 50 w, and is undergoing segmentation. After being expelled with the 
feces, an. embryo appears, and this hatches in a few days in the presence of 
air, moisture, and a suitable temperature. The larva now measures about 
450 mw, and goes on increasing in size. It then develops a sheath, and 
undergoes changes in the mouth-parts and cesophagus in such a way that 
it becomes ensheathed, incapable of taking food, and is thus very resistant 
to adverse conditions. Later on the larva becomes temporarily encysted, 
and may in this condition remain alive for considerable periods. They are 
then taken into the alimentary canal during grazing, or even in drinking- 
water. Once in the digestive organs, these larvee lose their sheath, and 
it is probable that they then bore into the walls of the viscera, and are 
then carried through the blood-stream until they reach the large bowel. 
Some of them, however, become arrested in the vasa vasorum, such as 
those of the anterior mesenteric artery, and others even reach the pleura 
and peritoneum. After a stay in the submucosa of the wall of the large 
bowel (verminous cysts), they develop a buccal capsule, and even a 
caudal bursa; but they only become sexually adult after leaving the 
mucous membrane for the lumen of the bowel. After this copulation 
takes place, and the cycle is repeated. A few observers suggest that 
it is not essential for the larvee to enter the blood-stream, and that they 
become directly encysted in the mucous membrane of the large bowel. 
This appears likely in Cylicostomum. Those which reach the anterior 
mesenteric artery and other parts are in this case assumed to have 


1532 SYSTEM OF VETERINARY MEDICINE 


entered a bloodvessel of the bowel, and so gained the general circulation 
by accident. It has been shown that the ankylostomes, a closely allied 
group, are capable of entering the skin in the larval stage, becoming 
arrested in the lungs, and passing up the trachea to their habitat in the 
small bowel. 

Insurious Errects.—From what has already been stated, it will 
be seen that verminous infestation of the digestive organs of the horse 
allows a distinction into four conditions—viz.: (1) ascariasis; (2) parasitic 
gastritis; (3) oxyuriasis; and (4) strongylosis. In the latter are included 
the effects of Cylicostomum and allied genera. 

Ascariasis—As previously mentioned, Ascaris megalocephala is a 
common parasite, and a few apparently produce little or no effect upon 
their host. When numerous, however, they may block the intestine, 
or enter the bile and pancreatic ducts. It injures the mucous membrane 
with its mouth-parts, and, if numerous, such injuries may lead to inflam- 
mation, ulceration, and even necrosis of the mucous membrane. Although 
it occasionally passes through the bowel wall, it does not appear capable 
of effecting this itself. The toxin given off has an action on the blood 
and nervous system. Occasionally this worm is found in the stomach. 

SymMptoms.—In young animals there is a catarrhal enteritis which 
may be of some duration, and with this there is diarrhoea. Loss of appe- 
tite and digestive irregularities are common, but rarely is there loss of 
flesh. Occasionally affected animals perspire freely and are easily 
fatigued, become unthrifty and rough-coated. Often a small amount of 
liquid is passed before a defecation. The passage of one of the worms, 
or microscopic examination of the feces, insures a correct diagnosis. 
Nervous symptoms resembling those of tetanus have been recorded. 

TREATMENT.—This is usually satisfactory. The best drug is tartar 
emetic (potassio-tartrate of antimony). It is given in Zii. doses in the 
form of a powder, combined with bitters and tonics, such as gentian root, 
ron sulphate, and a suitable spice. It is customary to offer a small 
bran-mash on the evening before treatment. On the next morning a 
powder is allowed in a double handful of moist bran. A bucketful of 
water is given, and in a couple of hours the breakfast is taken. A half- 
dozen powders given in this way is likely to expel most of the worms. 
Santonin is sometimes added to the powders. A course of physic can 
follow this treatment. Oil of turpentine in linseed oil is often used with 
success. | 

PROPHYLAXIS.—AlIl expelled worms should be burnt, and infected’ 
animals treated. There must be no means of food or water becoming 
contaminated by feces. The provender store and watering apparatus 


PARASITES AND PARASITIC DISEASES 1533 


should therefore be away from the stall and manure heap. Water- 
troughs should be protected from dust by suitable covers. 

Parasitic Gastritis—The horse is probably more often affected with 
this condition than is supposed.- T'richostrongylus axei (T. extenuatus, 
Strongylus gracilis) is usually the cause of the disease. The stomach often 
appears to be smaller than normal, but its walls are greatly thickened. 
The mucous membrane is usually corrugated and covered with an abnormal 
amount of mucus, which contains great numbers of the parasites. The first 
few inches of the duodenum may be similarly affected. Adenomatous-like 
formations on the gastric lining have been stated by some authors to be 
caused by this worm. 

Symptoms.—There is gradually increasing emaciation, anemia, and a 
capricious appetite. The unthriftiness increases, and the appetite is 
almost lost for several days altogether. There may be slight colic-like 
pains. Cases usually progress until after three to six months they become 
cachectic and die. | 

TREATMENT and PropHytactic Measures should be similar to those 
given for this disease in ruminants. The diagnosis is difficult, and treat- 
ment is not at all satisfactory. 

Oxyuriasis.—Although not actually important, yet the oxyures do 
affect their hosts when present in large numbers. They appear to live 
upon vegetable matter. 

Symptoms.—The general manifestations are practically negligible. 
The most important signs, however, are rubbing the tail, pruritus ani, and 
the appearance of a deposit of yellow material around the lower margin 
of the anus. This is stated to accumulate there as the eggs pass out with 
the feeces, but it appears most probable that the female is squashed there 
by the sphincter ani and tail. On microscopic examination it is seen to 
be composed almost entirely of eggs. 

TREATMENT. —Apart from the removal of the unsightly aaa det at the 
anus, treatment is rarely carried out. It is generally supposed that injec- 
tions into the rectum are valuable, but they only remove those parasites 
which are on their way to the anus from the higher reaches of the colon, 
and even the cecum. The most commonly used enemata are—(1) quassia 
infusion; (2) tobacco 3i. in 0.1. of boiling water; (3) turpentine 311. in 
O.i. of gruel; and (4) asafetida 311. in O.1. of warm water. The 
internal administration of powders containing sulphate of iron, santonin, 
and potassium antimony tartrate, followed by a purgative, are to be 
recommended. 

PRopHYLACTIC Mrasures.—Far more important than therapeutic 
agencies is it to prevent the entrance into the mouth of any substance 


1534 SYSTEM OF VETERINARY MEDICINE 


contaminated by ova. If this could be carried out, the parasites in many 
cases would disappear. Infected bedding is brought into proximity with 
the mouth when the animal is recumbent, and it is possible for sponges 
used on the anus to contaminate those used for the nose, whilst the 
grooming tools are resting in the basket. All these and similar items will 
have to be guarded against. 

Strongylosis——Under this term are included the effects produced by 
Strongylus, Triodontophorus, Cylicostomum, and other allied genera, 
although, perhaps, such an inclusion is not strictly correct. It is not too 
much to say that the losses and depreciation due to this group of worms 
must amount to several millions of pounds per annum in this country 
alone. Usually, young animals are most severely affected, and if they 
recover from the alimentary lesions, and are removed to stables, the 
vascular changes may be the indirect cause of death years afterwards. 
The breeding of young blood stock on certain holdings has often been 
abandoned on account of these helminthes. Similar remarks apply to 
hackneys and shires, although these breeds do not seem so vulnerable to 
their attacks. Mares that have for years been housed, on being put to 
stud and turned out to foal, often become so infested as to be almost 
useless by the time the foal is weaned. Veterinary literature contains 
many references to the infestation of horses which have been turned out 
to grass, and the liability of the grazier to compensate owners for the 
loss of their horses. Infection at pasture appears to take place in spring, 
and severe symptoms are shown in the following autumn and winter. 
Among town horses the larger worms gradually die out, and at the end of 
three or four years only a few are usually seen. Some cylicostome infec- 
tions, however, are to be seen in horses that have been housed for years. 

Lxstons.—The lesions actually due to these parasites can be best 
considered under a number of separate headings. (1) In the lumen of 
the bowel the adults of S. vulgaris, S. equinus, and S. edentatus produce 
small rounded wounds at the points of attachment, and abstract blood 
from the bowel wall. They prefer the caecum and first few feet of the 
colon, and are to be seen attached there immediately after the host’s death. 
They may be in coitus, and the number, especially of the former species, 
may be very great. The irritation of these attachments, the toxin gener- 
ated, and the bacteria so introduced, produce inflammatory and remote 
changes. The various species of adult Cylicostomum do not usually 
fasten themselves to the mucous membrane, and are found throughout 
the colon, and even the rectum. (2) Underneath the mucous membrane 
can be found a great number of small elevations containing immature 
forms of different genera. In some cases they may be quite macroscopic, 


PARASITES AND PARASITIC DISEASES 1535 


whilst in others the infected bowel has to be held up to the light, when 
the coiled worms may be found to be so numerous as to suggest that 
a great portion of the bowel must be greatly reduced in its functions. 
Sometimes the parasite may be expressed from its position into the lumen 
of the bowel, together with a little purulent material. Similar cysts 
containing almost fully-developed male and female specimens of Stron- 
gylus may be found in a number of other positions, such as under the 
visceral and parietal peritoneum, under the costal and pulmonary pleura, 
and in the peritoneal sac of the testicle. (3) In the bloodvessels where 
the young forms of S. vulgaris become arrested, aneurisms form. The 
most common seat of this change is the anterior mesenteric artery, but 
occasionally the posterior vessel is affected. A great number of animals 
are found to have this lesion on post-mortem examination, even in old 
age. It varies in size from that of a pea to that of a child’s head, and 
is most often conical in shape. The wall usually becomes greatly thick- 
ened, and although records of its rupturing are comparatively rare, this 
occasionally does happen. Within the aneurism are a number of jm- 
mature worms and parietal thrombus. This may occlude the vessel and 
be continued on to colic arteries, where large masses of caseous material 
may be found containing worms. As a result of breaking down of the 
thrombus, embolism, congestion, infarction, and other changes in the 
bowel wall take place. These give rise to a series of intestinal disorders 
simulating colic (see p. 280). If the thrombus formation projects into 
the posterior aorta, there is a great possibility of embolism of various 
arteries of the hind-limbs. These may be manifested by various obscure 
lamenesses. (4) Anemia results chiefly from the toxins secreted by 
these worms, and is always marked. 

Symptoms.—From what has already been said, it will be seen that 
the most important injurious effects are brought about by immature 
forms. Severe infestations of adult Strongylus are, however, not negligible 
in this respect. The following remarks apply to the intestinal form of 
the disease, no cognisance being taken here of the various vascular 
changes and the phenomena resulting therefrom. Infection appears to 
take place from drinking-water or the grass of damp and low-lying 
pastures. In the first stages of the disease there is unthriftiness, gradual 
loss of flesh, the coat may be very late or improperly shed, increasing 
weakness and languor. After a month or so, the important signs are 
emaciation, anemia, and diarrhoea. The temperature, pulse, and res- 
piration are little disturbed. The loss of flesh and weakness become 
marked. The animals, when forced to trot, do so in a very limp manner, 
and there is often momentary luxation of the patelle. The anemia is 


1536 SYSTEM OF VETERINARY MEDICINE 


shown by pallidity of the visible mucous membranes. Often when the 
head is turned the white of the eyes attracts one’s attention. The appe- 
tite varies from time to time, but patients soon tire of changes in the 
food. The diarrhoea is not always constant in degree, and if at grass, 
the ‘“red”’ or “ wire”? worms can often be found in the moist feces. 
After a varying period the emaciation becomes aggravated, and the 
animals die. The clinical picture suggests that the anemia produced 
by the toxin, and the invasion of the bowel wall by worms and micro- 
organs, are the actual causes of the symptoms. 

Draenosis.—Generally speaking, this is not always easy. The 
presence of the worms may often be demonstrated by rectal examination 
or by the microscopic examination of the feces. The possibility of a 
non-parasitic condition being present should not be lost sight of, even 
when the patient harbours worms. 

TREATMENT.—This is usually most unsatisfactory. If grazing 
animals are placed on a manger and bucket diet, further infection will be 
prevented. The bedding should be frequently burned and the box kept 
clean and nice-smelling. The fecal discharges often possess a peculiar 
smell, which sickens the patient. The best of easily digested food 
should be offered. The diarrhea will probably be removing great 
numbers of cylicostomes daily. If this is not so, a dose of turpentine 
may be given in oil. If the diarrhcea is too severe, tannalbin will often — 
check it a little. Warmth, in the form of rugs and bandages, is essential. 
Little can be directed against the greatest culprits—viz., the encysted 
bowel forms. Powders containing antimony, potassium tartrate, iron 
sulphate, santonin, gentian, and aniseed, can be given. Thymol and euca- 
lyptol in glycerin, spirit, and mucilage are used with some success. 
Several observers claim to have had good results by the subcutaneous 
and intravenous injection of atoxyl in 15 to 20 grain doses. Such treat- 
ment is directed against the immature forms. 

PropHyLactic Measures.—Generally speaking, these must follow on 
lines already fully indicated under Fascioliasis. It cannot be too strongly 
pointed out that the passage of feeces from an infected mare brought to 
a stud farm on to the pasturage where other brood mares are grazing, 
may be the means of setting up the disease in several breeding establish- 
ments when they return home. The steps to be taken are obvious— 
viz., the feeces should all be burned, but the practical difficulties in the 
way are very great. The hunter up from summer grass may spread the 
disease when he, in saddle, crosses various fields. When great losses 
have been occasioned, the best procedure is to exclude horses from the 
infected pastures, and to feed them to cattle and sheep for a year. 


PARASITES AND PARASITIC DISEASES 1537 


2. Round Worms of the Alimentary Canal of Ruminants. 


The ruminants generally are liable to become infested by a large 
number of nematodes. A great many of the parasites in the following 
table may also be found in other herbivora, such as the zebu, buffalo, 
giraffe, camel, llama, and antelope. Likewise, these animals often 
harbour different species of the genera there mentioned. Quite a number 
of species are thought to be of little or no importance as disease-producing 
organisms. Amongst these may be mentioned Chabertia ovina and 
Trichuris ovis, two very prevalent species; others, such as Ascaris vitu- 
lorum and A. ovis, are so rare in this country as to be almost negligible. 
From a clinical point of view, two conditions deserve attention. One 





Parasite. 


Ascaris vitulorum 


» ovis Kn el 
Bunostomum trigonocephalum 
aa phlebotomum 
Chabertia ovina 4! £3 
sophagostomum columbianum 
mt radiatum .. 
pe venulosum 
Hemonchus contortus 
Ostertagia circumcincta 


S ostertagia . 
a trifurcata .. 
i marshalli 
a occidentalis 
Cooperia oncophora 
«) curticer 
I punctata 
ot pectinata 


Nematodirus filicollis. . 
Trichostrongylus axet.. 


i instabilis 

er colubriformis 
4 probolurus .. 
ed vUtTINUs 

PS: capricola 


Gongylonema scutatum 
a verrucosum 

Strongyloides panillosus 
Trichuris ovis .. ; 
Capillaria brevipes 

sy longipes 

oe bovis 
Trichinella spiralis 
Gaigeria pachyscelis .. 


VOL, II. 





Host. 


Ox 


Sheep 
Sheep, goat 
Ox 


Sheep, goat 

Ox 

Sheep, goat 

Ox, sheep, goat 
Sheep, goat 

Ox 


Sheep, goat 
Sheep 


Ox, sheep, goat 
Sheep, goat 
Ox 


Ox; sheep, goat 
Sheep, goat ¥ 
Sheep 


Ox, sheep, goat 
Sheep 

Sheep, goat 
Ox, sheep, goat 
Sheep 


Ox 
Ox, sheep 


99 99 


Habitat, 








Fourth stomach, small in- 
testine. 
Smal] intestine. 


9? 99 


99 99 
Large intestine. 


Small intestine. 


29 99 


Fourth stomach. 
Small intestine. 
Fourth stomach. 
Small intestine. 


Fourth stomach, small in- 
testine. 

(Esophagus. 

Fourth stomach. 

Small intestine. 

Large intestine. 








97 


1538 SYSTEM OF VETERINARY MEDICINE 


being parasitic gastro-enteritis, which is associated with species belonging 
to the genera Bunostomum, Haemonchus, Ostertagia, Cooperia, Nematodirus, 
and Trichostrongylus. This is probably one of the most important dis- 
eases of cattle and sheep, and is world-wide in its distribution. The 
other disease is cesophagostomiasis, due to members of the genus 
Csophagostomum. It is not common here, although in imported sheep 
it was often very prevalent. Practically all the species in the above 
groups have at some time or other been included in the genus Strongylus, 
and are thus often spoken of as strongyles of the alimentary tract. 

Ascaris vitulorum Goeze.—The male is from 15 to 24 centimetres long, 
and the female may reach 30 centimetres. It is usually found in the 
small intestine, and more rarely in the fourth stomach of calves, where, 
if numerous, it may give rise to symptoms similar to ascariasis In the 
other animals. In some parts of France it is very prevalent, and appears 
to cause a disagreeable odour to the flesh of affected animals, which on 
this account are often condemned in meat inspection. 

Ascaris ovis Rud. measures 5 to 7 centimetres long in the male, and 
8 to 15 centimetres in the female. It must be regarded as a rare and 
unimportant species. Some authors question its validity as a distant 
species. | 

Bunostomum trigonocephalum (Rud.), (Strongylus trigonocephalus Rud.). 
There is a well-marked mouth capsule, with teeth. The female is from 
19 to 26 millimetres in length, and the male 12 to 17 millimetres. The 
ribs of the bursa come prominently off from the three common trunks— 
viz., two lateral and a dorsal. The externo-dorsal rays are asymmetrical, 
the right one being much longer and branching from the parent trunk, 
higher up than the left. It is a blood-sucker. B. phlebotomus Raillet 
(Strongylus radvatus Rud.) of the ox is smaller than the above species, 
the male being 10 to 12 millimetres long, and the female 16 to 19 milli- 
metres. Both of these species are pathogenic to their hosts. 

Chabertra ovina (Fabr.), (Strongylus ovinus Fabr., S. hypostomus Rud.). 
—The buccal capsule is large, and has no teeth; the head is bent so that 
the mouth faces the antero-ventral aspect. The male is about 14 milli- 
metres long. The ventro-ventral and latero-ventral rays are Closely 
opposed; the externo-lateral is thick; the medio-lateral and postero- 
lateral are thin and opposed to each other; then comes the externo-dorsal 
ray; the dorsal trunk is bifurcated, and each ray is again split, the inner 
branch being the longer in each case. The female measures 20 milli- . 
metres in length, and has the vulva justin front of the anus. Thisisa very 
common species, and does not appear to produce disease. 

Esophagostomum columbvanum (Curtice)—The mouth capsule is 


PARASITES AND PARASITIC DISEASES 1539 


small; the cuticle around the mouth is swollen, and then constricted. 
Behind this are the lateral membranes. The male is from 14 to 16 milli- 
metres in length, and has the rays of the bursa disposed very similarly 
to the above species, save that the externo-dorsal ray is undulated. The 
female is from 15 to 18 millimetres long, and has the vulva a short dis- 
tance in front of the anus. Records of this worm from the ox appear 
to be misdeterminations. 

(Esophagostomum radiatum (Rud.), (Strongylus radvatus Rud., S. infla- 
tum Schneid.) closely resembles the previous species; the male is from 14 
to 17 millimetres in length, and has a protuberance on the postero-lateral 
ray. The female reaches 22 millimetres in length, and has the tail ven- 
trally curved. This species is confined to the ox. 

(sophagostomum venulosum (Rud.),(Strongylus venulosus[Rud.]), occurs 
_in the sheep here; the lateral membranes are very narrow. The male is 
12 to 16 millimetres long, and the bursal rays are similar to the above 
species, but thicker. The female measures up to 22 millimetres. 

Hemonchus contortus (Rud.), (Strongylus contortus Rud.).—The mouth 
cavity 1s small, and not in the form of a buccal capsule. Both sexes vary 
sreatly in length; the male is from 10 to 20 millimetres long. The bursa 
consists of two large lateral lobes and a small dorsal lobe, which is not 
median, but attached to a lateral lobe, and supported by a ,-shaped ray. 
The lateral lobes have six rays each. The female is 18 to 30 millimetres 
in length; the vulva is 3 to 5 millimetres from the posterior extremity, 
and is protected by a tongue-like process, giving the side view a notched 
appearance. It is a common parasite of the abomasum and small intes- 
tine of cattle and sheep in this and other countries. When numerous, it 
is responsible for serious losses. 

Ostertagia circumcincta (Stadel.), (Strongylus circumcinctus Stadel., 
S. cervicornis McK'ad.).—This species was discovered by Stadelmann in 
1894, and renamed by McFadyean in 1897. The members of this genus 
are thin and thread-like. The male is 7°5 to 8°5 millimetres in length. 
The two lateral lobes of the bursa are supported by six rays each. The 
median lobe is insignificant, and is supported by a ,-shaped dorsal ray, 
each arm of which gives off a short branch on both sides, so that it appears 
to be trifid. The female is from 9 to 12 millimetres long; the vulva is 
about 2 millimetres from the posterior extremity, and appears to be 
notched as in Hemonchus contortus. 

Ostertagia ostertagia (Stiles), (Strongylus convolutus Ostertag).—This 
species is somewhat smaller than the preceding, the male being from 
6:5 to 7°5 millimetres long, with each branch of the dorsal ray split at its 
extremity. The female measures 8 to 9 millimetres in length, the vulva 


1540 SYSTEM OF VETERINARY MEDICINE 


is 1:5 millimetres from the tail-tip, and there is a flap of cuticle round the 
body at this point. This structure serves to distinguish it from the 
female of the previous species. Whereas O. circumcincta may be found 
in cattle and sheep, it seems possible that the one now under considera- 
tion is confined to the ox. From America Ransom has described 
O. occidentalis, O. marshalla, and O. trifurcata. |The EKuropean forms are 
pathogenic to their hosts. 

Cooperva oncophora (Raillet), (Strongylus oncophorus [Raillet], S. ventri- 
cosus [Rud.]).—The mouth cavity is small, and the skin of the head is 
transversely striated and swollen. The male is from 5 to 9 millimetres 
in length, and has two large lateral lobes to the bursa; the dorsal lobe is 
small, and has an incision on the middle line. The ventral rays turn 
towards the head, and the externo-lateral ray is very broad. The dorsal 
trunk is ,-shaped, each arm being bifid at its extremity, and giving rise 
to a short forward projecting branch on its course. The female is 6 to 
8 millimetres long, and has the vulva about 2 millimetres from the tail-tip. 
In this country it occurs most often in calves, but is also sometimes found 
in sheep. Other species are C. curticer Raillet, C. punctata Linst., and 
C. pectinata Ransom. 

Nematodirus fillicollis (Rud.), (Strongylus fillecollis Rud.).—The cuticle 
of the head is slightly inflated and transversely striated. The male is 
from 8 to 15 millimetres long. The dorsal lobe of the bursa is deeply 
notched, appearing as if the lobe itself were absent, with additions to the 
lateral lobes. Hach of these small additional portions is supported by 
a ray with a bifid extremity, and which joins the externo-dorsal ray. 
The lateral lobes are supported by six rays, the two ventral rays being 
close together, then the three lateral, and then the externo-dorsal. The 
spicules are long, and united at their tip. The female measures 12 to 
20 millimetres in length, and the vulva is placed at about 4 to 6 milli- 
metres from the posterior extremity, which is blunt. The body becomes 
visibly narrower behind the vulva. It is a widely distributed species. 

Trichostrongylus axer (Cobbold), (Strongylus gracilis McFad., S. ex- 
tenuatus Raillet).—This species was discovered by Cobbold in 1886, and 
redescribed by McFadyean in 1896. All the members of this genus are 
small and slender, and have an insignificant mouth cavity. The male is 
from 3°5 to 4:5 millimetres in length. The lateral lobes are compara- 
tively large, and the median lobe is practically absent. The ventro- 
ventral ray is slender, but all the others are fairly strong. The dorsal 
trunk is long, and divided at its extremity, each short arm being also 
bifid. The female is 4:5 to 5 millimetres long, and the vulva is about 
1 millimetre from the tip of the tail. It is a comparatively common and 


PARASITES AND PARASITIC DISEASES 1541 


injurious species, and is often associated with other members of its own 
or other genera. A number of other species are recognised, such as 
T. instabilis Raillet, T. probolurus Raillet, 7. vitrinus Looss, which may 
affect man, 7’. colubriformis (Giles), and 7. capricola Ransom. 

Gongylonema scutatum Miller has already been noticed (p. 1529). 
It is found in the esophagus of cattle or sheep, and often renders this 
part unmarketable. 

Gongylonema verrucosum (Giles) has been recorded from the stomach 
of the sheep in India, where it causes gallery formations in the mucous 
membrane. 

Strongyloides papillosus (Wed].).—This is a thin, hair-like species, of 
which there are two generations—viz., one parasitic and the other free 
living. The parasitic generation is composed of parthenogenetic females, 
which give rise to eggs. These hatch into, on the one hand, free-living 
males and females, and, on the other, into larve; and the latter, if taken 
in the host by the mouth or skin develop into the parasitic females. 
The free-living females give rise to embryos, which may enter the host, 
and thus also become parasitic females. The bowel forms are 3 to 6 
millimetres in length, and may be confused with the smaller tricho- 
strongyles. 

Trichuris ovis (Abildg.), (Lrichocephalus ovis Abildg., T. affinis Rud.).— 
The anterior portion of the body is very long and thin, and contains the 
cesophagus. The posterior portion is much thicker, and encloses the 
intestine and single reproductive organ. The posterior extremity is 
blunt and rounded. The male measures from 5 to 8 centimetres in 
length, and the thin portion of the body equals three-quarters of the whole 
length; the tail is spirally disposed. The female is about the same length 
as the male, and the anterior thin portion represents two-thirds of the 
body length. The vulva is at the junction of the two portions. The 
eggs are elliptical, with opercula at each end. The development is 
direct, the eggs hatching after ingestion. Itis world-wide in its distribu- 
tion, and occurs in a great number of ruminants, in which it usually has 
the head and neck buried in the mucous membrane of the cacum; but 
apparently it produces very little trouble. 

Trichinella spiralis (Owen) deserves only passing note. 

Capillaria bovis (Schnyd).—Members of this genus are often included 
in Trichosomum or Trichosoma. They resemble Trichurts in many 
respects, but the differentiation into anterior and posterior portions is 
not so marked, because they possess a very slender body. The male of 
the present species is 12 millimetres long, whilst the female measures 
20 millimetres. The eggs also resemble those of Trichuris, but are only 


1542 SYSTEM OF VETERINARY MEDICINE 


about half the size. The development is apparently the same—viz., 
direct after the ingestion of the eggs. Ransom has described two other 
species—viz., C’. brevipes and C. longipes. 

Gaigeria pachyscelis Raillet and Henry.—This species, which some- 
what resembles:a bunostome, has been recorded from India and Africa. 

Lirr-Historizs.—In the cesophagostomes the egg is segmented when 
laid, the embryo leaves the shell to become a larva in the presence of 
suitable conditions of moisture, temperature, etc. When ingested, the 
mucous membrane of the intestine is penetrated, and there is then pro- 
duced a nodule, which is at first small, and later becomes as large as a 
hazel-nut. The larva at first measures only 1 millimetre, and has been 
termed a strongyliform larva by Marotel; later, having developed, it 
becomes an ankylostomiform larva, and the final w@sophagostomiform larva 
gives rise to an asexual adult. The nodule is then vacated for the lumen 
of the bowel, where growth takes place, and both male and female become 
sexually adult. 

With slight variations, Hemonchus, Bunostomum, Ostertagia, Cooperia, 
Nematodirus, and Trichostrongylus have life-histories which conform to 
the following account, and this actually represents the life-cycle of the 
first-mentioned genus. The egg, when laid, is undergoing segmentation, 
and in the feeces of the host the embryo is liberated in a period varying 
from hours to weeks, according to the conditions of temperature and 
moisture. In the fecal matter the larva feeds, after another period 
develops a sheath, and lives upon its stored-up food material. This 
ensheathed larva is capable of withstanding dryness and low temperatures 
for several months, but above the temperature of 4'5° C. it is very active. 
When this degree of warmth exists, and in the presence of dew or rain, 
it ascends blades of vegetation. During conditions of dryness it again 
comes to rest. The encysted larva is eaten by the host, and becomes 
adult in about three weeks. Leiper has shown that Trichostrongylus 
pergracilis (Cobb.), already referred to (Vol. I., p. 457) as the cause of 
grouse disease, has a similar life-cycle. In Bunostomum there is the 
additional possibility of infection by way of the skin. Larval Ostertagia, 
when ingested, penetrate the surface of the mucous membrane, and 
become adult after two moultings. 

(Esophagostomiasis.—In the ox this is due to Msophagostomum 
radiatum, but in the sheep O. columbianum is chiefly responsible for the 
lesions. In sheep there is nothing very characteristic in the symptoms; 
the animals affected are of all ages, usually adults. There is anemia and 
emaciation, both of a gradually increasing type. Outward manifestations 
of the disease often occur in late summer, and if the infestation 1s not 
kept up, improvement takes place with the advent of spring. 


PARASITES AND PARASITIC DISEASES 1543 


In the ox a somewhat similar picture is seen, save that it is more 
rapid. Diarrhoea and emaciation become marked, and death may take 
place in a couple of months. | 

Lestons.—In sheep the larval forms are found in the nodules they 
produce. The large bowel, especially the cecum, is most liable to 
invasion; but the small one may sometimes be affected. Occasionally 
nodules may be found in the mesenteric lymphatic glands and the liver. 
The adult worms are free in the large bowel. In cattle the small bowel 
is most often the seat of lesions, and this would account for the usually 
more severe symptoms. The nodules vary in size from that of a barley- 
corn up to that of a nut. On section, they differ in colour from nearly 
black, with a lighter-coloured centre, to green, and even white, in the 
older lesions. They are usually situated in the submucosa, and there is 
enlargement, and even infection, of the mesenteric glands. The nodule 
usually contains a parasite. Infection is thought to take place in autumn, 
symptoms being shown during the next summer. There cannot be any 
satisfactory medicinal treatment for the disease, and prevention can 
only follow on general lines. 

Meat Insprction.—Infected wae known to butchers as “ pimply 
cut” or “ knotty ropes,” are useless for commercial purposes, and are 
eee Laatacetek 

Parasitic Gastro-Enteritis—The genera responsible for this disease 
have already been mentioned. In this country it is, however, more par- 
ticularly associated with Hamonchus contortus, Ostertagia circumcineta, 
O. ostertagia, and Trichostrongylus axet. The other groups are at times 
present, with clinical pictures suggesting injurious effects; thus, Cooperia 
oncophora has been shown to be numerous in some outbreaks of gastro- 
enteritisin calves. In cattle young animals are most likely to be attacked, 
and although the same usually applies to sheep, at times older animals 
are seriously infested, and especially is this so in pregnant ewes. 

Symproms.—These are somewhat similar in all ruminants, but the 
following remarks apply more especially to sheep: If lambs are running 
with the flock, they will often be noticed to be thriving badly, on account 
of the lack of the dams’ milk. There is nearly always diarrhcea, together 
with loss of flesh and appetite. The diarrhcea is often profuse, watery, 
and usually without any other visible discharges, such as mucus. With 
the rapid loss of flesh, the fleece along the back is elevated, harsh, and 
may finally become loose. The absence of appetite carries with it cessa- 
tion of rumination. Anemia, which is marked, is shown by pallor of 
the visible mucous membranes. (idema of the intermaxillary space is 
often noticeable. After a few days, the patient spends much time on the 


1544 SYSTEM OF VETERINARY MEDICINE 


ground, and all the symptoms become aggravated. In sheep: death 
often takes place in from three days to three weeks; but in calves the 
disease is not so acute. Bronchial worms very often coexist, and there 
are then corresponding thoracic symptoms. Liven in the pure gastro- 
enteritis there is, however, a few degrees of fever in the early stages. 
Lzstons.—The carcass shows all the indications of anemia and emacia- 
tion. The contents of the abomasum are usually very liquid, and some 
portions of the mucous membrane are highly coloured. Similar changes 
are seen in the duodenum. The most important feature is the discovery 
of the parasites, either in the fluid contents, in the mucus upon the 
mucous membrane, or embedded in the membrane itself. This can 
usually be accomplished by the dilution of a few drops of the material 
in a petri-dish, and examining in the dish or on a slide under the 23-inch 
lens. It should be remarked that a similar dispute has arisen here as 
in the case of grouse disease as to the actual cause of the disease. 
Although a few authorities blame micro-organisms, which have gained 
access to the tissues on account of the worm infestation, the majority 
seem convinced that the worms are the most important factor. 
DraGnosis.—This must depend upon a number of animals being 
affected with symptoms as described above, and by the demonstration of 
the parasites. An animal is nearly always available for post-mortem 
examination when the veterinarian is consulted. The fourth stomach 
should have both orifices ligatured before removal, and the viscus should, 
if possible, be examined when warm. In the absence of such an examina- 
tion, the disease is likely to be confused with a number of other conditions, 
such as scour from non-verminous causes, tuberculosis, Johne’s disease, 
and for the effects of some of the mineral or vegetable poisons. 
TREATMENT.—This is often most unsatisfactory in the simple- 
stomached animals, but the dilution to which medicants may be reduced 
in the ruminant’s stomach is an additional barrier. It is usually stated 
that it is best to give a drench, despite the present day popular feeling 
against this method of administration. The animal should be standing 
on all four legs. However, the following powder has been used with a 


varying degree of success: 


BR Acid. arseniosi is ee ah SRL. 
Sodii chlor. iy es 4 Beet hig 
P. ferri sulph. 3 st 4 be SAGE 
P. nucis arece di i oe ieugil. 
P. nucis vom. 7 ai - PUPAE 
M. ft. pulv. 


Sig.: To make thirty powders: Give one daily to an adult sheep. 


PARASITES AND PARASITIC DISEASES 1545 


Copper sulphate is extensively used in the Colonies, and so are some 
of the arsenic-containing sheep-dips. Dodd recommends the following: 


Copper sulphate .. Ap oe .. 4028. 
Fresh mustard... a #2 -. 4028. 
Mix well in rain-water vi ap .. 3 galls. 


Dissolve in an enamel) bucket. 


Dose for lambs: Three to six months of age, 2 ounces; six to nine 
months of age, 3 ounces; nine to twelve months of age, 34 to 4 ounces. 
To be given after a twenty-four-hour fast, and no water to be allowed 
on the days of drenching. 

For sheep the same mixture in 24 gallons of water, with a dose of 
4 ounces. 

For calves he advises 15 to 30 grains of copper sulphate in a quart of 
rain-water. 

In America a 1 per cent. solution of coal-tar creosote is recommended. 
The doses are as follows: Cattle—yearlings, 1 pint; calves, three to eight 
months old, 5 to 10 ounces. Sheep—twelve months and over, 3 to 5 
ounces; lambs, four to twelve months old, 2 to 4 ounces. 

A 1 per cent. solution of lysol in $-pint doses for sheep is recom- 
mended by McFadyean; but Haskell has recorded some untoward results 
following its use. 

Thymol, first made into a paste, then suspended in water, and 
followed by a purgative, is recommended by Brumpt. He gives a four 
months old lamb 31. of thymol in about # pint of water, and in about 
six hours allows a saline purgative. Caze claimed good results in sheep 
from the daily administration of a soup-ladleful of the following mix- 


ture: 


Oil of cade Ag ‘a a .. 50 parts. 
Oil of turpentine .. 7 He hah G0 Mamdiaes 
90 per cent. alcohol oe - RYE THe F0N 


Tobacco has been used by a number of practitioners, either in the 
green state or dry, but its employment is not very considerable. 

A rich and abundant diet is always important. Keeping the animals 
in a bare yard, where the faeces can be properly destroyed, and the food 
given from non-infected mangers, is advisable. 

PROPHYLAXIS.—The general remarks already made apply equally to 
gastero-enteritis. Apart from the dosing of affected animals, and on 
account of the many different species of animals that are likely to become 
invaded, preventive measures have to be drastic. If the parasite present 


1546 SYSTEM OF VETERINARY MEDICINE 


is one, such as Hemonchus contortus, which does not affect the horse, 
these animals may be turned on to infected pastures. Otherwise ‘a 
year’s rest from cattle, with surface dressings or a rotation of crops, will 
be necessary. 


3. Round Worms of the Alimentary Canal of the Pig. 


The round worms of the stomach and intestines of the pig are ap- 
parently not clinically important. This is explained by the fact that 
the pig rarely comes under the veterinarian for medicinal treatment. 
Ascaris suum, however, occasionally calls for remedial measures; and 
Trichinella spiralis is an important species from a public health point of 
view. 


Parasite. Habitat, 
Ascaris suum .. es my .. Small intestine. 
Arduenna strongylina .. -. .. Stomach. 
sy dentata edd ae af a 

Crassisoma urosubulatum Me .. Small intestine. 
Globocephalus longemucronatus a S 4 
Gnathostomum hispidium sf .. Stomach. 
Gongylonema scutatum .. % .. CXsophagus. 

i pulchrum : if 
sophagostomum dentatum & .. Large and small intestine. 
Physocephalus sexalatus by .. Stomach. 
Simondsia paradoza .... Se es ‘ 
Strongyloides suis - ap .. Small intestine. 
? Strongylus rubidus ... Pi .. Stomach. 
Trichinella spiralis i 0, .. Small intestine. 
Trichuvis suis .. Ap Y .. Cecum. 


Ascaris swum Goeze is from 15 to 17 centimetres long in the male, 
and 20 to 25 centimetres in the female. The average thickness is about 
3 millimetres in the former, and 5 millimetres in the latter. It is one of 
the commonest nematodes of swine in this country, especially young 
animals. 

Arduenna strongylina (Rud.), (Spiroptera strongylina Rud.).—The body 
is filiform, the mouth has two lips, and the cuticle is transversely striated. 
The male is from 10 to 15 millimetres in length, with an asymmetrical 
bursa, the right lobe of which is broader than the left. One spicule is 
short and the other long. The tip of the tailis coiled once. The female is 
from 16 to 22 millimetres in length, and the vulva is situated at about 
the middle of the body length. The egg contains a well-marked embryo 
at birth. Itis a widely distributed species. 

Arduenna dentata (Linst.) somewhat resembles the above worm, but is 


PARASITES AND PARASITIC DISEASES 1547 


larger, the males being from 25 to 35 millimetres in length, and the females 
40 to 55 millimetres. It appears at present to be confined to the East. 

Globocephalus longemucronatus (Molin).—There is a buccal capsule. 
The male is about 7 millimetres long, and has a small trilobed bursa, 
whilst the female attains 8 millimetres in length. 

Gnathostomum hispidium Fedtsh.—The body is furnished with 
cuticular appendages. The head is marked off from the rest of the 
body. There are two lips to the mouth. The male reaches 25 millimetres 
in length; the female 30 millimetres, and has the vulva at the middle of 
the body length. This worm attaches itself to the mucous membrane of 
the stomach, but is not a common species. It is also stated to have 
been found in the ox. ; 

Gongylonema scutatum (Miiller), already referred to on p. 1529, also 
occurs In the pig’s cesophagus. G. pulchrwm Molin is somewhat smaller 
than the above species. 

(sophagostomum dentatum (Rud.).—Unlike most members of this 
genus, the present species has a plain head and neck. The male is from 
8 to 12 millimetres in length, with a bursa somewhat similar to that of the 
ruminant cesophagostomes. The female attains a length of 15 milli- 
metres. Both the adult and larval forms are usually found in the large 
intestine, the former in its lumen, and the latter in nodules under the 
mucous membrane. It is comparatively common in this country. 

Physocephalus sexalatus (Molin).—There is a cuticular inflation sur- 
rounding the mouth and pharynx, which is followed by three wings on 
each side. The male is 6 to 9 millimetres in length, and has the tail 
spirally twisted, usually three times. The female reaches 19 millimetres 
in length, and its diameter behind the wings is least, from which point 
it increases, and is greatest at the posterior extremity. The vulva is 
just behind the middle of the body length. The egg when laid contains 
anembryo. It is apparently world-wide in its distribution. 

Strongyloides suis Lutz.—The parasitic females are 3°7 millimetres 
in length, and many of the remarks made concerning the species inhabit- 
ing ruminants apply equally to this parasite. 

? Strongylus rubidus Stiles and Hass. is a thin red worm of the stomach, 
whose actual genus has not yet been definitely ascertained. It is, how- 
ever, not a true Strongylus, but appears to be closely related to the 
trichostrongyles. The male is about 6 millimetres long, and the female 
is 2 millimetres longer. It occurs in this country, usually, however, in 
small numbers, and presumably without pathogenic effects. 

Trichuris surs (Schrank), (Trichocephalus crenatus Rud.).—This species 
closely resembles the other members of the genus. The male is 3 to 


1548 SYSTEM OF VETERINARY MEDICINE 


4 centimetres in length, of which the anterior thin portion occupies 
five-eights. The female attains 5 centimetres, and the thin portion 
occupies two-thirds of the total length. It is comparatively common in 
the pig’s cecum in England. 

Trichinella spiralis (Owen), Sumondsia paradoxa (Cobbold), and Cras- 
sisoma urosubulatum, deserve only to be mentioned, the former being fully 
dealt with in the next section, and the latter two on account of their 
unimportance. 

Ascariasis.— Ascaris suum may occasionally be so numerous as to 
completely occlude the small intestines, and many cases are on record 
of numbers of them having gained access to the liver by way of the bile 
duct. They may reach and penetrate its capsule, and thus be found free 
in the peritoneal cavity. Animals from six weeks to four months old 
are most often attacked, and oft-times a number of pigs are affected at 
the same time. 

Symproms.—There is: unthriftiness at first and rickets may coexist. 
After a while convulsions occur, usually at feeding-time. As the animal 
approaches the feeding-trough it foams at the mouth, trembles violently, 
staggers, and falls backwards; the fit may last from a few seconds to three 
or four minutes. Whilst on the ground kicking is violent, and the respira- 
tion is greatly accelerated. After an attack the animal may remain 
quiet in the corner of its stye, and if food is again approached a second 
convulsion may take place. Dulness and weakness of the hind-limbs 
may also be seen. 

Diacnosis.—This is usually not difficult, a post-mortem examination 
often being available; but when this is not so, the eggs may be demon- 
strated in the feces. They are 66 wu long, with a thick shell, which is 
covered with mammillate projections. 

TREATMENT.—For sucking-pigs calomel in milk alternated with castor 
oil is most useful. For weaned pigs Bru had good results with decorti- 
cated castor meal, calomel, powdered male shield fern, wormwood, and 
pomegranate seeds in milk or gruel, on an empty stomach, for three morn- 
ings. It is advisable to follow such a course of treatment by a saline 
purgative. Many of the anthelmintics used for the herbivora are unsuit- 
able for swine. . 

PREVENTION.—Apart from the difference in the roaming and feeding 
habits of the porcine host, the preventive measures will be on similar 
lines to those given under Ascariasis of the Horse (p. 1532). 

Parasitic Gastritis—It appears likely that Arduenna strongylina, 
A. dentata, and Physocephalus sexalatus, may cause important gastric 
lesions in the nature of intense inflammation and even ulcerations. The 


PARASITES AND PARASITIC DISEASES 1549 


worms are often found enveloped in mucus in such lesions. It has been 
pointed out by Foster that the holes caused by the parasites may allow 
the entrance of bacteria. These worms do enter the mucous membrane 
deeply, and the lesions mentioned above closely resemble those caused 
by Bacillus necrophorus. The further aspects of the condition are not 
well understood; this being so, remedial and preventive measures must 
follow general lines. 


4. Round Worms of the Alimentary Canal of the Dog and Cat. 

Apart from three or four species, the nematodes of the domesticated 
carnivora are not of great clinical importance. The following list con- 
tains most of the forms encountered: 























Parasite. Host, Habitat. 
Anchylostomum caninum. . .. | Dog and cat | Small intestine. 
Uncinaria stenocephala .. .. | Dog se it 
Belascaris marginata if ipl ise x 

nh cate “4 Ser wat Bs i 
Toxascaris limbata ae .. | Dog a a 
Gnathostomum spinigerum .. | Dog and cat | Stomach. 
Ollulanus tricuspis e wo Cat + 
Oxyuris compar & .. | 2Dogand cat | Large intestine. 

» vermicularis aes ae UOF ai - 
(Spiroptera) sanguinolenta 5 (Esophagus and stomach. 
Trichinella spiralis ie .. | Dog and cat | Small intestine. 
Trichosomum lineare a BEY: by i 
Trichuris depressiusculus iy ie bays Caecum. 
‘3 serratus ee hi Gat A 
| nk campanula le ae Ss e 


Anchylostomum caninum (Ercol.).—The body is of a whitish hue, and 
the buccal capsule has three curved teeth on each side. The male is from 
9 to 12 millimetres in length, the lateral lobes are well developed, and the 
dorsal one is small. Both ventral rays lie close together, the three lateral 
are well separated, the externo-dorsal projects into the lateral lobe, and 
the termino-dorsal divides near its tip into two short branches, each of 
which is again trifurcated. The female.is from 10 to 20 millimetres in 
length, with the vulva situated towards the posterior third of the body 
length. This species inhabits the small bowel of several wild carnivores 
besides the dog and cat. 

Uncinaria stenocephala (Raillet)—This worm is thinner than the pre- 
ceding; the mouth capsule has a chitinous plate on each side, and beneath 
this is a curved tooth. The male measures about 7 millimetres in length, 


1550 SYSTEM OF VETERINARY MEDICINE 


whilst the female attains 10 millimetres. This species often accompanies 
A. caninum, but is not found in the cat. 

Belascaris marginata (Rud.), (Ascaris marginata Rud.).—The body is 
whitish in colour, with widely separated striations; the cephalic wings are 
long and semi-lanceolate; and the posterior extremity is conical, with a 
rounded tip. The male is from 5 to 10 centimetres in length, and the 
caudal wings are hardly visible. The spicules are comparatively short — 
(750 to 950 w) and have rounded ends. The female measures 9 to 18 
centimetres, and has the vulva at the anterior quarter of the body length, 
and the uterine trunk is at least 2 centimetres long. This is a common 
parasite of the dog. 

Belascarts cata (Schrank), (Ascaris mystax Rud.).—The cephalic wings 
in this species are straight in front, and rounded as they join the body 
of the worm. The male is from 3 to 6 centimetres in length, and is often 
curled into an S. The posterior extremity is hollowed like a spoon, and 
there are distinct and straight caudal wings. The spicules are from 1°7 to 
1:9 millimetres long. The female is from 4 to 10 centimetres long, has the 
vulva at the anterior quarter of the body-length, and the uterine trunk 
is at least 2 centimetres long. This species is commonly parasitic in the 
small bowel of the cat; 1t mav be found in the stomach. 

Toxascaris limbata Raillet and Henry.—This species may show a 
trace of pink in its coloration. The body is plump, and the striations are 
closer together than in the previous two species. The cephalic wings are 
long and semi-lanceolate. The male is from 4 to 6 centimetres in length, 
without caudal wings, and the spicules measure from 1:2 to 1'5 millimetres. 
The female is from 6 to 10 centimetres in length, and has the vulva at the 
anterior third of the body length. The uterine trunk is at the most 
5 millimetres long. This is a common species of the dog. 

Gnathostomum spinigerum (Owen).—The cuticle of the head is covered 
by eight rows of chitinous leaves, and the anterior portion of the body 
has a number of tridental lamine of different shapes. The male measures 
5 millimetres in length and 0°5 millimetre in diameter, and has a spirally 
coiled tail. The female is about twice these dimensions, and has the vulva 
in the posterior half of body-length. It is a rare parasite of the mucous 
membrane of the stomach of the dog, cat, and man in the East, where it 
produces elevations up to the size of a walnut. 

Ollulanus tricuspis Leuck.—This minute worm attains only 1 milli- 
metre in length. The body is thick. The male has a bursa, the lateral 
lobes of which are supported by six rays. The female has three caudal 
points, is viviparous, and gives rise to comparatively large embryos. 
The adults are found in the substance of the gastric mucous membrane. 


PARASITES AND PARASITIC DISEASES 1551 


Some of the larval forms reach various organs, such as the pleura, dia- 
phragm, and lungs of the immediate host, where they become encysted 
and perish; others gain the exterior, and so reach the intestines of rats 
and mice. From here they pass to the muscles and become encysted. 
The ingestion of an affected rodent by a cat is thought to complete the 
life-cycle. Gastritis results from the adult worms, and the minute nodules 
in the lungs and other organs somewhat resemble tuberculosis. 

Oxyuris compar Leidy.—This is a rare worm of the cat’s small howel, 
and is from 8 to 15 millimetres long. Zurn stated that he found O. ver- 
micularis L., the common thread of children, in the intestine of a dog. It 
is, however, possible that some confusion has taken place with regard to 
this and the previous species. 

(Sprroptera) sanguinolenta Rud. is a red worm. The male is from 
3 to 5 centimetres in length, with a spirally twisted tail. The female 
attains 8 centimetres, and has the vulva situated 5 millimetres from the 
mouth. Besides the usual habitat—viz., in tumours of the cesophagus 
and stomach—they have been found in the lungs, lymphatic glands, and 
large arteries. The gastric elevations vary in size from that of a nut to 
that of a walnut, but are rarely numerous. The life-cycle is completed 
through the cockroach (Periplantea orientalis L.). The egg contains an 
embryo when laid, and the cockroach becomes infected from the dog’s 
feeces. Dogs infect themselves by the ingestion of larva-bearing beetles 
(Grassi). Symptoms are not often shown, but vomition is said to occur. 
Although prevalent in France and Italy, it is only occasionally met with 
here. 

Trinchinella sprralis (Owen) must occasionally occur in the small bowel, 
as the dog and cat have been shown to harbour the muscular form (see 
p. 1563). 

Trichosomum lineare Leidy has been recorded from the small intes- 
tineofthecat. Itisarare and small species, attaining about 8 millimetres 
in length. 

Trichuris depresswusculus (Rud.), (Trichocephalus depressiusculus Rud.). 
—This species closely resembles the other members of the same genus. 
The male is from 4°5 to 7°5 centimetres long, and the thin anterior portion 
occupies three-quarters of the total length. The female has approximately 
the same dimensions. Itis not uncommon in the dog’s cecum. It rarely 
gives rise to symptoms. The development is direct. Von Linstow has 
described two species from the cat—viz., T. serratus and T. campanula. 

Ankylostomiasis.—This disease is due to the effects of Anchylostomum 
caninum and Uncinarva stenocephala in the small intestine. Other names 
for the condition are “ uncinariosis,” “ hook-worm disease,” “‘ pernicious 


1552 SYSTEM OF VETERINARY MEDICINE 


anemia,” and “ bleeding from the nose.” The most serious results are 


seen in packs of hounds. 

Lire-History.—The segmented eggs reach the exterior in the feces, 
and in the presence of sufficient air, moisture, and temperature hatch in 
from three to six days. The resulting larva moults in about three days, 
and having enlarged moults again in about eight days more, and so be- 
comes ensheathed. Movement and feeding having ceased, the parasite, 
becomes very resistant to adverse circumstances, but when ingested con- 
tinues its development. In the stomach it remains on the mucous mem- 
brane for eight to ten days, and then moults. Ina few days more another 
moult takes place, and it becomes adult. Infection may also take place 
by the penetration of larve into the skin. In the general circulation they 
are arrested in the tissue of the lungs, whence they bore into the air-spaces, 
and so gain the trachea. Passing up this, they reach the pharynx and 
then are swallowed. From this point the development continues, as 
described above. 

Symptoms.—Afiected animals gradually become weak and anemic, 
then flesh is lost in spite of a constant appetite. Fatigue is marked and 
listlessness increases. The coat stares, and the skin becomes scaly and 
reddened. There may be patches of eruption at the thighs and nose. 
A muco-purulent discharge from the nose is then seen, and this becomes 
blood-stained; later blood is passed at irregular intervals. The limbs 
are swollen and cedematous, and the diarrhoea, skin lesions, and weakness 
now become exaggerated, and fits occur. The disease may last for two 
or three months and even longer. The anemia is so marked that the 
red cell count falls from 5,000,000 or 6,000,000 down to 1,500,000 or 
2,000,000. The leucocytes are increased in number. In the cat the 
symptoms are somewhat similar, with a persistent black -coloured 
diarrhoea and vomition. 

Lestons.—The alimentary lesions consist of hemorrhagic inflamma- 
tion of the small bowel, resulting from the attacks of the parasites. The 
two species of worms are often associated on post-mortem examination. 
There may be small isolated ulcerations. The intestinal wall may be 
thickened, and the mesenteric lymphatic glands enlarged. There are also 
present cedema of the limbs and general indications of wasting disease. 
The symptoms are usually apparent about two to four weeks aiter 
infection, according to its severity. On the Continent of Europe, and 
in certain parts of the United States, the disease appears to be 
prevalent. | 

Dsaenosis.—Although the disease resembles a number of others, the 
microscopic examination of the feces after a vermifuge has been given 


PARASITES AND PARASITIC DISEASES 1553 


should reveal the presence of numerous ellipsoidal eggs, 80 u long and 50 u 
in diameter. The smaller worm has slightly smaller ova. 

PROPHYLAXIS.—In kennels, where packs of hounds are kept, a new 
arrival should be isolated for a month, treated with vermicides, and the 
feeces then examined. In infected places isolation of the affected is 
essential. The kennel must be kept clean and dry, and the feeding- 
dishes cleaned thoroughly. The methods of infection—by way of the 
mouth and skin—must be kept in mind. Widespread disinfection and 
destruction of egg-containing feces are likewise important. 

TREATMENT.—After fasting and the exhibition of a laxative (calomel), 
Megnin used 40 to 60 grains of kamala with success. Arsenic in small 
doses improved its therapeutic action. Perroncito obtained good results 
with etherial extract of male shield fern. It may be combined with 
chloroform and castor oil. In a couple of days a saline is given in 
saturated chloroform water. Thymol, in 5 to 10 grain doses, is also 
recommended. Good feeding is essential, and this should be accom- 
panied by tonics and hygienic surroundings. 

Ascariasis.—In the dog this is due to Belascaris marginata and Toxas- 
caris limbata, and in the cat to Belascaris catt. In the dog it is an 
extremely common disease. Young animals are most likely to show 
symptoms, and old ones may harbour the parasite without any apparent 
symptoms. Puppies may become infected very soon after birth, and at 
an early age (fourteen to twenty-one days) may be found to harbour com- 
paratively large specimens. The majority of patients are, however, from 
one to four months old. It has previously been remarked that the worm’s 
life-history is direct—viz., by the ingestion of embryo-containing eggs. 
In sucking puppies this can, therefore, easily take place if the dam 
harbours the adult worms, and her mammary glands or bedding become 
soiled by egg-containing feces. Similar remarks apply to the cat, save 
that, as a general rule, the host is not so much disturbed. 

Symptoms.—An affected puppy usually does not thrive or grow well, 
and generally eats voraciously. The breath is foetid and the anus may 
be rubbed along the ground. The abdomen may become distended— 
“ pot-bellied.” Later there is an unthrifty coat, flesh is lost, and the 
appetite becomes irregular. If a great number of worms are present, 
there is a catarrhal enteritis, which is shown by diarrheea. In a number 
of cases the animal may vomit any worms which may have reached the 
stomach, and more rarely the parasites are passed per anum. The 
temperament seems to be altered in the direction of becoming unpleasant 
and snappy. Insome cases there are convulsions, and less often paralysis 
of the hind-limbs. Tf very numerous, impaction of the bowel occurs, with 

VOL, I. 98 


1554 | SYSTEM OF VETERINARY MEDICINE 


its consequent indications of abdominal pain may result. On post- 
mortem examination invagination of the small bowel into the colon may 
be accompanied by a great number of ascarides. 

Dracnosis.—Inasmuch as vermicide treatment is so often offered to 
puppies, this is rarely seriously attempted after the clinical picture has 
been reviewed. The feces, however, can often be shown on microscopic 
examination to contain ova. In Tozxascaris the ova measure about 80 wu 
in diameter, and have a thick, smooth shell; in Belascaris they are a little 
smaller and the shell is finely alveolated. 

TREATMENT.—This is not always satisfactory. In full-grown dogs, 
santonin, male shield fern, and freshly powdered areca nut, in a suitable 
adjuvant, is a common prescription. Laxatives and fasting are ordered 
before treatment, and a purgative is given after it. American wormseed 
oil (chenopodium) has practically displaced santonin at many practitioners 
hands, on account of the dangers of that drug, especially to young animals. 
For puppies under two months old, the following mixture is recommended : 
Wormseed oil, oil of aniseed, and spirits of nitrous ether, 4 ounce each; 
oil of turpentine, 4 drachm; castor oil and olive oil, 54 ounces of each. 
For medium-sized puppies under six weeks of age, give 4 drachm in a 
little milk; for eight weeks old puppies give 1 drachm. If the bowels 
do not soon act, give a little castor oil. The dose may be repeated in 
a couple of days. Toy breeds take about a quarter of the above doses. 
The cat requires small doses of the above mixture. 

For puppies older than eight weeks, Wallis Hoare mentions the 
following: 


B Ol. chenopodii.. rf a rae 2A 
Pulv. santonini .. i xs Pay EAI 
Chloroformi Wi ee ee SWE He. 
Sp. eth. nit. al = aT SER cit 
Ol. terebinth. 8 ie! ts ; elie 
Ol. anisi .. iba if, bys hones 
Ol. ricini .. a cit be ase 
Ol. olive. . A + AF MOEA 


M. ft. mist. Sig.: Give 31. in 31. of castor oil. 


If the bowels do not act within four hours, give castor oil Z11. Repeat 
the mixture if worms are not then voided within two hours. Allowing 
Zi. for a three months puppy, increase it by half for every three months, 
up to the age of twelve months. Small breeds take a fourth of these 
doses. 

For adult dogs he advises the following: 


PARASITES AND PARASITIC DISEASES 1555 
BR Ol chenopodii 


OV. 
Thymol .. Sil. 
Adther sulph. my a . 3 ABs 
Chloroformi at 4) a Jaca) 
Ol. ricini .. ad 3vlil.ss. 


M. ft. mist. Sig.: Give 3ss. to 3ii. in castor oil, according to the 
size of the patient. 


PREVENTION.—What has been said in this respect under hook-worm 
disease applies equally well here, save that the consequences of any neg- 
lected precautions are not quite so serious. Careful attention in the form 
of treatment should be given to brood bitches before they become heavily 
pregnant, and if they are suspected to harbour ascarides at full term, the 
perineum and mammary glands should be washed and disinfected, care 


being taken not to cause the latter organs to be left with an unpleasant 
taste or smell. 


BIBLIOGRAPHY. 


Bru: Sur les Convulsions d’ Origine Vermineuse chez le Porcelet. Revue Vétéri- 
naire, 1909, p. 212. 


CazE: Gastro-Intestinal Strongylosis in Sheep. Veterinary Record. Vol. xxi., 
1909, p. 745. 

CoBBOLD: Parasites: A Treatise on the Entozoa of Man and Animals. London, 
1879. 

Dopp: Stomach Worms in Sheep. Department of Agriculture and Stock, 
Queensland. Bulletein 1, 1908. 

Foster: The Round Worms of Domestic Swine. U.S. Department of Agriculture. 
Bureau of Animal Industry.’ Bulletein 158. Washington, 1912. 

Gites: A New Schlerostome from the Large Intestine of Mules. Scientific 
Memoirs by Medical Officers of the Indian Army, 1892. 

GREm™: The Ascaris megalocephala. Veterinary Record. Vol. xxiv., 1912, p. 582. 

HASKELL: Parasitic Gastritis in Sheep. Veterinary Record. Vol. xxiv., 1909, 

. 473. 

ee, Proceedings of National Veterinary Medical Association, 1911. 

Some New Parasitic Nematodes from Tropical Africa. Proceedings of the 

Zoological Society of London, 1911, p. 551. 

——-— The Bionomics of Trichostrongylus pergracilis (Cobbold). The Grouse in 
Health and Disease. London, 1911. 

—-_— Two New Genera of Nematodes occasionally Parasitic in Man. British 
Medical Journal, June 1, 1907. 

A New Cylicostome from the Horse in London. Veterinary Journal. 

Vol. xx., 1913, p. 460. 

Looss: Die Sclerostomen der Pferde und Esel in Egypten. Centralblatt fiir Bak., 
Parasitenkunde und Infek. Band xxvii., pp. 154 and 184. 

MirteR: A Résumé of our Knowledge on the Occurrence of Gnathostomum 
spinigerum in India, and its Relation to a Similar Parasite found in Man. Veteri- 
nary Journal. Vol. xix., 1912, p. 687. 

PILLERS: The Ascarides of the Domesticated Animals. Veterinary Record. 
Vol. xxiii., 1910, p. 158. 

Cooperia oncophora in Diarrhceic Calves. Idem. Vol. xxv., 1912, p. 305. 

———— On the Presence of Ascarides in the Peritoneal Cavity. Veterinary 
News. Vol. ix., 1912, p. 605. 











1556 SYSTEM OF VETERINARY MEDICINE 


RAILLET AND HENRY: Sur la Classification des Strongylide. Comptes Rendus 
de la Soc. de Biol. Tome Ixvi., 1909, pp. 87 and 168. 

Recherches sur les Ascarides des Carnivores. Idem. Tome Ixx., 1911, 
Novi p12. 

—_—— Quelques Helminthes Nouveaux on peu connus du Groupe des Bunos- 
tomiens. Bulletin de la Soc. de Pathologie. Exotique. Vol. iii., 1910, 

. 311. 

eae The Nematodes Parasitic in the Alimentary Tract of Cattle, Sheep, 
and Other Ruminants. U.S. Department of Agriculture. Bureau of Animal 
Industry. Bulletin 127. 

The Life-History of a Parasitic Nematode (Hebronema musce). Science, 
N.S. Vol. xxxiv. 

WALLIS Hoare: Parasitic Gastritis in a Mare. Veterinary Record. Vol. xxiii, 
1910) pi251- 

Veterinary Therapeutics. London, 1908, p. 725. 











(C) Helminthiasis of the Muscular and Other Tissues. 


The nematodes found in the muscular and other tissues are not so 
important, clinically speaking, as the two groups that have just been 
considered. Some demand attention in meat inspection. From the point 
of view of the practitioner little can be done by medication when symp- 
toms are shown, and only in a few cases is surgical interference satis- 
factory. Apart from the linguatules, leeches, bladder worms, tape- 
worms, and trematodes, which have received consideration elsewhere, a 
number of nematodes, already mentioned in the two last subsections, 
may also occur in various parts of the body. In the horse, Strongylus 
equinus, S. edentatus, and S. vulgaris, may be found underneath the 
parietal peritoneum, and the latter is common in the anterior mesen- 
teric artery. In the pig, Ascarzs swum is often seen in the liver; and 
Hemostrongylus vasorum of the dog’s arteries has been described under 
the subsection on Respiratory Worms. Ollulanus tricuspis, of which 
mention was made when discussing the alimentary parasites of the cat, 
may occur in the muscles of that animal. Quite a number of the para- 
sitic nematodes of the muscles and connective tissues are not confined 
to one host, and a great many of them belong to genera included in the 
family Filaride. The table on p. 1557 shows some of the most important 
forms, their hosts, and habitats. 

Dioctophyme renalis (Goeze), (D.visceralrs Collet-Mey, Strongylus gigas 
Rud., Hustrongylus gigas Dies.).—This is one of the largest of the nema- 
todes, and is of reddish-brown colour. The male is from 20 to 40 centi- 
metres in length, and about 6 millimetres in diameter. The female may 
measure more than twice these dimensions. The eggs are about 68 pu 
long and 40 yw in diameter, and the envelope is covered with a number 
of small depressions. The adult worm is found in the kidney of the 


PARASITES AND PARASITIC DISEASES 1557 


horse, ox, pig, dog, man, and a number of other mammals, where it 
causes destruction of the organ, with consequent pain and blood-stained 
urine. There is usually only one parasite present, and the unaffected 
kidney undergoes hypertrophy. Occasionally they leave the kidney by 
way of the ureter, and gain the bladder, to be expelled at micturition. 
It is a comparatively rare species, and a number of important points in 
its bionomics are unknown. 














Species. Host. Habitat. 
Dioctophyme renalis .. | Horse, ox, pig, dog Kidney 
Dermofilaria irritans .. | Horse, ass Skin wounds 
Dracunculus medinensis Horse, ox, dog Subcutaneous tissue 
Setaria ilaria equina .. | Horse, ox Peritoneal cavity 
S. Labiatopapillosa 5 gO Peritoneal cavity 
Filaria multipapillosa .. | Horse, ass Subcutaneous tissue 
F. inermis of, -. | Horse Vitreous humour 
F.. recondita is .. | Dog Blood 
F. trispinulosa .. ee WO Vitreous humour 
FP. vmmitis be ae Og Heart 
Oncocerca reticulata .. | Horse Suspensory ligament 
O. cervicalis me .. | Horse Ligamentum nuche 
O. lienalis “4 Ley ial 3p. < Subcutaneous tissue 
O. gutturosa re Rea CX: Subcutaneous tissue 
O.armillatta .. aaah Ox Aortic walls 
O. capre .. ag .. | Goat Tongue 
Thelazia lachrymalis .. | Horse 
pel hades 3 ass (BOX | Excretory ducts of lachry- 
T. gulosa sy rsx ee tarde 
T.alfortensis .. ins wOx | 8 
T.callipeda .. .. | Dog 
Stephanurus dentatus .. | Pig Perinephritic adipose tissue 
Trichosomum plica 2.42 Dog Bladder 
T. felis catr ele .. | Cat Bladder 
Trichinella spiralis .. | Pig, ox, sheep, dog, cat | Larve in muscular tissues 








Dermofilaria irritans Rivolta (Fdarva orritans [Rivolta]).—At present 
this species is known only by a larval form, which is about 3 millimetres 
in length, and has a very slender body. Itis found in summer or granular 
sores, or granular dermatitis of the horse and ass. Apparently ordinary 
wounds are infected during summer, and they become covered with 
reddish-brown granulations, which have a tendency to spread. They 
vary in size up to that of a pea, and may be on any part of the body. 
There is great local pruritus, and affected animals bite, rub, and other- 
wise greatly aggravate the lesions. The condition persists usually for 
months, and may show caseous and calcareous areas. The therapeutic 
aspect of the disease is most unsatisfactory, and all that can be done is 
to allay the irritation and resort to surgical dressings. The countries 


1558 SYSTEM OF VETERINARY MEDICINE 


where the parasite appears to be most prevalent are hot regions, such as 
Italy and Algeria. ? 

Dracunculus medinensis (L.), (Falarva medinensis L.).—This is a very 
long species, the female measuring from 50 to 80 centimetres, but only 
about 1 to 1°5 millimetres in diameter. The adult female has no vulva, 
and the embryos gain the exterior by rupture of her body-wall. In water 
they reach the cavity of Cyclops coronatus by way of the latter’s annular 
interstices. When this crustacean is taken into the alimentary canal in 
drinking-water, the larval worm is carried to its habitat underneath the 
skin. The male worm is comparatively small. The guinea worm is 
prevalent in Africa, and has been recorded from South America and 
India. Dracontiasis in the lower animals appears to be most prevalent 
in the dog, although the horse and ox are sometimes affected. The 
worm is generally situated underneath the skin of one of the limbs, and 
gives rise to elongated cord-like swelling. This gradually becomes 
extremely painful, and a number of purulent foci appear. The number 
of parasites present varies from one to four or five. In man the rupture 
of the female at the time of extraction is said to be followed by serious 
consequences, but this does not appear to be so in the dog. The treat- 
ment adopted is usually surgical removal. 

Setarva equina (Abildg.), (F. papillosa Rud., Filaria equina Abildg.), 
—This species has the body white in colour, and finely striated in a 
transverse manner. The male is from 6 to 8 centimetres long, and 
0°5 millimetre thick, with a spirally coiled tail. The female is about 
twice these dimensions, viviparous, and terminates in a blunt promi- 
nence. The normal habitat of this species is the peritoneal cavity of 
the horse and ass, where it is often attached to the outer covering of the 
large bowels. It has also been found in the scrotal sac and arachnoid 
space of the spinal cord. Symptoms are rarely shown. The female is 
viviparous, but the evolution is not known for certain. At different 
times F’. sanguinis equi—a minute worm—has been recorded from the 
blood of animals, which on post-mortem examination harboured the species 
now under consideration in the peritoneal cavity. Baruchello reported 
an outbreak of small tumours on the neck, withers, and tail of horses, in 
which he found small nematodes from 5 to 15 millimetres long, and a 
number of these animals had great quantities of S. equina in the peri- 
toneal cavity in post-mortem examination. He assumed this was a 
further step in the life-history of the species. In India and other 
countries an intra-ocular filariasis is met with. The worm present is 
of a reddish colour, the males measure about 30 millimetres in length, 
and the females are a little longer. By some it is often spoken of as 


PARASITES AND PARASITIC DISEASES 1559 


a distinct species (fF. oculi, F. pellucida), and by others it is regarded as 
an immature form of S. equina. Its presence is manifested by epiphora, 
photophobia, and conjunctivitis. Treatment consists of puncturing the 
cornea when the worm is seen to be active. Presumably, the inter- 
ference of an insect, as described for F. zmmuitis (p. 1560), is necessary 
for the completion of the life-cycle. Apparently this species has also 
been found in the ox. Itis not common in England. 

Filarva inermis Grassi, found in the ball of the eye, is often con- 
founded with the previous species, and possibly some of the records of 
S. equina from the eye refer to this species. 

Filaria multipapillosa Cond. and Drou. (F. hemorrhagica Raillet) 
measures 28 millimetres in the male, and the female is about twice this 
length. It is a parasite of the subcutaneous tissue of equines. The 
lesions usually consist of hard and painless elevations, which rupture 
and give rise to a flow of blood, hence the terms “ hemathydrosis ” and 
“parasitic cutaneous hemorrhage.” The elevations are most often seen 
on the neck, shoulders, and sides of the chest, and are not numerous. 
It is usually an unimportant condition. 

Setaria labiatopapillosa (Aless.), (F. cervina Dies., Filaria labiato- 
papillosa Aless.), closely resembles S. equina. The female, however, 
terminates in a number of papille. It is found chiefly in the peritoneal 
cavity of cattle and a number of species of deer. The worm found in 
the eyeball is thought to belong to this species. It is not an important 
worm. | 

Filaria recondita Grassii—The adult female is stated to have been 
found in the fat of the hilum of the dog’s kidney. It was 3 centimetres 
long. The larval forms, however, are found in great numbers in the 
blood in various hot countries. A drop of blood may contain from three 
to fifteen of them, and 30,000 to 50,000 may thus occur in one host. 
Apparently, these larval forms may be taken up by the dog flea (Cteno- 
cephalus canis), the human flea (Pulex irritans), and even the tick (Rhipi- 
cephalus sanguineus), and in them undergo changes until the final host 
is reached. The forms found in the blood are approximately 280 wu long 
and 5 w in diameter, and are often designated Hamatozoon lewist. 

Filaria trispinulosa Dies. was found in the ocular globe of the dog 
by Gescheidt. It measured 7 millimetres, and he called it F. oculs canine. 

Filaria immatis Leidy (Dirofilaria tmmatis [Leidy ]).—The body is thin, 
and white in colour; the mouth is small, round, unarmed, and furnished 
with six papille. The male is 12 to 18 centimetres long, and about 
8 millimetres thick. The posterior extremity is coiled into a spiral. The 
female is approximately twice these dimensions, has the vulva only 


1560 SYSTEM OF VETERINARY MEDICINE 


7 millimetres from the mouth, and is viviparous. The normal habitats 
are the right ventricle, auricle, and pulmonary artery of the dog. 
It is most prevalent in China and Japan, but also occurs in Kurope, 
the United States, South America, and other hot countries. The 
embryo hatch in the uterus of the female, and then gain the general 
circulation, where they measure 290 uw long and 5 w in diameter. 
They appear to be more numerous in the blood at night than during 
the day. Ifa dog harbouring these immature forms is bitten by a 
mosquito, they are taken into the fly’s stomach with the ingested 
blood. From here the larve migrate into the gnat’s Malpighian 
tubes, and after a series of changes become free in the cavity of the 
insect. In the end they gain the labium, from which they escape by 
rupture of its sheath into the wound inflicted in the act of biting. Once 
in the blood, the larva, which is nearly 1 millimetre long, arrives at the 
heart, and becomes adult. A great number of mosquitoes have been 
shown to be capable of transmitting F. immitis, amongst the chief of 
which are Anopheles maculipennis, A. bifurcatus, and Culex penicillaris. 
The symptoms shown by animals harbouring the adult worm are ex- 
tremely variable. More often than not, the presence of hematic filariasis 
is hardly suggested. Sometimes convulsions are followed by death. 
The most typical picture is dulness, weakness, cardiac embarrassment, 
with dropsy and fits. A number of animals, especially Great Danes, 
show lameness of one of the hind-limbs. The presence of the larvee in 
the blood may give rise to inflammatory conditions of a number of 
organs, especially the kidneys and bladder. The demonstration of the 
micro-filarize in the peripheral blood taken at night-time insures a correct 
diagnosis. Medicinal treatment is at present practically useless, and 
preventive measures have for their aim the isolation of healthy dogs 
from mosquito bites, also infected dogs, and the destruction of larva- 
bearing insects. In China great numbers of imported dogs are killed 
by the disease. 

Oncocerca reticulata (Dies.), (Filaria reticulata Crepl., Spiroptera 
reticulata Raillet)—This worm is found embedded in small nodules of 
fibrous tissue in the connective tissues of the horse’s fore-limbs below 
the carpus. Its commonest seats are the bifurcation of the suspensory 
ligament and the flexor tendons. The exact length of the adults is not 
definitely known, because the worms can only be removed from their 
“nests”? piecemeal. The female is approximately 40 to 50 centimetres 
long, and 0°4 millimetre in thickness; and the male is about half these 
dimensions. The female is ovoviviparous. They are prevalent in parts 
of France, Austria, and Russia, but have only been recorded here on one 


PARASITES AND PARASITIC DISEASES 1561 


or two occasions. The worm-nests or tumours are usually small, but 
sometimes reach a diameter of 2 to 5 centimetres. They are often 
ovoid in shape, fibrous in consistence, and, when cut, show a yellowish 
surface, in which the outline of the sections of the worm may be visible. 
Old lesions become impregnated with lime salts. Symptoms are not 
often shown. When deep-seated, the nodules may simulate the changes 
in sprained tendon or ligament, and there may be lameness. If the 
tumour is superficial, it may resemble some forms of wind-galls. 

Oncocerca cervicalis Raillet and Henry is another equine species, 
which was previously confused with the foregoing. It causes similar 
fibrous changes, but is found in the ligamentum nuche. 

Oncocerca lenalis (Stiles), (O. reticulata [Dies.], O. gibsoni [Cleland], 
Filaria gibsont Cleland, Spiroptera reticulata Raillet)—This species 
causes in cattle very similar lesions to those which have been described 
above for O. reticulata. For this reason they were formerly regarded as 
one and the same species in different hosts. In cattle, however, the com- 
monest seats of the worm-nests are in the subcutaneous and intermuscular 
tissues of the brisket. They may occur in other situations. The nodules 
vary in size from that of a pea to that of a walnut, and if subcutaneous, 
may be visible in the living animal. It has been found extensively in 
cattle from Australia, the United States of America, and other countries. 
Although these parasites have attracted considerable attention in meat- 
inspection circles, they do not appear to be a very important group, 
and numerous points in their bionomics still require to be elucidated. 

Oncocerca gutturosa Neum. is also a bovine species, which has been 
figured by Neumann. From the tissues at the junction of the internal 
and middle coats of the aorta of cattle in India and Sumatra, Raillet and 
Henry have described O. armillattus. During his investigations into the 
diseases of camels in India, Leese discovered worm-nests in the subcu- 
taneous tissue of the head of a camel, which Raillet and Henry specified 
as O. fasciata. 

Oncocerca capre Linst. has been recorded from the tongue of the 
goat. 

Thelazia lachrymalis (Gurlt), (Filaria lachrymalis Gurlt, F. palpe- 
bralis Wilson).—The body is white and transversely striated, and the 
mouth capsule is small. The male, which has almost equal spicules, 
measures 10 millimetres, whilst the female is 16 millimetres, long. This 
species is found in the excretory ducts of the lachrymal glands, and on 
the conjunctiva of the horse’s eye. The disease produced is usually spoken 
of as verminous conjunctivitis. The symptoms shown vary from a slight 
to a severe conjunctivitis. In most cases there may be opacity and 


1562 SYSTEM OF VETERINARY MEDICINE 


ulceration of the cornea. When the lids are everted, the worms may be 
seen actively crossing the mucous membrane. Treatment consists of 
removing the worms with the forceps, and irrigation of the organ with 
sedative and antiseptic collyria. 

Thelazia rhodesi (Desm.), (Filaria lachrymalis Raillet, F. palpebrarum 
Raillet).—This species is notable on account of the depth of its trans- 
verse striations, which give it an almost denticulated appearance. The 
male, which has unequal spicules, is from 8 to 12 millimetres long, and 
the female measures 12 to 18 millimetres. 

Thelazia gulosa Raillet and Henry is somewhat smaller than the 
last species, but the transverse striations are very fine. The same 
authorities have described a further species—T. alfortensis. The above 
three worms are found in the excretory ducts of the lachrymal glands 
of the ox. They appear to be prevalent in France, and produce an 
analogous condition in cattle to that described in the case of the horse, 
save that the disease is, perhaps, a little more severe. 

Thelazia callupeda Raillet and Henry.—This species was found under 
the nictitating membrane of a dog’s eye in India by Dale. 

Stephanurus dentatus Dies. (Sclerostoma pinguicola Verrill).—The 
body is plump, and may appear tricoloured, due to the tints of the cutis, 
reproductive organs, and contents of the alimentary canal. The mouth 
is furnished with a chitinous boundary, which has six small tooth-like 
prominences. The male measures 20 to 30 millimetres in length, and 
has a multilobed caudal bursa. The female attains 30 to 40 millimetres 
in length. It appears to be common in the United States, and also 
occurs in Australia and Brazil. Although it has been found in the 
mesentery and fat surrounding the abdominal viscera, its normal habitat 
appears to be in the adipose tissue enveloping the kidney of the pig. 
On this account it has been called the kidney worm. The worms are 
generally found in small cavities or cysts containing two or four speci- 
mens. In severe infestations it may be found in the liver. Numerous 
clinical pictures have been attributed to this parasite, but we are at 
present somewhat in the dark as to its pathogenic powers, life-history, 
treatment, and prophylaxis. 

Trichosomum plica Rud. has been found in the bladder of a dog 
in Ireland. It possesses the general characters of the genus already 
given on p. 1541. The male measures 15 to 30 millimetres, and the 
female is approximately twice these dimensions. It is an unimportant 
species. 

Trichosomum felts cati Dies. is a rare parasite of the bladder of the 
cat. 


PARASITES AND PARASITIC DISEASES 1563 


Lrichinella spiralis (Owen), (Trichina spiralis Owen).—This is a small 
worm hardly visible to the naked eye. The integument is smooth, 
The male is 15 millimetres long, and 40 w in diameter, and the posterior 
extremity carries two prominent appendages on each side of the cloaca. 
The female is from 3 to 4 millimetres in length, 60 w in thickness, 
and is viviparous. The vulva opens in the anterior fifth of the body 
length. The adult worms are found in the intestine, from which fact 
they are often referred to as the intestinal form. A great number of 
mammals are liable to its invasion, amongst which may be mentioned 
man, the rat, rabbit, guinea-pig, and all the domesticated animals. The 
herbivora are, however, comparatively rarely affected. From a sanitary 
point of view, man, the pig, and the rat are the most important hosts. 
Its geographical distribution is wide. Germany, which carries out a 
regular method of inspection, gets the credit of being badly affected. 
In America it also occurs to an appreciable extent. Holland and Russia 
are often thought to be the means of spreading the disease amongst. the 
German people. In a number of other European countries it occurs 
rarely. The Annual Report for 1909 of the Chief Veterinary Officer to 
the Board of Agriculture and Fisheries contains an account of an out- 
break in this country, in which man, swine, and rat, were shown to be 
affected. 

Lire-History.—After fertilisation, the female gives rise to eggs, 
which become embryos in the uterus, and these then pass out of the 
vulva. The adult female lives for about five to six weeks, and during 
that time gives rise to approximately 10,000 to 15,000 offspring. A 
number of these are expelled in the feeces with the adults. Most of them, 
however, reach the blood-stream by way of the intestinal vessels. A 
number of authorities have stated that the immature forms may bore 
directly into the muscles, which they infest, or even use the lymph- 
stream. Having arrived at the muscular or other tissues, they cease 
movement, coil up, and finally become encysted as a result of the inflam- 
matory changes produced. The cyst is usually within the sarcolemma, 
lemon-shaped, and measures about 0°4 millimetre long by 0°2 millimetre 
broad. In this condition the larva is usually spoken of as the muscular 
form. In the encysted condition the larva is incapable of further 
growth, but. apparently lives for several years, after which it becomes 
completely calcified. The completion of the life-cycle is brought about 
by the ingestion of portions of muscle containing the cysts. These 
are then dissolved, the parasites become adult in the fresh host’s 
intestine, and after awhile the muscles are found to harbour the encysted 
forms. 


1564 SYSTEM OF VETERINARY MEDICINE 


TRICHINOSIS, OR TRICHIASIS.—These terms are nearly always applied to 
the muscular form of the disease, although the presence of the adult 
worms in the bowel deserves similar recognition. From the veterin- 
arian’s point of view, the pig is the most important host. The dog, 
however, has often been found to harbour the muscular form of the 
parasite, especially in countries where that animal is used for food. The ~ 
disease deserves special attention, inasmuch as it affects man. 

Meruop or Inrecrion.—A brief outline of the life-cycle has already 
been given, and it has been further stated that man, the pig, and rat, 
are the most important hosts in this country. The adults and larve, 
which are to be found in the feeces, have been shown to be incapable of 
infecting animals by ingestion. Cases are on record where this has 
apparently happened, but the explanation is that the feeces contained — 
undigested portions of infective material. Rats obtain the parasite by 
eating scraps of refuse containing the muscle worm, or by eating their 
comrades which are affected with the disease, so that in rats alone the 
infection can be kept up. In some towns great numbers of them have 
been shown to be affected. Swine become contaminated either by the 
ingestion of waste pieces of infected pork and other meat, or by eating 
dead trichinous rats. Man contracts the disease when he partakes of 
raw or improperly cooked pork. 

Symptoms.—In naturally occurring cases very little is shown, but in 
‘severe or experimental cases the following phenomena have been noticed: 
After the arrival in the intestines of the trichine-containing material, 
wntestinal trichinosis will appear within three to seven days. This con- 
sists of dulness, fever, thirst, depression, injected mucous membranes, 
arched back, straight tail, and diarrhoea. These symptoms persist for 
two to four weeks, and correspond to the period occupied by the hatching 
of the embryos. After the first seven days or so there is slight improve- 
ment in the alimentary symptoms, but muscular trichiasis now manifests 
itself by stilty and uncertain action, and stiffness of the joints. These 
and the affected muscles become painful. The animal remains on the 
ground a great deal, and may appear paralysed in the hind-limbs, gives 
forth expression of pain, and may show discomfort in swallowing. This 
corresponds to the immigration period of the larve into the muscles. 
After a varying period, these symptoms gradually abate, and the host 
is left stiff. 

Lestons.—These consist only of the encysted trichine in the muscles., 
Their size is from 0°5 to 1 millimetre, and they vary in colour according 
to their age and the amount ot calcification that has taken place. The 
number of “specks ”’ present is likewise subject to variation according 


PARASITES AND PARASITIC DISEASES 1565 


to the severity of the infestation. Leuckart found 1,500 in a gramme of 
muscle, and Cobbold estimated a human body to contain 100,000,000 
encapsuled worms. The muscles most often affected are the diaphragm, 
especially its pillars, those of the shoulder and larynx, the psox 
muscles, and the intercostals. The cheeks, ocular muscles, abdominal 
wall, and thigh, come next in severity of infection. 

Diaenosis.—This is rarely possible in the living animal. It is sug- 
gested that harpoonage of susceptible muscles should be practised, but 
it is difficult on account of the thickness of the skin. Far more im- 
portant is the post-mortem diagnosis in meat inspection. In some 
countries portions of all the slaughtered pigs are subjected to microscopic 
examination, in which case the muscles chosen, the time to be occupied, 
and the remuneration of the inspector, are prescribed by law. Usually, 
pieces about the size of a barley grain are chosen, and placed on areas 
of a graduated portion of glass. There are most often twenty-four 
squares, and another piece of glass is clamped above the portions of 
meat until they are flattened out sufficiently to be examined under the 
low power of the microscope. The most likely portions of a muscle to 
show lesions are its transition into tendon, origin, and insertion. Some 
consider the most reliable method is to take twenty-four specimens from 
the pillars of the diaphragm. In Saxony the pillars of the diaphragm, 
diaphragmatic, intercostal, abdominal, lumbar, and laryngeal muscles 
are presented for trichina examination. In Berlin the diaphragmatic 
pillars, abdominal, intercostal, and laryngeal muscles are examined. The 
best method of settling the point as to whether the trichine are alive or 
dead is by feeding them to a rat. This, of course, can only be carried 
out in this country by licence of the Home Office. 

PropHyLactic Mrasures.—Although the treatment either of the 
intestinal or muscular forms of the disease is out of the question, pre- 
vention is important. The extinction of rats in the piggery should 
be first carried out, and no waste meat should be offered to swine until 
it has been properly boiled. The association of pig-sties and knackeries 
should not be allowed. 

Meat Inspection.—As trichinosis is such an important disease of 
man, all affected carcasses, no matter how slightly, should be totally con- 
demned. The age of the lesions should not modify this procedure. In 
Prussia the skin, bristles, and fat, are allowed to be used for commercial 
purposes, certain parts useful in soap and glue manufacture are also 
passed for these purposes, and the whole body may be employed for the 
production of chemicals. In Saxony, in addition to regulations similar 
to the above, the meat is passed for sale as human food after it has been 


1566 SYSTEM OF VETERINARY MEDICINE 


declared to be trichinous and cooked in a steamer for half an hour at 
80° C. Joints of about 10 pounds weight are used. Pickling for a month 
also allows it to be offered for sale as trichinous pork. 


BIBLIOGRAPHY. 


CLELAND AND JOHNSTON: Worm-Nests in Cattle due to Filaria gibsoni. Journal 
of Comparative Pathology and Therapeutics, vol. xxiii., 1910, p. 335. 

Low: The Development of Filaria wmmitis in the Mosquito. Veterinary News, 
vol. ix., 1912, p. 432. 

OsTERTAG: Handbook of Meat Inspection (Wilcox). New York, 1907. 
RAILLET AND HenRy: Les Thelazies Nematodes Parasites de | iil. 
Rendus de la Société de Biologie, tome Ixviii., 1910, No. 5, p. 213. 

Nouvelle Observations sur les Thelazies Nematodes Parasites de I iil. 
Idem., tome lxvii., 1910, No. 16, p. 783. 
Les Onchocerques Nematodes Parasites du Tissue Conjunctif. Idem., tome 
lxviii., 1910, No. 6, p. 248. 
Stockman: Annual Reports of Proceedings under the Contagious Diseases 
Animals Act. Board of Agriculture and Fisheries, 1909. 


Comptes 








A LIST OF THE MOST IMPORTANT ANIMAL 
PARASITES (EXCLUSIVE OF PROTOZOA) 
OF THE DOMESTICATED ANIMALS 


By A. W. NOEL PILLERS, F.R.C.V.S. 


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‘ANILSHINI AOAVT 

















POISONS. 
By E. WALLIS HOARE, F.R.C.V.S. 


Owi1ne to the fact that veterinary toxicology has now become a 
special study, and that a complete work dealing with the subject has 
been written by Professor G. D. Lander, it is neither necessary nor 
desirable for us to attempt in these pages more than an outlined descrip- 
tion of the effects, diagnosis, and treatment, of the more common poisons 
met with in veterinary practice. 

For full information on the subject of toxicology, the reader is referred 
to the work mentioned, which, we may remark, should be in the hands 
of all students and practitioners, not only for the purpose of reference, 
but also as a valuable clinical guide in the diagnosis and treatment of 
cases of poisoning in animals. 

In veterinary practice cases of poisoning come under two headings— 
viz., (1) Malicious, (2) Accidental. 

Malicious poisoning results from the act of evil-disposed or spiteful 
persons. It is of comparatively rare occurrence in the larger animals, 
but is frequently met with in dogs. The toxic agent is usually given to 
dogs in a portion of meat, and the poison generally selected is one of the 
various rat pastes or powders which contain strychnine, arsenic, or phos- 
phorus, or a combination of these. In agrarian outrages, which are now 
a thing of the past, horses or cattle were poisoned by means of arsenic 
placed in the food. 

Accidental poisoning may occur under a variety of circumstances. 
In horses, cattle, sheep, pigs, and goats, it may result from the ingestion 
of poisonous plants. Cattle furnish by far the largest number of cases, 
owing to their tendency to eat whatever green substances come within 
their reach, especially when pasture 1s scarce. 

Another fairly common source of poisoning in cattle results from the 
carelessness or ignorance of attendants, who leave toxic substances, such 
as paint, weed-killers, ete., in places to which the animals have access. 

Carelessness in applying certain dressings or applications to the skin 
is responsible for poisoning in the sheep, dog, or cat. In the two latter 
animals absorption of the toxic material may occur from the skin, or by 


licking the coat the poison gains access to the system. 
1572 


POISONS 1573 


Krrors in the dosage of potent drugs must also be recognised as 
causes of poisoning, as 1s exemplified by toxic symptoms following the 
administration of too large doses of strychnine to the dog, also in the use 
of too strong solutions of cocaine as a local anesthetic. 

Errors in dispensing occasionally occur, and cause poisoning, such as 
mistaking one drug for another—e.g., giving potassium nitrate for mag- 
nesium sulphate, or combining a solution of strychnine with alkalies, in 
which case the alkaloid is precipitated, and the last dose in the bottle 
proves toxic. 

Dogs are frequently poisoned when they accidentally gain access to 
lands on which poison has been “ laid,”’ with a view to prevent trespass 
of dogs, and consequent injury to sheep. _ Unfortunately, it is the inno- 
cent dog who usually pays the penalty. 

Poisoning from food containing deleterious substances is not uncom- 
mon in veterinary practice. 

Draaenosis oF Porsonrinc.—In the popular mind any case of sudden 
illness or death is attributed to poisoning. Not infrequently, when a 
horse or a cow suffers from the effects of careless drenching, and suc- 
cumbs to asphyxia, the owner attributes the cause to poison, and may 
even attach blame to the prescriber or the dispenser. 

No doubt there are certain circumstances and phenomena which are 
suggestive of poisoning, such as the sudden occurrence of violent symp- 
toms and death without apparent cause in a number of animals on the 
same pasture or on similar diet. Under such conditions careful post- 
mortem examinations should be carried out, and the viscera should be 
placed in a perfectly clean vessel, with a view to chemical analysis. The 
surroundings of the animals should be carefully examined, and a diligent 
search made for the presence of poisonous plants. Unless the latter are 
discovered, and the leaves, etc., of these correspond with similar leaves 
in the stomach, the practitioner should not give a positive diagnosis of 
poisoning. Such cases are exemplified in cases of poisoning by yew or 
rhododendron. 

With these exceptions, it is impossible to give a correct diagnosis of 
poisoning on the evidence furnished by symptoms or by post-mortem 
appearances alone, and an opinion must be deferred until a chemical 
analysis of the viscera has been carried out. No doubt the symptoms 
of strychnine-poisoning in the dog are very characteristic, but even 
in such an instance, for medico-legal cases, a chemical analysis is 
essential. 

For further information on the subject of the diagnosis of poisoning, 
the reader is referred to Lander’s “‘ Veterinary Toxicology.” 


1574 SYSTEM OF VETERINARY MEDICINE 


The following are the most common mineral or inorganic poisons met 
with in ordinary veterinary practice: Arsenic, lead, mercury, phosphorus, 
and less frequently sodium chloride and potassium nitrate. 


Mineral Poisons. 


Arsenic—Sourcrs or Poisonrnc.—In sheep, the employment of dips 
containing an excessive amount of the agent. In the horse, administra- 
tion of the drug in toxic doses by accident, or given by attendants to 
improve the animal’s condition. Local applications, as in the treatment 
of warts and mange. In cattle and horses, contamination of water and 
herbage through copper-smelting furnaces, etc. 

In the dog, malicious or accidental poisoning may result from rat- 
powders or vermin-pastes. Gray points out that in the dog a few large 
doses of arsenic are less likely to cause toxic effects than long-continued 
small dosage, as in the former instance the drug is got rid of by vomiting. 
Fowler’s solution is more toxic than arsenious acid. 

Symproms.—In herbivora, salivation, thirst, colic, violent purging, 
and tenesmus, rapid, weak pulse, collapse, and death. In chronic cases, 
dulness, loss of appetite, ophthalmia, salivation, emaciation, chronic 
disease of the joints, and periostitis of the bones of the limbs. 

In the dog, nausea, vomiting, moaning, purging, colicky pains, and 
death in convulsions, are observed. 

Morsip ANATomMy.—Intense gastro-enteritis, with ecchymoses and 
extravasations. In some cases gastric ulcer and perforation have been 
observed. The Oe containing the poison remain free from decom- 
position. 

TREATMENT.—In herbivora, precipitate tincture of perchloride of 
iron, with carbonate of soda. Filter, and give ad lb. in warm water. 
Calcined magnesia and dialysed iron are also useful. Demulcents, such 
as white of egg, lmseed tea, oil and lime-water, should be given in large 
amounts. Hypodermic injections of morphine are indicated to relieve 
the pain, and strychnine to overcome nervous prostration. 

In the dog, demulcents, white of egg, oil, and lime-water, etc., arnt 
be given, also freshly precipitated ferric hydroxide, or dialysed iron, and 
opiates to relieve pain. 

Lead (Plumbism)—Sovurces or Porsonrne.—Soft water (rain-water, 
free of lime and magnesia salts, and containing oxygen and CO,) passing 
through lead pipes favours the solution of lead, and later on causes it to 
separate in the form of white flakes of basic carbonate. W. Williams 
observed several cases of plumbism in hunters from this cause.- In cattle 


POISONS 1575 


and dogs, toxic effects occur from licking fresh white-lead paint, or red- 
lead paint. In dogs, also, from licking liniments containing Goulard’s 
extract, or actetate of lead. Toxic effects from metallic lead have been 
demonstrated. These may occur from exposure of bullet-splashes to 
weather, leading to oxidation of the lead and the formation of a soluble 
coating. The herbage may be impregnated with the effluvie from lead- 
works, and so prove toxic. 

SYMPTOMS.—Cases are comparatively rare in the horse. Cattle, 
sheep, pigs, and dogs, are more frequently affected. Lead-poisoning 
may be evidenced by gastro-enteritis, colicky pains, coma, and 
death. 

In the horse, convulsions, partial paralysis, roaring, and marked 
respiratory distress, are observed. According to W. Williams, plumbism 
is not uncommon in horses in North Wales. 

In the chronic form a blue line may appear around the gums at the 
base of the incisor teeth. | 

In acute lead-poisoning in cattle, marked abdominal pain, grinding 
of the teeth, salivation, constipation, a staggering gait, delirium, impair- 
ment of vision, and finally a semicomatose condition, have been recorded. 

Morsip ANAToMy.—In cattle, gastritis and enteritis are often present. 
Cases are recorded in which particles of lead have been found in the 


reticulum. 

In the horse, congested patches are found in the villous coat of the 
stomach, and enteritis is also common. 

TREATMENT.—Saline purges, such as Epsom or Glauber salt, with 
dilute sulphuric acid, milk and eggs ad lub., stimulants, strong tea or coffee. 
In chronic cases potassium iodide is advised. 

Mercury (Hydrargyrism)—Sources or Polsontne.—Too strong solu- 
tions of corrosive sublimate used as antiseptic dressings or injections, the 
prolonged administration of calomel, absorption of mercurial dressings 
applied to the skin, also from the animal licking ointments containing 
mercury. 

Symproms.—Salivation, tenderness of the mouth and gums, impaired 
appetite, dyspepsia, diarrhoea, muscular tremors, emaciation, and in 
some cases osseous affections. For a description of mercurial stomatitis 
in cattle, see p. 321. Large doses of corrosive sublimate cause gastro- 
enteritis and general collapse. 

TREATMENT.—In acute cases give white of egg and demulcents ad 
lib. Sulphur is advised in order to form insoluble sulphides. In chronic 
cases prescribe a mouth-wash containing chlorate of potash. Give 
potassium iodide internally to hasten elimination. 


1576 SYSTEM OF VETERINARY MEDICINE 


Phosphorus — Sources oF Porsonrne. — Rat-pastes and yvermin- 
killers. Common in the dog and cat, rare in the larger animals. 

Symptroms.—Vomiting, intense thirst, abdominal pain. The vomite 
material may be of a dark green colour, and may appear luminous in the 
dark. In some cases vomiting of blood occurs, also convulsions followed 
by coma are observed. Usually it is a slow poison, death not occurring 
before two or three days. Occasionally cardiac paralysis results, with 
a rapidly fatal termination. Partial recovery is not uncommon, followed 
by jaundice, convulsions, and coma. 

Morsip ANatomMy.—Inflammation and ulceration of the gastric and 
intestinal mucosx, also fatty degeneration of the liver and heart. 

TREATMENT.—In the dog, give sulphate of copper in doses of 3 grains 
dissolved in water every five minutes until vomiting occurs. Then con- 
tinue in 1-grain doses every quarter of an hour, combined with morphine 
if vomiting continues. Fats, oils, milk, eggs, etc., should be avoided, 
as they render the phosphorus soluble. Mucilaginous drinks may be 
given ad lab. 

Sodium Chloride—Sourcss or Potsonrne.—In cattle, as the result of 
large doses given as a purgative and in concentrated form. In pigs cases 
have been recorded arising from the animals drinking brine (brine- 
poisoning). Some authorities express doubt with reference to the toxic 
action of sodium chloride in the pig, and suggest that the solutions in- 
criminated may contain toxic substances, such as organic poisons, 
derived from the decomposition of proteids. Lander’s experiments 
showed that even large doses of common salt given in the food produced 
no abnormal effects in pigs. Instances are recorded of poisoning in 
fowls after eating a salted potato mash. 

Symproms.—In cattle, extreme thirst, abdominal pain, depression, 
and collapse, are observed. 

In pigs, the symptoms recorded were marked thirst, salivation. 
vomition, sometimes diarrhoea, vertigo, convulsive movements, para- 
plegia, and death within three days, or in some cases in a few 
hours. | 

Morsip ANaTomMy.—KEvidences of acute gastro-enteritis, also con- 
gestion of the cerebral meninges. 

TREATMENT.—Demulcents and sedatives. Bromide of potassium to 
combat the nervous symptoms. 

Potassium Nitrate—Source or Polsontne.—The administration of 
potassium nitrate to cattle in error for Epsom salt. 

Symproms.—Violent pain, tympanites, convulsions, and collapse, 


followed by death. 


POISONS 1577 


Morprp Anatomy.—Acute inflammation of the abomasum, conges- 
tion of the kidneys, non-coagulation of the blood; in some cases hema- 
turia, 

TREATMENT.—Demulcents, belladonna, and stimulants. 

Zinc Sulphate—Source or Poisontnc.—W. Williams records cases 
where by accident or ignorance sulphate of zinc was given to cattle instead 
of Epsom salt. 

SyMPToMs.—Nausea, sweating, continuous vomiting, and death from 
exhaustion within a few hours. 

TREATMENT.—Demulcents, opiates, and tannin. Alkaline carbonates 
are advised to render the zinc salt insoluble. 

Non-irritant Compounds of Zinc.—Lander points out that non-irritant 
compounds of zinc, such as the oxide or carbonate, appear quite 
harmless to sheep, and as herbage is often contaminated by these com- 
pounds in the vicinity of metal smelting works, owing to the fumes 
resulting therefrom, the point is of practical value from a forensic 
aspect. 


Organic Poisons and Drugs. 


Carbolic Acid—Sources or Potsontnc.—The use of too strong solu- 
tions as surgical dressings for wounds or as applications for diseases of 
the skin; administration of the drug by error. In cats, the use of car- 
bolic disinfecting powder on the floors of buildings to which the animals 
had access has caused fatal poisoning on several occasions. In such 
instances the poison enters the system by the animals licking their paws. 

Symproms.—In the horse, salivation, muscular tremors, a staggering 
gait, accelerated respirations, cold extremities, and convulsions followed 
by coma. The urine has an olive-green or brown colour, and may contain 
blood. 

In the dog, vomiting, muscular twitchings, abdominal distension, 
accelerated respirations, paraplegia, collapse, and death. 

In the cat, clonic and tonic spasms, dilatation of the pupils, saliva- 
tion, and a feeble and irregular action of the heart. 

Morgip ANatoMy.—The internal organs may exhale a strong odour 
of carbolic acid. Patches of inflammation are found in the stomach and 
intestines; nephritis may be present in some cases. 

TREATMENT.—Sodium sulphate, in order to convert the carbolic acid 
into sulphocarbolates, which are inert, and are excreted by the kidneys. 
Demulcents, olive oil, and lime water ad lib. Saccharate of lime is also 
advised. Stimulants are indicated to combat heart failure. Oil of 
turpentine has been found to act as an efficient antidote in the horse. 


1578 SYSTEM OF VETERINARY MEDICINE 


Creolin, Cyllin, ete.—Sourcrs or Poisonrine.—Strong solutions used 
as dressings to the skin of dogs and cats. 

Symptoms.—Unsteady gait, especially in the hind-limbs, a subnormal 
temperature, prostration, clonic spasms of the voluntary muscles, espe- 
cially those of the limbs, jaws, and eyelids; complete paralysis, succeeded 
by collapse and death. 

TREATMENT.—Wash the skin with warm water containing sulphate 
of magnesia, dry thoroughly, clothe warmly, administer diffusible stimu- 
lants, and place in warm surroundings. 

Strychnine—Sourcrs oF Poisontne.—Too large doses of the drug, 
especially in the dog and cat, both of whom are very susceptible to its 
action. Careless prescribing—e.g., combining lig. strychnine with 
alkalies, so that strychnine is precipitated, and the last dose in the bottle 
proves toxic. Rat-pastes and vermin-killers. The ingestion of “‘ poisoned ” 
meat. Malicious use of the agent. 

SymptToms.—Strychnine-poisoning is of rare occurrence in the horse. 
Cases are recorded in cattle as the result of the hypodermic employment 
of the drug in the treatment of paralysis following milk fever. The 
prominent symptoms in all animals are the occurrence of violent clonic 
spasms, which are readily induced by a very slight external stimulus, 
such as a current of air; the respirations are accelerated and laboured, 
and evidences of abdominal pain may be observed. 

Macqueen observed in the horse twitching of the superficial muscles 
as a preliminary symptom, then rearing, fallmg down, and galloping 
movements. The spasms were followed by a period of quiescence. 

The symptoms in the dog vary in severity according to the amount 
of the drug taken. A large dose may cause death after two or three 
convulsions, as the breathing becomes arrested by violent contraction of 
the diaphragm and other respiratory muscles. A smaller dose may pro- 
duce shorter convulsions and longer intervals of quiescence, with gradual 
lessening of reflex irritability, and death from asphyxia. During the 
convulsions the head is drawn backwards, and the fore and hind limbs 
are extended. All the muscles of the body are involved, but the action 
of the extensors generally prevails over the others. At the commence- 
ment of the convulsions tremors or involuntary twitchings occur in the 
limbs, and the muscles feel hard and firm. Immediately after a con- 
vulsion the muscles relax, prostration occurs, the respirations become 
more regular, but a second convulsion quickly follows on the first. 

Morpip ANAToMy.—Besides the usual post-mortem appearances of 
asphyxia, congestion of the cerebral and spinal meninges is observed, and 
occasionally patches of congestion are found in the intestines. 


POISONS 1579 


TREATMENT.—In the dog, emetics should be administered as soon as 
possible. The most reliable emetic is apomorphine, administered hypo- 
dermically, the dose being from 1, to #5 grain, or 5 minims of the 1 in 50 
solution. The treatment in cases of strychnine-poisoning must be prompt 
to be effectual; indeed, once the drug has become absorbed and exerts 
action on the nervous system, emetics are of little value. Besides, the 
vomited material may enter the trachea during a convulsion, and prove 
dangerous. Antidotes administered by the mouth should be given 
between the convulsions. Bromide of potassium, $ ounce, with chloral 
hydrate, 30 grains, should be given in solution, and 2 drachms of the 
former with 10 grains of the latter may be given every fifteen or twenty 
minutes if necessary. The inhalation of chloroform, so as to produce 
light anesthesia, is useful to combat the convulsions. 

Other antidotes recommended are nitrite of amyl inhalations, animal 
charcoal, tannic acid, curare (4 grain by hypodermic injection). In cases 
of emergency tobacco may be given. Morphine has also been tried with 
success. 

Cocaine—Sources or Porsonina.—The subcutaneous injection of too 
strong solutions of the drug for the purpose of inducing local anesthesia. 

Symptoms.—In the horse, salivation, great excitement, quickened 
pulse, dilatation of the pupils, increase of reflex activity, and increased 
peristaltic action of the intestines. These effects pass off in about two 
hours. 

The dog is very susceptible to the action of cocaine, the hypodermic 
injection of a strong solution of the drug producing in a few minutes 
epileptiform convulsions, champing of the jaws, profuse salivation, 
marked respiratory distress, tetanic spasms, and death from asphyxia. 

TREATMENT.—The inhalation of amyl nitrite, stimulants, such as 
ammonia and alcohol, the hypodermic injection of ether. 

Cantharides—Sources or Porsonine.—Absorption of cantharidin 
from too extensive an application of a fly-blister; administration of the 
drug in error. In the dog, from licking applications containing can- 
tharides, as well as absorption of the drug by the skin. 

Symptoms.—Internally, cantharides acts as an irritant to the ali- 
mentary tract, toxic doses producing gastro-enteritis, nephritis, strangury, 
and hematuria. If administered in solution, the mucous membrane of 
the mouth and throat becomes blistered, and the pain and ee of 
the cesophagus may interfere with deglutition. | 

Irritation of the stomach also occurs, evidenced by vomiting in the 
dog. Purging, abdominal pain, shock, and collapse, are other symp- 
toms observed. The drug is absorbed from the alimentary canal, and 


1580 SYSTEM OF VETERINARY MEDICINE 


to a less extent from the skin. It exerts a special irritating effect on 
the organs by which it is eliminated from the system—viz., the kidneys 
and the genito-urinary tract. 

Acute nephritis occurs, with albuminuria, the urine being scanty and 
containing blood, or total suppression of urine may be present. There 
is also vesical irritation, frequent attempts at micturition, and evidences 
of aphrodisiac effects, such as the occurrence of frequent erections of the 
penis. The pulse becomes rapid and feeble, the respirations laboured, 
while the presence of convulsions and coma point to a specific action on 
the nervous system. 

TREATMENT.—In cases where absorption of the drug has occurred 
from the application of a blister to the skin, the blistered part should be 
washed with warm water containing an alkali, such as bicarbonate of 
soda, and an emulsion consisting of carbonate of potash, olive oil, and 
water applied. 

Oil alone should not be used, as at tends to render the cantharidin more 
soluble and more easily absorbed. 

Internally, mucilaginous drinks and demulcents should be freely 
given, and, if pain be present, an opiate combined with bicarbonate of 
soda is indicated. On no account should oil or fatty matters be admanis- 
tered as antidotes to cantharides, as they render the cantharidin more 
soluble, and thus facilitate absorption of the agent. 

Paraffin Oil—Sources or Potsonine.— Cases were observed by 
W. Williams in which horses, cattle, and sheep, were slowly poisoned by 
drinking from a stream into which the refuse from paraffin works was 
discharged, also from eating fodder which had deposited upon it oils 
given off in the distillation of paraffin shale. 

SymMptToMs.—The symptoms observed were gradual loss of flesh and 
persistent diarrhoea. The post-mortem appearances were anemia, wast- 
ing of the muscles, a greyish-black appearance of the intestines, and the. 
presence of dull, dark grey or blackish spots therein. The mesenteric 
glands were enlarged, and both these, as well as the lacteals, were found 
to contain paraffin. The chief action of the agent seemed to be exerted 
on these glands, as the power of absorption was lost, the chyle vessels 
being rendered impermeable by the paraffin. 

A point worthy of note is that some of the affected animals had ceased 
to have access to this stream for some months, and still the characteristic 
smell of paraffin was present in the organs of the body on post-mortem 
examination. 

The antidote advised for paraffin oil poisoning is the free use of stimu- 
lants, and in the dog emetics should be given in the early stages. 


POISONS 1581 


Poisonous Plants. 


Yew-Tree.—All varieties are toxic—viz., the common yew (Taxus 
baccaia), the Irish yew (T. fastegiata), and the yellow yew. The active 
principle is taxine, which exerts a narcotic action, but the sap contains 
a volatile oil (oil of yew), which acts as an irritant. Yew-polsoning is 
common in cattle, either resulting from animals gaining access to demesne 
lands, etc., or from clippings of a yew-hedge, or branches from a yew- 
tree being placed within their reach. The leaves are toxic both in the 
green and dry state. Cases are also observed in horses, sheep, and 
goats. 

SyMPTOMS.—In many instances death takes place very rapidly while 
the animal is ruminating, and we have seen a number of cattle drop dead 
as if shot. In others, marked prostration, feeble pulse, coldness of the 
surface of the body, and collapse, are observed. In cases where the 
toxic agent is taken on a full stomach, symptoms may be deferred for 
some time, and in the horse intestinal paralysis has been observed, death 
not taking place until sixteen to seventeen hours afterwards. 

Morsip ANAaToMy.—Acute gastritis is present In many instances, 
also acute cerebral congestion. The diagnosis must be based on the 
detection of yew leaves and twigs in the stomach; hence a post-mortem 
is essential before a definite opinion can be given, when a number of 
animals are attacked. 

- TREATMENT.—Stimulants and raw linseed oil are advised, but it is 
apparent that if the stomach contains a large amount of yew-leaves, 
antidotes of any kind will fail. In cattle, if the diagnosis be established, 
rumenotomy should be carried out early. In less severe cases full 
doses of raw linseed oil with stimulants prove successful. 

Rhododendron.—This agent not infrequently causes severe toxic 
effects, especially in cattle. 

Symptoms.—Delirium, staggering, salivation, excitement, staring 
eyes, and vomiting, are often observed. In some instances the animal 
rushes forward, and presses the head against surrounding objects. If 
the head be raised, free vomiting may be induced, and the vomited 
material contains the leaves and young shoots of rhododendron, thus 
enabling a diagnosis to be made. 

Diarrhoea, evidences of abdominal pain, and paralysis, have been 
observed. 

TREATMENT.—F ull doses of raw linseed oil, also stimulants. If pain 
be a prominent symptom, chloral hydrate should be given. Opiates 


1582 SYSTEM OF VETERINARY MEDICINE 


should be avoided, as they tend to cause retention of the toxic agent in 
the stomach. The free vomiting is a natural means of getting rid of the 
poison. 


Potato-Poisoning. 


Unripe and green potatoes and old damaged sprouting tubers cause 
poisoning in horses, calves, and pigs. The toxic agent is solanin. In 
the horse, a large amount of new potatoes, when the animal is unaccus- 
tomed to this kind of food, may cause intense irritation of the intestines 
and severe diarrhoea, followed in some instances by enteritis and death. 
Similar phenomena may occur in pigs. 

In the case of damaged and sprouting potatoes, marked prostration. 
severe purgation, muscular tremors, mydriasis, and collapse, have been 
observed. In pigs, diarrhoea, vomiting, exhaustion, imperceptible pulse, 
and coma, may occur. 

TREATMENT.—In the horse, a moderate dose of raw linseed oil is 
indicated to secure elimination of the toxic agent. Stimulants are also 
advisable, and hypodermic injections of strychnine to combat collapse. 
If pain be severe, a dose of chlorodyne should be given. 

For the pig, tannin and linseed tea are advised. 

For full information on other poisonous plants which are less fre- 
quently than those mentioned the cause of poisoning in animals, the 
reader is referred to ‘‘ Veterinary Toxicology,” by G. D. Lander. 


Poisoning due to Food. 


This may depend on food damaged by decomposition, or by fungi, 
also food containing toxic principles per se, or adulterated with poisonous 
materials. 

Ptomaine poisoning has already been dealt with (see p. 493). 

Poisoning due to Diseased Forage and Moulds.—See p. 146. The 
reader is referred to “‘ Veterinary Toxicology,’’ by G. D. Lander, and 
to “ Veterinary Hygiene,” by F. Smith, for a full consideration of this 
subject. 

Cake-Poisoning.—This occurs as the result of adulteration of feeding- 
cakes with castor oil beans (Ricinus communis) or croton beans (Croton 
taghum). According to W. Williams, even a less quantity than 1 per 
cent. in the food causes serious illness, and may prove fatal. The use 
of the residual press-cake of castor oil beans also exerts toxic effects. 

Symproms.—Toxic effects may not be manifested for several days 
alter the ingestion of the adulterated cake. The symptoms observed 


POISONS 1583 


were marked prostration, profuse diarrhcea, the evacuations containing 
blood-clots and large quantities of mucus. According to Lander, purga- 
tion, although usual, may be absent in some cases. In calves, severe 
stomatitis, salivation, and champing of the lips, were observed. On 
post-mortem, intense gastro-enteritis was found. 

TREATMENT.—W. Williams advised demulcents, such as starch, 
gruel, linseed tea, also opium and chalk, with carbolic acid or hypo- 
sulphite of soda, and the judicious administration of stimulants, with 
eggs and milk. 

Poisoning by Java Beans (Phaseolus lunatus).—These beans contain 
cyanogenetic glucosides, such as phaseolunatin, which yields on fermenta- 
tion, glucose, acetone, and hydrocyanic acid. According to Lander, the 
percentage of glucoside in the wild East Indian varieties (which vary in 
colour from pale reddish-brown to purple) amounts to rather more than 
0-1 per cent. The white beans of the same species contain only about 
one-tenth part of this proportion of glucoside, and in the cultivated 
varieties the proportion is very small. Lander also points out that from 
the practical pomt of view only the dark-coloured, and especially the 
purple beans, are to be regarded with suspicion. 

McCall investigated the subject, and demonstrated that the meal of 
Java beans proved toxic even after boiling for one hour. 

SyMPTOMS.—These resemble the phenomena observed in poisoning 
by hydrocyanic acid—viz., salivation, spasms, convulsions, vertigo, 
paralysis, and death from asphyxia. 

Lathyrism.—This term is applied to the toxic effects produced by 
feeding on Lathyrus sativus, the Indian pea. Several varieties of the 
genus Lathyrus are known to be poisonous. Outbreaks of lathyrism 
have been recorded in England since 1884, and McCall in the Veterinarian 
(1886) published complete observations on the subject. The condition 
only occurs when large amounts of the pea enter into the rations for 
a prolonged period of time. When 1 or 2 quarts are added daily to 
the ordinary food, symptoms may not be manifested until about the 
eighteenth day, and even in fifty days after the cessation of pea-feeding 
the phenomena may occur. According to several observers, if the peas 
were boiled, no toxic effects were produced. 

Symproms.—These only occur when the animal is put to work or 
even exercised. Marked difficulty in respiration, accompanied by roaring, 
is observed, and in some instances death from asphyxia occurs unless 
tracheotomy be performed. In the outbreak which was recorded in the 
horses of the Bristol Tramway Company, many of the animals fell down 
suddenly without any apparent cause. In others the following symp- 


1584 SYSTEM OF VETERINARY MEDICINE 


toms were observed while the horses were at exercise: Roaring, heaving 
flanks, mouth wide open, tongue hanging and livid, nostrils dilated, 
staggering, dyspnoea, and profuse sweating. These occurred in par- 
oxysms which lasted for several minutes. McCall observed that mere 
excitement was sufficient to induce a paroxysm. 

Death sometimes occurred during a paroxysm, but in most instances — 
tracheotomy was followed by recovery. Hunter found that some months 
after the tracheotomy-tube was removed recovery was not complete, 
although there was marked improvement in the breathing, and the animals 
worked without distress. 

Morsip Anatomy.—In chronic cases, thickened congested patches in 
the stomach and intestines, engorgement of the lungs, bronchial catarrh, 
irregular congested patches in the larynx, especially in the vicinity of the 
glottis, the intrinsic muscles of the larynx atrophied and pale, and 
showing fatty degeneration. 

TREATMENT.—Tracheotomy, rest, and removal of the cause. 

For further information on lathyrism, the reader is referred to McCall’s 
paper on the subject in the Veterinarian, 1886, p. 789. 

Lupinosis.—See p. 573. 


APPENDIX TO VOL. IL. 


SCRAPIE 
By G. MAYALL, M.R.C.V.S. 


THIs is a disease of sheep which is said to have been known in England 
as far back as 1732. A description of it is given by Mr. Thomas Beale, of 
Morboune, who writes that affected sheep appear much wilder than usual, 
bounce up from their lair, and run as though pursued by dogs. They 
show high-headedness, and later on rub themselves against trees and 
posts. There is violent itching of the skin, but no cutaneous eruption. 
Finally, the animal appears to be stupid, separates from the flock, walks 
irregularly, generally lies, and eats little.* 

Sir Stewart Stockman, at a meeting convened in the autumn of 1913 
by the Yarrow and Kttrick Pastoral Society at St. Boswells, said—‘‘ The 
symptoms of the malady could, he thought, best be described in relation 
to stages of the disease. The first stage lasted about three weeks, more 
or less. At this time the symptoms were intermittent, and they had to 
shepherd the sheep to observe them. The affected animal frequently 
changed its position, separating itself from the others. It ate as usual, 
but would sometimes drink a large amount of water, if available. It 
often ruminated in the upright position, holding the head high. The 
pupil of the eye was dilated, and the look fixed. When moved, the 
scrapie sheep often turned this way or that in an excited, stupid fashion; 
then they trotted away in front, lifting the fore-feet high. When put ina 
loose-box, jerky movements of the ears, eyelids, muscles of the lips, 
shoulders, and thighs, were noticeable. The above stage was characterised 
by twitchings and excitability. Later there was occasional straining, 
and passage of small quantities of feces and urine, and the twitchings 
became more marked. If chased, the animal might suddenly fall down, 
lie for a few minutes, and then get up again and move away. This might 
be called the second stage, and carried them to about the sixth week of 
noticeable illness. Then itching began along the back to root of tail, 

* M’Gowan, “ Investigations into Scrapie.”’ 
VOL. II. 1585 100 


1586 SYSTEM OF VETERINARY MEDICINE 


became more intense, and extended to sides, shoulders, and limbs. 
(third stage). Towards the end sheep appeared almost demented by this 
itching. The thirst was intense. The animals emaciated rapidly, got 
weak in the hind-quarters, and became paralysed. Affected sheep might 
live for a fortnight or longer if fed. From start to finish, the disease. 
appears to last from three to four months.” 

As to the nature of the disease, Sir Stewart Stockman believes it to be 
contagious. M’Gowan considers it to be due to a heavy infection of the 
sheep with a protozoon parasite (sarcosporidium—the Sarcocystvs 
tenella). He believes that scrapie is not contagious. 

TREATMENT.—No remedy has been found up to the present. The 
disease has been got rid of by completely replacing the susceptible stock 
from an infected source. M’Gowan recommends sending affected 
animals to the butcher at once, and, in the early stage of the disease, 
entirely changing the stock by bringing in fresh young ewes and getting 
rid of the old ones. Where a complete change of stock is not made, 
breeding stock should be kept up from the progeny of the older ewes. A 
diseased animal should not be used for breeding, and in-breeding should 
be avoided. Inasmuch as the tup may spread infection he should be 
destroyed after the season if he has been used for affected or suspected 
ewes. 

Louping-all, Lumbar prurigo, Tremblante (French), Traberkrankheat 
(German), has been described to be due to an infectious neuritis, due to 
the Bacillus chorew paralytice ovis; also to a pyemic inflammation of the 
membranes of the cord. In America the disease is stated to be due to 
the Bacillus lactemorbi, but this has not been definitely established. 
In the report of the Departmental Committee of the Board of Agri- 
culture (1906) louping-ill was ascribed to a large, sporulating, rod- 
shaped bacillus, to be found in the peritoneal fluid of affected sheep. 
Armstrong, in his book on “ The Sheep,” writes: “‘ It is a disease of the 
spinal cord. As an animal affected with louping-ill walks, its action is 
peculiar, a dropping of the limbs and jerking of the body being constant. 
From this circumstance the idea of leaping is conceived, hence the term 
‘* leaping,” or “ louping-ill.”” From the fact that swallowing is difficult, 
the malady has been called “ thwart-ill”’ or ‘‘ throttle-ill.” All writers 
consider louping-ill to be infectious. For further information on the 
disease, see Vol. I., p. 1251. 

In louping-ill sheep of all ages and classes are liable to infection. 
Lambs may be affected at birth. Scrapie affects principally sheep about 
two yearsold. As already remarked, M’Gowan ascribes this disease to the 
Sarcocystis tenella. 


SCRAPIE 1587 


Messieurs. P. Cagny and R. Gouin consider that “ tremblante ” is a 
nervous affection, the causes of which are little known. Lambs and 
sheep under one and a half years old are chiefly affected. Hutyra and 
Marek state that the actual cause of trembling, or the trotting disease, 
is unknown, but “it appears to be most likely that it is a polyneuritis.”’ 

Post-MortTEM FINDINGS IN ScrApiz.—Extensive infection of the 
muscles with the microscopicanimal parasite Sarcocystis tenella(M’ Gowan). 

Post-Mortem FiInpines 1n Loupine-Itu.—The peritoneal cavity con- 
tains an opaque greyish fluid, varying from 6 to 12 ounces in volume. 
The peritoneum is congested, but never inflamed. In other cases there 
may be a peritoneal transudate clear and straw-coloured (Mellon—see . 
Vol. I., p. 1255). Besnoit and Morel found parenchymatous inflamma- 
tion of the smallest branches of the peripheral nerves. 


CORRIGENDA. 


Page 12, line 17 from bottom, for “common” read “‘ sometimes observed.” 

Page 12, line 16 from bottom, delete ‘‘ so.” 

Page 116, in the formula, for “ Aqua fervens’”’ read ‘‘ Aquee ferv.”’ 

Page 213, line 18 from bottom, for “‘ snemas’”’ read “‘ enemata.”’ 

Page 228, last line, for “‘ p. 20’’ read “*‘ p. 201.” 

Page 231, line 5 from top, for “‘ peritonitis ’’ read “ enteritis.” 

Page 241, line 5 from bottom, for “‘ tenesemus ”’ read “‘ tenesmus.”’ 

Page 257, line 9 from bottom, for “ always” read “‘ nearly always.”’ 

Page 269, first line, for “‘ favouy ”’ read “‘ favour.” 

Page 269, line 3 from top, for “‘ onlr”’ read “‘ only.” 

Page 269, line 21 from top, for “* coli bacillus ’’ read ** bacillus coli.”’ 

Page 280, line 18 from top, for “ trongylus ” read * Strongylus.” 

Page 352, line 5 from bottom, for “innervation” read “loss of nerve 
power.” 

Page 446, line 20 from top, delete ‘‘ internally.” ‘ 

Page 515, line 15 from bottom, for “ Moniliac andida’”’ read ‘‘ Monilia 
candida.” 

Page 637, line 2 from bottom, for “‘ iodine of potassium ”’ read “‘ iodide of 
potassium.”’ 

Page 989, last line, for “‘ 100° F.” read ** to 100° F.” 

Page 1165, line 15 from top, for “‘ incude ”’ read “‘ include.”’ 

Page 1246, line 10 from bottom, for “‘ Sarcocystes”’ read “* Sarcocystis.” 

Page 1260, last line, for “‘ sretless ”’ read “‘ restless.”’ 

Page 1261, line 10 from bottom, for “lesion ’’ read “‘ lesions.” 

Page 1283, line 11 from top, for “ contain ”’ read “‘ contains.”’ 

Page 1342, line 10 from top, for “ are unfit’ read “‘ and are unfit.”’ 

Page 1504, line 8 from top, for “‘ kumala”’ read ‘“‘ kamala.”’ 


1588 


INDEX TO VOL. I. AND VOL. II. 


References to Volume I. are in heavy type. 


A 


ABDOMEN, physical examination of, 166 
Abdominal dropsy in dog, 628 
in horse, 611 
in ruminants, 623 
pain, attitudes in, 167 
varieties of, 163 
pulsation, 990 
vertigo, 145 
Abducens nerve, paralysis of, 1196 - 
Abomasal indigestion of sucklings, 1400 
Abomasitis, 381 
Abomasum, catarrh of, 381 
torsion of, 387 
tumours of, 387 
ulcer of, 386 
Abortin, 336 
Abortion, epizodtic, in cattle, 325; see also 
Epizoodtic abortion 
bacteriology, 330 
differential diagnosis, 335 
etiology, 330 
modes of infection, 331 
morbid anatomy, 334 
prophylaxis, 336 
symptoms, 333 
treatment, 336 
infectious, in birds, 342 
in bitches, 342 
in cats, 342 
in mares, 343 
sporadic, 329 
varieties of, 329 
Abscess, actinomycotic, in pharynx of 
cattle, 325 
anal, in dog, 505 
cerebellar, 1171 
cerebral, 1144 
formation in orbital gland of cat, 
509 
of brain, 1144 
of intestine in dog, 501 
in horse, 287 
of liver in cattle, 566 
in dog, 589 
in horse, 544 
of lung in horse, 870 
of pancreas in horse, 525 
of spinal canal in horse, 1189 
perinephric, in cattle, 740 








Abscess, perinephric, in horse, 707 
pericesophageal, 470 
pharyngeal, in cattle, 325 
postpharyngeal, in horse, 42 
psoas, in horse, 707 
renal, in dog, 765 

in horse, 702 
retropharyngeal, in horse, 42 


| Acariasis, auricular, 1479 
| Acariens, the, 1439 


Achondroplasia, 1341 
Acne, contagious, 224 
Actinobacillosis, 269 
Actinomyces bovis, 258 
Actinomycosis, 257 
bacteriology of, 258 
differential diagnosis, 264 
etiology, 257 
in birds, 268 
in cats, 267 
in dogs, 267 
in man, 268 
morbid anatomy, 259 
symptoms in cattle, 261 
in horses, 263 
treatment, 265 
Actinomycotic abscess in pharynx of cattle, 
325 
mammitis, 263, 395 
Adenitis, submaxillary, 31 
Aigagropiles, 323 
Mrophagy, 1227 
African (South) horse-sickness, 1281 
Agalaxia, contagious, 404 
Air embolism, 1096 
entrance of, into jugular vein, 1096 
sinuses of head, diseases of, in cattle, 
940 
in dog, 972 
in horse, 809 
Albumin, quantitative estimate of, 669 
tests for, 668 
Albuminuria, 667 
physiological, 667 
Alvitis, 364 
Amaurosis, 1195 
** Amphoric echo,” 797 
Amyloid degeneration df kidneys in cattle, 
4, 


in dog and cat, 766 
in horse, 707 


1589 


1590 


Amyloid degeneration of liver, in dog and 
cat, 592 
in horse, 557 
Anemia, 1286 
acute, 1287 
cerebral, 1155 
chronic, 1287 
general, 1287 
local, 1286 
infectious, 927 
pernicious equine, 927 
primary or essential, 1287 
progressive, idiopathic or pernicious, 
1289 
secondary or symptomatic, 1287 
alterations in blood, 1287 
chronic, 1287 
course, 1288 
differential diagnosis, 1288 
etiology, 1287 
morbid anatomy, 1287 
prognosis, 1288 
symptoms, 1287 
treatment, 1288 
Anal abscess in dog, 505 
glands, diseases of, in cat, 513 
in dog, 505 
ceatarrh of, 505 
pouches, impaction of, in dog, 506 
Anaplasmosis, 1034 
Aneurism arterio-venous, 1077 
in cattle, L111 
in dog and cat, 1125 
in horse, 1076 
of anterior mesenteric arteries, 1082 
of aorta, 1078 
of arteries of hind-limb, 1083 
of brain, 1155 
of carotid artery, 1083 
of coronary arteries, 1083 
of the heart, 1069 
of lumbar arteries, 1083 
of other bloodvessels in abdominal 
cavity, 1083 
of palatine artery, 1083 
of pharyngeal artery, 1083 
of posterior aorta, 1078 
of pulmonary artery, 1084 
of spermatic artery, 1084 
of utero-ovarian artery, 1084 
verminous, colic due to, 280, 1535 
Angina, croupous or pseudo-diphtheritie, 
in dog, 464 
in horse, 34 
in pig, 447 
pectoris in dog, 1120 
in horse, 1072 
Angiocholitis in cattle, 562 
in dog and cat, 586 
in horse, 538 
Ankylostomiasis, 1551 
Anthrax, 21 
bacteriology, 25 
diagnosis, 35 
differential, 39 














SYSTEM OF VETERINARY MEDICINE 


Anthrax, diagnosis, during life, 38 
post-mortem, 35 
double staining reaction with methy- 
lene blue, 27 
etiology, 22 
in cattle, 31 
incidence, 23 
in dogs, cats, and poultry, 42 
in horses, 32 
in man, 1304 
in sheep, 34 
morbid anatomy, 29 
in cattle, 29 
in horses, 31 
in sheep, 31 
in swine, 31 
period of incubation, 1303 
prognosis, 41 
prophylaxis, 41, 1305 
protective inoculation, 42 
public health, 1304 
symptoms, 31 
in birds, 1303 
in cattle, 31 
in horses, 32 
in man, 1304 
in sheep, 34 
in swine, 34 
treatment, 45 
preventive, 42, 45 
with anti-anthrax serum, 45 
Antitetanic serum, 248, 245 
Anus, diseases of, in cat, 513 
in dog, 504 
Aortic insufficiency, in dog and cat, 1124 
in horse, 1051 
stenosis, in dog and cat, 1124 
in horse, 1054 
Aphtha epizoodtica, 764 
epizootic fibrinous, 787 
malignant, in sheep, 300 
sporadic, 15 
Aphthous inflammation of the mouth in 
lambs, 427 
stomatitis, mycotic, 1309 
Apoplexy, cerebral, in dog, 1256 
in horse, 1156 
intestinal, 280 
** parturient,’’ 1368 
pulmonary, 855, 861 
** Armagh foot and mouth disease,’’ 318 
Arrhythmia, 1022 
Arsenic, poisoning by, 1574 
Arterial wall, chronic inflammation of, 1073 
Arteriosclerosis, 1073 
Articular rheumatism, acute, in cattle, 13896 
in dog, 1397 
in horse, 1388 
in pig, 1397 
in sheep, 1396 
chronic, in cattle, 1399 
in dog, 1399 
in horse, 1397 
in pig, 1399 
in sheep, 1399 


INDEX 


Ascariasis in the dog, 1553 
in the horse, 1532 
in the pig, 1548 
Ascaris marginata, 1550 
megalocephala, 1528 
mystax, 1550 
Ascites, chylous, in cat, 632 
in birds, 637 
in dog, 628 
in horse, 611 
in ruminants, 623 
Aspergillosis, 1206 
in birds, 1209 
in dogs, 1220 
in horses, 1216 
in man, 1221 
in oxen, 1214 
in sheep, 1216 
Aspergillus, 146 
Asthenia in poultry, 467 
Asthma in birds, 988 
in cattle, 948 
in dog and cat, 978 
in horse, 850 
compared with broken wind, 852 
medico-legal aspect of, 851 — 
Ataxia, 1133 
Atelectasis, 847 
in swine, 966 
Atheroma, 1075 
Atony of rumen, reticulum and omasum, 
in cattle, 379 
in goats, 437 
Atrophy, acute yellow, of liver in cattle, 
562 
in dog and eat, 586 
in horse, 537 
in sheep, 573 
of brain in dog, 1259 
of optic nerve in horse, 1195 
of pancreas in dog, 529 
of supra- and infra-spinati muscles in 
horse, 1200, 1243 
Auditory nerve, paralysis of, in dog, 1271 
Auricular acariasis, 1479 
Auscultation of abdomen, 167 
of chest, 796 
of heart, 1005 
Avian anthrax, 1303 
aspergillosis, 1209 
cholera, 420 
contagious catarrh, 444 
diphtheria, 319 
plague, 484 
roup, 444 
tuberculosis, 187 
variola, 595 
Azoturia, 1349 
course and duration, 1361 
differential diagnosis, 1362 
etiology, 1350 
history, 1349 
morbid anatomy, 1355 
occurrence, 1349 
pathogenesis, 1352 





1591 


| Azoturia, prognosis, 1362 


prophylaxis, 1366 
symptoms, 1357 
treatment, 1363 


Azoturia in cattle, 1366 


B 


| Babesia, 979 
| Bacillary necrosis, 282 


bacteriology, 282 
in calves, 284 
in cats, 295 
in dogs, 295 
in horses, 289 
in rabbits, 298 
treatment, 287 
pyelonephritis in cattle, 523 
Bacillus acne, 224 
Bacillus anthracis, 22,25 
Bang’s, of cattle abortion, 330 
bipolar, 407 
bronchicanis, 653 
chauveri, 49 
cholere suis, 5414 
choree paralytice ovis, 1251 
equisepticus, 828 
lactis aerogenes, 379 
mallet, 63 
mastidis contagiosa, 379 
of acne, 224 
of avian tuberculosis, 187 
of black quarter, 49 
of braxy, 1245 
of caseous suppuration, 211 
of distemper, canine, 646, 653 
of fowl cholera, 424 
of Johne’s disease, 198 
of malignant cedema, 12 
of necrosis, 282 
of Nicolaier, 228 
of Nocard and Mollereau, 379 
of swine erysipelas, 552 
of tetanus, 228 
of tuberculosis, 110 
ovoid, 407 
phiei, 200, 1313 
Preisz-Nocard, 211, 220, 225 
pseudo-tuberculosis, 205 
pyeclonephritidis bovis, 523 
pyocyaneus, 503, 609 
Rauschbrand, 49 
sarcophysematos bovis, 49 
Bacteremia, 1 
Bacterial diseases of fish 945; see also Fish 
septicemia, 1 
Baleri, 1055 
Barbone, 416 
Basedow’s disease, 1303 
Bassetism, 1341 
Bee disease, Isle of Wight, 1134 
Bees, 1434 
Belascaris cati, 1550 
marginata, 1550 





Benzoars, 324 
Bifid tongue, 26 


1592 


Big-head in turkeys, 436 
Bile-duct, catarrh of, in dog and cat, 586 
in horse, 538 
Bile, tests for, 535 
Bile test, Gmelin’s, 535 
Rosenbach’s, 535 
Biliary calculi in birds, 594 
in cattle, 563 
in dog and cat, 587 
in horse, 547 
in pig, 576 
in sheep, 574 
cirrhosis, 553 
ducts, inflammation of, in cattle, 562 
fever in dog, 1029 
lithiasis, 547, 563, 587, 594; see also 
Calculi 
Bird fever, 439 
Birds, administration of medicines to, 514, 
989 
anthrax of, 1209 
aspergillosis of, 1209 
catarrhal roup of, 444 
coccidiosis of, 1176 
contagious epithelioma of, 323 
diseases of circulatory organs, 1126 
of digestive system, 514 
of liver, 594 
of nervous system, 1278 
of respiratory organs, 986 
of urinary organs, 789 
hematoziasis of, 1118 
infectious leucocythemia of, 494 
septic fever of, 468 
Blackhead in turkeys, 1181 
Blackquarter, 47 
bacteriology, 49 
differential diagnosis, 53 
morbid anatomy, 50 
prognosis, 52 
protective inoculation, 55 
symptoms, 51 
temperature in, 51 
Blackquarter in sheep, 57 
Blackwater, 983 
Bladder, diseases of, in cattle, 744 
inflammation of, in cattle, 744 
inversion and prolapse of, in cattle, 
750 
paralysis of, in cattle, 749 
rupture of, in cattle, 749 
tumours of, in cattle, 749 
Bladder, diseases of, in dog and cat, 772 
eversion of, in dog and cat, 782 
hemorrhage of, in dog and cat, 776 
hernia of, in dog and cat, 781 
inflammation of, in dog and cat, 772 
paralysis of, in dog and cat, 775 
parasites of, in dog and cat, 782, 1562 
rupture of, in dog and cat, 776 
spasm of, in dog and cat, 775 
torsion of, in dog and cat, 782 
tumours of, in dog and cat, 780 
Bladder, congenital malformations of, in 
horse, 729 





SYSTEM OF VETERINARY MEDICINE 


| Bladder, diseases of, in horse, 715 


hemorrhage of, in horse, 719 
hernia of, in horse, 728 
inflammation of, in horse, 720 
inversion of, in horse, 728 
paralysis of, in horse, 717 
prolapse of, in horse, 728 
rupture of, in horse, 719 
sabulous deposits in, in horse, 727 
spasm of, in horse, 718 
tumours of, in horse, 727 
Bladder worms, the, 1483 
Blastomycosis of goose, 1223 
Blood, clinical examination of, 1280 
diseases of the, 1280 
estimation of hemoglobin content, 
1285 
of number of corpuscles per cubic 
millimetre, 1284 
microscopic examination of, 1281 
relative volume of corpuscles and 
plasma, 1285 
Bloodvessels, diseases of the, in cattle, L111 
in dog, 1125 
in horse, 1073 
Bloody flux of cattle, 417 
‘** Blown,”’ or “‘ bloating,” 351 
Blue tongue, 1269 
Borna sickness, 8914 
Botriomyces ascoformans, 275, 278 
Botriomycosis, 275 
differential diagnosis, 278 
etiology, 275 
in cattle, 280 
in man, 281 
in pigs, 281 
symptoms and lesions, 276 
treatment, 279 
Bovine farey, 271 
piroplasmosis, 981 
pleuro-pneumonia contagiosa, 559 
Bot fly, 1427 
effects of, 1430 
treatment, 1431 | 
Brachial plexus, paralysis of, in dog, 1272 
in horse, 1202 
Bradycardia, 1020 
Brain and its membranes, diseases of, in 
cattle, 1239 
abscess of, in cattle, 1240 
congestion of, in cattle, 1240 
hemorrhage of, in cattle, 1241 
hydrocephalus, in cattle, 1240 
inflammation of, in cattle, 1239 
tumours of, in cattle, 1241 
Brain and its membranes, diseases of, in 
dog and cat, 1253 
abscess of, in dog and cat, 1255 
atrophy of, in dog and cat, 1259 
hemorrhage of, in dog and cat, 1255 
hydrocephalus, in dog and cat, 1256 
injury and concussion of, in dog and 
cat, 1259 
thrombosis and embolism of vessels 
of, in dog and cat, 1258 


INDEX 


Brain, tumours of, in dog and cat, 1258 
Brain and its membranes, diseases of, in 
horse, 1128 
abscess of, in horse, 1144 
compression and concussion of, in 
horse, 1165 
congestion of, in horse, 1154 
hemorrhage of, in horse, 1156 
hemorrhagic cysts of, in horse, 1167 
hydrocephalus, in horse, 1134, 1148 
inflammation of, in horse, 1142 
parasites of, in horse, 1170 
parasitic cyst of, in horse, 1161 
tumours of, in horse, 1161 
Brain, diseases of, in birds, 1278 
in pig, 1248 
in sheep, 1246 
inflammation of, in pig, 1249 
in sheep, 1246 
Braxy, 1244 
Breast pang, 1072 
Bright’s disease, 686, 697, 735, 737, 751, 
754, 759, 761, 789; see also Nephritis 
British redwater, 1005 
“* Broken mouth ” in sheep, 427 
Broken wind, 893; sce also Pulmonary em- 
physema, 894 
medico-legal aspect of, 902 
Bronchial asthma in birds, 988 
in cattle, 948 
in dog and cat, 978 
in horse, 850 
croup in cattle, 946 
in horse, 849 
Bronchiectasis, 848 
Bronchitis, acute, in birds, 987 
in cattle, 946 
in dog and cat, 976 
in horse, 844 
in pig, 964 
in sheep, 959 
capillary, in cattle, 950 
in dog and cat, 976, 979 
in horse, 844 
chronic, in cattle, 947 
in dog and cat, 977 
in horse, 847 
croupous, in cattle, 946 
in horse, 849 
mechanical, in cattle, 951 
in horse, 845 
Bronchocele, 1302 
Broncho-pneumonia due to foreign bodies 
in cattle, 951 
in dog and cat, 980 
. in horse, 884 
in cattle, 950 
in dog and cat, 979 
in horse, 884 
infectious, of American cattle, 416 
Broncho-pulmonary hemorrhage, 859 
Bronchorrhagia, 859 
Buccal membrane, congestion of, 20 
mucosa, morbid alterations of, 12 
Bulbar paralysis, infectious, 632 





1593 
Bulbar paralysis, progressive, in cattle, 
1241 


in horse, 1174 
** Bull-burn,”’ 362 


C 


Caderas, mal de, 1061 
Cxcum, impaction of, in dog, 497 
in horse, 206 
inflammation of, in dog, 490 
invagination of, in horse, 260 
Cage birds, septic fever of, 408 
Cake-poisoning, 1532 
Caleareous degeneration 
558 
Calculi, biliary, in birds, 594 
in cattle, 563 
in dog and cat, 587 
in horse, 547 
in pig, 576 
in sheep, 574 
false, in horse, 223 
intestinal, in horse, 223 
oat-hair, in horse, 224 
of tonsils in horse, 33 
pancreatic, in cattle, 527 
preputial, in cattle, 750 
in horse, 730 
renal, in birds, 789 
in cattle, 742 
in dog and cat, 768, 770 
in horse, 711 
in pig, 755 
in sheep, 752 
true, in horse, 224 
urethral, in cattle, 750 
in dog and cat, 782, 784 
in horse, 729 
in pig, 755 
in sheep, 753 
vesical, in cattle, 748 
in dog and cat, 778 
in horse, 724 
in pig, 755 
in sheep, 752 
‘ Calf diphtheria,” 282 
Calves, dyspepsia in, 400 
Canadian horse-pox, 224 
Canine distemper, 635 
bacteriology, 646 
course, 692 
differential diagnosis, 694 
etiology, 642 
immunisation, 702 
morbid anatomy, 660 
prognosis, 692 
prophylaxis, 697 
recurrence, 642 
symptoms, 667 
alimentary, 680 
cutaneous or eruptive, 667 
febrile, 691 
hepatic, 688 
infantile, 687 


of liver in horse, 


1594 
Canine distemper, symptoms, malignant, 
688 


muscular, 690 

nervous, 682 

ocular and nasal, 671 

oral, 681 

respiratory, 675 

suppurative or phlegmonous, 
686 


urino-genital, 690 
treatment, 707 
typhus, 735 
Cantharides, poisoning by, 1579 
Carbolic acid, poisoning by, 1577 
Carbuncle of coronary band, 300 
Carceag, 1013 
Cardiac impulse, 1005 
insufficiency, 1028 
kidney, 682 
murmurs, 1005 
symphysis in cattle, 1105 
in horse, 1012 
Caseous lymphadenitis of sheep, 209 
Castor oil beans, poisoning by, 1582 
Casts, organised, in urine, 672 
varieties of, 673 
Cat, coccidiosis of, 1202 
diphtheria of, 317 
distemper of, 720 
epizootic enteritis of, 761 
gastro-enteritis of, 760 
influenza of, 867 
Catalepsy, 1216 
Catarrh, acute bronchial, in birds, 987 
in cattle, 946 
in dog and cat, 976 
in horse, 844 
in pig, 964 
in sheep, 959 
gastric, in cattle, 381 
in dog and cat, 477, 511 
in horse, 136 
in pig, 449 
in sheep, 433 
gastro-intestinal, in cattle, 400, 
413 


in dog, 478, 490 
in horse, 142, 266 
intestinal, in cattle, 413 
in dog and cat, 490, 512 
in horse, 265, 266 
nasal, in birds, 986 
in cattle, 938 
in dog and cat, 969, 971 
in horse, 799 
in pig, 963 
in sheep, 958 
of bile-ducts in birds, 594 
in cattle, 562 
in dog and cat, 586 
in horse, 538 
chronic gastric, in dog and cat, 481, 
512 


in horse, 149 
nasal, in cattle, 940 








SYSTEM OF VETERINARY MEDICINE 


Catarrh, chronic nasal, in dog and cat, 970, 


in horse, 802 ‘ 
of guttural pouch, 811 
contagious avian, 444 
laryngeal, in cattle, 943 
in dog and cat, 973 
in horse, 814 
in swine, 964. 
of the crop, 516 
of maxillary and frontal sinus, in 
cattle, 940 
in dog, 972 
in horse, 809 
pharyngeal, in cat, 510 
in cattle, 324 
in dog, 464. 
in horse, 35 
Catarrhal fever of horses, 843 
malignant, of bovines, 528 
roup in birds, 444 
Catheter, employment of, in cat, 784, 786 
in ox, 748 
Cattle plague, 916; see also Rinderpest 
Cauda equina, chronic interstitial neuritis 
of, 1205 
Cella infra-orbitalis, inflammation of, in 
fowl, 986 
Cellulitis epizodtic, 843 
perinephritic, in cattle, 740 
Cerebellar hemorrhage in dog, 1256 
in horse, 1159, 1170 
Cerebellum, diseases of, in horse, 1170 
abscess of, in horse, 1171 
hemorrhage of, in dog, 1256 
in horse, 1159, 1170 
tumours of, in dog, 1258 
in horse, 1162, 1163 


| Cerebral abscess in cattle, 1240 


in dog, 1255 
in horse, 1144 
anemia in horse, 1155 
aneurism in horse, 1155 . 
apoplexy in dog, 1256 
in horse, 1156 
bloodvessels, embolism and throm- 
bosis of, 1160 
hemorrhage in cattle, 1241 
in dog, 1256 
in horse, 1156 
hyperemia in horse, 1154 
Cerebrum, tumours of, in horse, 1162 
Cerebro-spinal meningitis, epizootic, in 
cattle and sheep, 897 
in dogs, 898 
in horse, 889, 1306 
Charbon, 21 
Chest, physical examination of, 794 
Cheyne-Stokes type of respiration, 584 
Chicken-pox, 576, 595 
Chlorosis in sheep, 1288 
‘* Choking ”’ in cat, 510 
in cattle, 329 
use of probang in, 335 
in dog, 469 


INDEX 


“ Choking”’ in dog, use of probang in, 471 
in horse, 68 
treatment of, 73 
American method of treat-— 
ment, 79 
instrumental, 76 
Knisley’s method, 80 
medicinal, 75 
in pig, 448 
in sheep, 428 
Choleastomata, 1162 
Cholecystitis in cattle, 563 
in dog and cat, 587 
Cholelithiasis, 547 
Cholera, duck, 438 
owl, 420 
Choleraic gastro-enteritis of birds, 975 
Chondroids of guttural pouch, 812 
Chorea in cattle, 1244. 
in dog and cat, 1275 
in horse, 1216 
in swine, 1250 
Chorioptic mange, 1477 
Chylous ascites in cat, 632 
Circulatory organs, diseases of, in birds, 
1126 





in cattle, 1098 

in dog and cat, 1116 

in horse, 1000 

in sheep, goats, and swine, 
113 


’ 


‘ Cireus mode of progression ’’ in abdom- 
inal affections, 168 
Cirrhosis of kidney in dog and cat, 761 
in horse, 697 
of liver, atrophic, 551 
biliary, 553 
capsular, 552 
choliangiotic, 553 
hypertrophic, 55] 
toxic, in cattle, 569 
Cirrhosis of liver in cattle, 569 
in dog and cat, 590 
in horse, 550 
in pig, 577 
in sheep, 575 
of lung, 888 
** Clew-bound, ’ 377 
Cloacitis, 505 
Clots, ante-mortem, 1007 
in heart, 1006 
post-mortem, 1006 
Cocaine, poisoning by, 1579 
Coccidia, the, 1164 
Coccidian enteritis in cattle, 421 
Coccidiosis of birds, 1176 
of cat, 1202 
of dogs, 1201 
of goats, 1199 
of horses, 1200 
of man, 1203 
of mouse, 1203 
of oxen, 1188 
of pigs, 1200 
of rabbits, 1168 





1595 


_ Coccidiosis of sheep, 1197 


renal, of goose, 1186 
Cochlear nerve, paralysis of, in dog and 
cat, 1271 
Ceenurosis, 1489 
due to Cenurus cerebralis, 1489 
serialis, 14,92 
Colic due to verminous aneurism, 280 
flatulent, in horse, 179 
in swine, 451 
in cattle, 465 
in the dog, 489 
in the horse, 168 
in young unbroken animals, 223 
obstructive, in foals, 221 
in horse, 188 
“* sand,”’ in horse, 228 
spasmodic, in cattle, 405 
in dog, 489 
in horse, 169 
thrombo-embolic, in horse, 280 
treatment of, 177 
Colon, dilatation of, in dog, 501 
double, impaction of, in horse, 188 
other forms of displacement with 
torsion, of, 250 
torsion or displacement of pelvic 
flexure in horse, 243 
volvulus and displacements, with 
torsion of, 242 
impaction of, in cattle, 410 
obstruction of, in dog, 497 
single, impaction of, 211 
torsion of, 256 
Compression of brain, 1165 
of peripheral nerves, 1193 
of spinal cord, 1187, 1242 
Concretions in stomach of horse, 155 
Concussion of brain, 1165 
of spinal cord, 1186, 1242 
Congenital defects, nasal cavities in dog 
and cat, 973 
of bladder, 729 
of palate, 34 
of tongue, 26 
Congestion, acute pulmonary, in cattle, 948 
in dog and cat, 978 
in horse, 855 
intestinal, in horse, 280 
of brain in horse, 1154 
of buccal membrane in horse, 20 
of hard palate in horse, 20 
of kidneys, 677, 732, 751, 789 
of liver, 539, 565, 588 
Constipation in cat, 513 
in dog, 496 
in horse, 306 
in parrots, 522 
in sheep, 434 
in swine, 452 
Constriction of cesophagus, 66 
Contagious abortion, 325 
acne, 224 
agalaxia, 404 
avian catarrh, 444 


1596 


Contagious bovine pleuro-pneumonia, 559 
bacteriology, 559 
differential diagnosis, 565 
etiology, 559 
morbid anatomy, 561 
preventive inoculation, 569 

prophylaxis, 567 
symptoms, 563 
ecthyma in sheep, 300 
epithelioma of birds, 323. 
gastro-enteritis of the dog, 735 
granular vaginitis of cattle, 348 
pneumonia of the horse, 825 
bacteriology, 828 
complications, 837 
course, 839 
differential diagnosis, 839 
etiology, 827 
modes of infection, 828 
morbid anatomy, 829 
prognosis, 839 
prophylaxis, 840 
sequel, 838 
symptoms, 833 


SYSTEM OF VETERINARY MEDICINE 


_ Croup, nasal, in cattle, 938 








treatment, 840 
pseudo-rabies, 630 
pustular dermatitis of sheep, 300 
stomatitis, 596 
Convulsions, puerperal, in bitch, 1276 
in cow, 1244 
in mare, 1216 
in sow, 1249 
Cornstalk disease, 416 
Coronary band, carbuncle of, 300 
Corpora quadrigemina, diseases of, 1163 
Coryza, acute, in cattle, 938 
in dog and cat, 969 
in horse, 799 
in sheep, 958 
in swine, 963 
Cough, types of, 793 
“ Coup de soleil,” 1234 
Cow-pox, 571 
false, 576 
‘“Cramming”’ birds with food, accidents 
due to, 988 
Cramp of muscles of tibia, 1203 
radial, in dog, 1272 
Cranial nerves, diseases of, 1195 
tumours implicating, 1163 
Crayfish and prawn plague, 1134 
Creolin, poisoning by, 1578 
Cretinism, 1305 
Crib-biting and wind-sucking, 1227 
medico-legal aspect of, 1232 
“ Crop-bound,” 518 
Crop, diseases of, 516 
impaction of, 518 
parasites of, 519 
pendulous, 517 
** Crop-sick,”’ 516 
Croton beans, poisoning by, 1582 
Croup, 817 





bronchial, in cattle, 946 


in horse, 849 


in horse, 805 
Croupous angina, 43 
bronchitis in cattle, 946 
in horse, 849 
enteritis in cattle, 416 
in dog, 493 
laryngitis in cattle, 943 
in horse, 817 
pharyngitis in cattle, 325 
in dog, 466 
pneumonia in cattle, 949 
in dog and cat, 979 
in horse, 864 
in sheep, 961 
rhinitis in cattle, 938 
in horse, 805 
Crura cerebri, diseases of, 1173 
Crural nerves, paralysis of, in cattle, 1243 
in dog, 1272 
in horse, 1203 
Crusta labialis, 300 
Cud, ‘‘ dropping of,” 343, 428 
“* spewing of,” 343 
Cyanosis, 1068 
Cyanotic induration of kidney, 681 


- Cyllin, poisoning by, 1578 


Cyst, retention, in dog, 460 
Cystic caleuli. See Caleuli, vesical 
disease of kidney in cattle, 741 
Cysticercosis, 1484 
due to Cysticercus bovis, 1486 
cellulose, 1484, 
ovis, 1487 
pisiformis, 1488 
tenuicollis, 1487 
Cystitis, chronic hemorrhagic, in cattle, 745 
in cattle, 744 
in dog and cat, 772 
in horse, 720 
in sheep, 752 
in swine, 755 
Cysts, emphysematous, of mesentery in 
swine, 626 
hemorrhagic, of brain, 1167 
in parenchyma of kidney in swine, 755 
parasitic, of brain, 1161 


D 


Demodex folliculorum, 1452 
Dengue, 944 
Dental fistula in dog and cat, 972 
Depraved appetite in cattle, 397 
in sheep, 432 
Dermatitis, pustular, in horse, 224 
in sheep, 300 
Desquamative stomatitis in cattle, 318 
‘* Dew-blown,”’ 430 


| Diabetes insipidus in dog, 1311 


in horse, 1308 
mellitus in cattle, 1313 

in dog, 1313 

in horse, 1313 
pancreatic, in dog, 529 


INDEX 


Diaphragm, “ chorea of,” 990 
diseases of, 990 
hernia of, 992 
rupture of, 992 
in cattle, 995 
in dog, 995 
in horse, 992 
_ spasm of, 990 
Diaphragmatic hernia, 992 
pleurisy, 913 
Diaphragmatocele, 992 
Diarrhea in cattle, 422 
in foals, 300 
in goats, 440 
in horse, 299 
in lambs and sheep, 434 
in parrots, 522 
in swine, 454 
Diarrhea, chronic, in cats, 512 
in cattle, 420 
Diarrheic enteritis in foals, 277 
in young dogs, 492 
Digestive system, diseases of, in birds, 514 
in cat, 507 
in cattle, 308 
in dog, 456 
in goats, 436 
in horse, 1 
in sheep, 424 
in swine, 441 
Dilatation of heart in cattle, 1107 
in dog, 1119 
in horse, 1026 
of intestine in dog, 501 
in horse, 289 
of cesophagus in cattle, 337 
in dog, 468 
in horse, 461 
of stomach, acute, in dog, 474 
chronic, in dog, 476 
in horse, 128 
Diphtheria, avian, 319 
* calf,’’ 282 
of cat, 317 
relationship with human diphtheria, 
310 
Diphtheritic inflammation of the mouth in 
young swine, 446 
Diplegia, 1133 
** Dirty mouth ” in cattle, 318 
in sheep, 426 
Dislocation of vertebrze, 1188 
Displacements of intestines, 236 
with torsion, 239 
of pelvic flexure of double colon, 243 
Distemper, canine, 635; see also Canine 
feline, 720 
of ferret, 733 
of guinea-pig, 734 
of rabbit, 733 
spasms, 275 
Distomatosis, 1510 
Distomiasis, 1510 
Diverticulum of cesophagus, 62, 468 
of rectum in the dog, 501 


1597 


| Dog, aspergillosis, 1220 
bacillary necrosis, 295 
biliary fever, 1029 
coccidiosis of, 1201 
contagious gastro-enteritis, 735 
distemper, 635 
fistulous dermatitis, 295 
infective venereal granuloma, 367 
influenza, 867 
Leishmaniasis, 1161 
malignant jaundice, 1029 
piroplasmosis of, 1029 
pox, 592 
rabies, 604 
specific venereal disease, 366 
Stuttgart disease of, 735 
typhus of, 735 
Doubtful etiology, diseases of, 1348 
Dourine, 1067 
Dropped elbow, 1201 
jaw in dog, 1270 
lip, 1197 
stifle, 1203 
** Dropping after calving,” 1368 
‘* Dropping the cud ” in cattle, 343 
in sheep, 428 
Dropsy, abdominal, in dog, 628 
in horse, 611 
in ruminants, 623 
chronic, of lateral ventricles, 1148 
of pericardium, 1018 
of pleura in dog, 984 
in horse, 927 
Dry mouth, 12, 317 
“ murrain,” 377 
Duck cholera, 438 
septicemia, 451 
Ductless glands, diseases of, 1299 
| Duodenum, impaction of, in horse, 218 — 
| perforating ulcer of, in dog, 495 
stricture of, in dog, 500 
Dysenteric enteritis in dog, 493 
Dysentery in cattle, 417 
in horse, 297 
“ red,’’ in cattle, 421 
Dyspepsia in calves, 400 
in cattle, 387 
in dog, 481 
in horse, 134 
in recently weaned calves, 404 
nervous, in horse, 150 
post-parturient, in cattle, 387 
Dyspnea, 792 
Dysuria, 715 





E 
East Coast fever, 994 


| Eechinococcosis, 1493 


due to Echinococcus alveolaris, 1495 
polymorphus, 1493 
Eelampsia in bitch, 1276 
in cattle, 1244 
in horse, 1216 





in swine, 1249 
puerperal, in bitch, 1276 


1598 


Eclampsia, puerperal, in cow, 1244 
in mare, 1216 
in sow, 1249 
Ectasis, 61 
Eczema epizodtica, 764 
“* Egg-binding,”’ 523 
** Elbow, dropped,” 1201 
Electric currents, contact with (effects of), 
1236 
Elephantiasis, 1383 
Embolism, 1093 
air, 1096 
effects of, 1094 
malignant, 1093 
Embolism and thrombosis of cerebral blood- 
vessels, 1160, 1241 
Embryocardia, 1032 
Emphysema, pulmonary, in birds, 988 
acute alveolar, in horse, 893 
in cattle, 953 
in dog and cat, 981 
in swine, 967 
chronic alveolar, in horse, 893 
in cattle, 955 
in dog and cat, 982 
interstitial, in horse, 906 
Empyema in cattle, 956 
in dog and cat, 984 
in horse, 922 
Encephalitis, acute, in cattle, 1239 
in dog, 1254 
in horse, 1142 
in pig, 1248 
in sheep, 1246 
chronic, in horse, 1147 
purulent, in cattle, 1240 
in dog and cat, 1255 
in horse, 1144 
Endoarteritis, chronic, in birds, 1127 
in cattle, L111 
in dog and cat, 1125 
in horse, 1073 
Endocarditis, acute, in birds, 1126 
in cattle, 1107 
in dog and cat, 1121 
in horse, 1036 
in swine, 1114 
benign or verrucous, 1039 
chronic, in birds, 1127 
in cattle, 1109 
in dog and cat, 1123 
in horse, 1045 
in swine, 1115 
malignant or ulcerative, 1040 
Endometritis, acute, 638, 647; see also 
Acute metritis 
chronic purulent, 652 
** Entéqué,”’ 953 
Enteritidin, 1313 
Enteritis in birds, 520 
Enteritis in cat, 512 
acute catarrhal, 512 
chronic catarrhal, 512 
epizootic, of cat, 761 
Enteritis, acute, in cattle, 413 








SYSTEM OF VETERINARY MEDICINE 


Enteritis, acute, catarrhal, in cattle, 413 
chronic, in cattle, 420 
coccidian, in cattle, 421 
croupous, in cattle, 416 
hemorrhagic, in cattle, 417 
pseudo-membranous, in cattle, 416 
ulcerative, in cattle, 417 
Enteritis in dog, 490 
acute catarrhal, 490 
chronic catarrhal, 491 
croupous or dysenteric, 493 
Enteritis in foals, 277 
Enteritis, acute, in horse, 262 
differential diagnosis, 273 
etiology, 267 
morbid anatomy, 270 
prognosis, 276 
symptoms, 271 
treatment, 276 
Enteritis in sheep, 435 
Enteritis in swine, 451 
Enteritis, varieties of, 265 
Enteroliths, 224 
Ependymitis in dog, 1255 
in horse, 1148 
Epididymitis, infectious, in horse, 372 
Epilepsy in birds, 1279 
in dog and cat, 1273 
in horse, 1212 
in swine, 1248 
Jacksonian, 1213 
secondary or reflex, 1213 
true, 1212 
Epileptiform convulsions, 1212, 1273 
Epistaxis in cattle, 940 
in horse, 806 
Epithelioma contagiosum, 323 
of the tongue, 25 
papulosum, 1130 
Epitheliosis, 323 
Epithelium in urine, 673 
Epizo6tic abortion in cattle, 325 
bacteriology, 330 
complications, 334 
diagnosis, 335 


abortin or reaction 
method, 336 

agglutination method, 
335 

fixation of complement, 
336 


etiology, 330 
modes of infection, 331 
morbid anatomy, 334 
mortality, 332 
occurrence, 326 
period of incubation, 333 
prophylaxis, 336 
symptoms, 333 
treatment, 336 

cellulitis, 843 

cerebro-spinal meningitis in horse, 889, 

1306 
enteritis of cat, 761 
fibrinous aphtha, 787 


INDEX 


Epizodtic gastro-enteritis of cat, 760 


infectious epididymitis of the horse, | 


372 
lymphangitis, 1289 
paraplegia, 900 
pneumo-enteritis of the turkey, 436 
pneumo-pericarditis in the turkey, 
433 
Equine pernicious anemia, 927 
piroplasmosis, 1015 
Eructations, 94 
Erysipelas, 249 
bacteriology, 250 
differential diagnosis, 253 
etiology, 250 
morbid anatomy, 251 
of swine, 551 
prophylaxis, 254 
symptoms, 251 
treatment, 255 
Erythematous stomatitis, 130 
Eustrongylus gigas, 1556 
Eversion of bladder in cow, 750 
in dog and cat, 782 
in mare, 728 
Exanthema, vesicular, of horses and cattle, 
359 
Exophthalmic goitre, 1302 
Eye, diseases of motor nerves of, 1196 


F 


Facial nerve, paralysis of, in cattle, 1243 
in dog, 1271 
in horse, 1197 
sinuses, diseases of, 809 
Facial and turbinated bones, myxoid de- 
generation of, 811 
Fecal impaction in the dog, 496 
stasis in the dog, 496 
** Fainting ”’ in goats, 1247 
Farcy, 59 
bovine, 271 
Guadelope form of, 272 
symptoms of, 79 
** Fardel-bound,”’ 377 
Fasciola hepatica, 1506, 1507, 1509 
Fascioliasis, 1510 
Fatty degeneration of heart in cattle, 1107 
in dog and cat, 1120 
in horse, 1034 
in swine, 1114 
of kidneys in dog and cat, 766 
of liver in birds, 594. 
in cattle, 570 
in dog and cat, 592 
in horse, 556 
in sheep, 575 
Fauces, inflammation of, 35 
Fehling’s test for sugar, 1316 
Feline distemper, 720 
typhus, 760 
Fermentation test for sugar, 1316 
Ferry’s anti-distemper serum and vaccine, 
706 








1599 


Fever, swine, 538 
bird, 43 
Fibrillation, 1029 
Fibrinous bronchitis, 849 
Filaria immitis, 1559 
Filariasis, intra-ocular, 1558 
Fish, bacterial diseases of, 946 
coli-bacillosis of the fresh-water her- 
ring, 969 
epizootic diseases of fresh-water fish, 
946 
fungous disease of, 1156 
furunculosis of the salmonidee, 957 
infection in fish, 966 
lepidorthosis of white fish, 968 
nodular diseases of, 1133 
other fish infections, 970 
protozoal diseases, 1118 
red plague of carp and tench, 966 
of eels, 967 
saprolegniosis, 1152 
spotted diseases of the red-spotted 
trout, 963 
Be eee epizootic in gudgeon, 
965 


tuberculosis of carp, 970 
typhus of the perch, 969 
ulcerative diseases of salmon, 963 
ulcerous septicemia of goldfish, 966 
yellow plague of roach, 969 
Fistula, dental, 972 
of esophagus, 42, 83 
of reticulum, 370 
pharyngeal, 42 
Fistulous dermatitis in dog, 295 
Flatulent colic, 179 
in horse, 179 
in pig, 451 


| Fleas and jiggers, 1432 


injurious effects and treatment, 
1433 
Flies, blood-sucking, 1416 
British species of, 1417 
exotic species of, 1419 
injurious effects of, 1420 
remedial measures, 1422 
blow, 1424 
injurious effects of, 1426 
remedial measures, 1426 
varieties of, 1424, 
gad breeze, 1417 
warble and bot, 1427 
injurious effects of, 1430 
remedial measures, 1431 
Floating kidney in dog, 768 
Fluke disease, 1509 
or sucker worms, 1505 
Fly, autumn breeze, 1418 
house, 1418 
New Forest, 1419 
ox breeze, 1417 
small rain breeze, 1417 
stable, 1418 
Foals, enteritis in, 277 
obstructive colic in, 222 


1600 


Foals, scrotal hernia in, 223 
Feetor oris, 12, 317 
“ Fog sickness, ? 351 
Follicular mange in dog, 1453 
in ox, goat, and pig, 1456 
mites, 1452 

Foot and mouth disease, 764 
course and prognosis, 779 
differential diagnosis, 784, 

1309 
etiology, 766 
in cattle, 773 
in dogs, cats, birds, 783 
in horses, 782 
in man, 789 
in pigs, 781 
in sheep, 780 
malignant or 
form, 778 

modes of infection, 768 
morbid anatomy, 772 
mortality, 779 
period of incubation, 773 
prophylaxis, 787, 1308 
pseudo-, 785, 1309 
public health, 789 
symptoms, 773 
treatment, 788 

Foot and mouth disease, ‘‘ Armagh,” 


septiczemic 


false, in sheep, 426 
Forage poisoning in horses, 1806 
Foramen ovale, pervious, 1068 
Foreign bodies in intestine of dog, 499 
of horse, 228 
in liver of cattle, 564 
of horse, 550 
in cesophagus of cattle, 329 
of dog, 469 
of horse, 68 
of pig, 448 
in pharynx of horse, 52 
in rumen and reticulum, 368 
in stomach of dog, 486 
of goat, 439 
of horse, 155 
of sheep, 432 
in tongue of horse, 24 
Fowl, anthrax of, 1303 
cholera, 420 
coccidiosis of, 1176 
contagious venereal catarrh, 371 
diphtheria, 399 
distemper, 444 
epizootic dysentery of the fowl and 
turkey, 464 
infectious enteritis, 445 
paratyphoid disease, 466 
plague, 484 
sleeping sickness of, 483 
spirochetosis of, 1227 
“* Frémissement cataire,’? 1005 
Fremitus or thrill, 1005 
Friction sounds in pericarditis, 1014 
in pleurisy, 798 


SYSTEM OF VETERINARY MEDICINE 


Fragilitas ossium, 1318 
Fungous disease of fish and alevins, 1156 
Furunculosis of salmonidez, 957 


G 


Gall- bladder, inflammation of, in bitds, 594.4 
in cattle, 563 
in dog and cat, 587 
Gall- sickness, 1034 
Gall-stones in birds, 576 
in cattle, 563 
in dog and cat, 587 
in horse, 547 
in pig, 576 
in sheep, 574 
Gangrene, traumatic, 15 
Gangrenous coryza, 529 
mamumitis of ewes, 398 
of goats, 399 « 
stomatitis, 18 
vaginitis of cattle, 356 
Gaseous indigestion in cattle, 351 
intestinal indigestion in horse, 179 
: in pig, 451 
Gastrectasis in dog, 474 
in horse, 128 
Gastric catarrh, acute, in dog and cat, 477, 
51il 


in horse, 136 
in pig, 449 
chronic, in dog and cat, 481 
in horse, 149 
impaction in the dog, 474 
in foals, 106 
in horse, 96 
indigestion, acute, in dog, 474 
tympany, acute, in cattle, 351 
in dog, 475 
in horse, 108 
use of stomach-tube in, 
118 
ulcer in cattle, 386 
in dog, 484 
in horse, 131 
Gastritis in birds, 519 
in cat, acute, 511 
chronic, 512 
in cattle, 381 
parasitic, 1543 
in dog, acute, 477 
chronic, 481 
toxemic, 477 
toxic, 480 
ulcerative, 484 
in horse, acute, 134 
chronic, 149 
phlegmonous, 139 
toxic, 141 
in pig, 449 
parasitic, 1548 
in sheep, parasitic, 1543 
‘* Gastro-encephalitis,” 145 
Gastro-enteritis in cattle, 381 
parasitic, 1543 


INDEX 


Gastro-enteritis in dog, hemorrhagic, 493 
mycotic, 493 
in horse, acute, 143 
infectious, 145 
mycotic, 145 
Gastro-enteritis, choleraic, in birds, 975 
infectious, in dog, 735 
Gastro-intestinal catarrh in calves, 400 
- acute, in horse, 142 
chronic, .in cow after calving, 
1377 
Gastrophilus equi, 1427, 1430 
hemorrhoidalis, 1428 
“ Gid,” or “sturdy,” in sheep, 1489 = 
symptoms, 1489 
treatment, 1491 
Gid, protozoal, in rainbow trout, 1180 
Gizzard, diseases of, 519 
Glanders, 59 
_bacteriology,.63 
diagnosis, 86 
aids to, 88 
mallein in, 90 
etiology, 62 
form, acute, 85 
chronic, 86 
subacute, 85 
in man, 100 
methods of infection, 66 
morbid anatomy, 70 
period of incubation, 65 
preventive measures, 94 
pseudo-, 220° 
symptoms, 79 
** Glanders, feline,” 971 
Gliomata, 1161 
Glisson’s capsule, inflammation of, 543 
** Gloss anthrax,” 32, 46, 1303 
Glossina (tsetse-flies), 1420 
Glossitis in dog, 461 
in horse, 21 
in pig, 446 
in sheep, 428 
Glossoplegia in dog, 461 
in horse, 25 
Glottis, edema of, 818 
Gluteal nerves, paralysis of, 1205 
Glycosuria, 1313 
physiological, 1313 
Glycuronie acid, normal presence of, in 
_ _ urine of dog, 1316 
Gmelin’s test for bile, 535 
Gnathism, 1341 
Goat-pox, 589 
Goats, nervous or stiff-legged, 1247 - 
“ Going-light ” in birds, 467 
Goitre, 1302 
cystic, 1302 
exophthalmic, 1303 
parenchymatous, 1302 
Goose, blastomycosis of, 1223 
renal coccidiosis of, 1186 
septicemia of, 437 
spirochetosis of, 1234 
Gorged stomach in horse, 96 


VOL. II, 








1601 


Gotch, 447 
Gout in birds, 1346 
in the dog, 1345 
in the horse, 1345 
in the pig, 1345 
** Grand mal,”’ 1213 
Granular vaginitis, contagious, 349 
** Grass staggers,” 97 
Graves’ disease, 1303 
Grouse disease, 457 
Grunting, 840 
Macqueen’s views on, 842 
medico-legal aspect of, 842 
varieties of, 841 
** Gut-tie ” in cattle, 409 
Guttural pouches, chondroids of, 812 
chronic catarrh of, 811 
tympanites of, 813 
ulceration of, 812 


H 


Hemaphysalis punctata, 1449 
Hematomata of liver, 541 
of spleen, 1300 
Hematomyelia, 1185 
Hematopinus, 1436 
Hematorachis, 1185 
Hematothorax, dog and cat, 985 
Hematoziasis of birds, 1118 
Hematuria in horse, 670 
chronic, in cattle, 745 
enzootic, in cattle, 745 
vesical, in cattle, 745 
Hemoglobin, Heller’s test for, 672 
Hemoglobinemia, simple, 1296 
paralytic, 1348; see also Azoturia 
Hemoglobinuria, 671, 1348 
paroxysmal muscular, 1348 ; see alse 
Azoturia 
toxemic, 1348; see also Azoturia 
Hemopericardium, 1018 
Hemophilia, 1297 
Hemopis, 50 
Hemoptysis, 859 
Hemorrhage, broncho-pulmonary, 859 
cerebellar, in dog, 1256 
in horse, 1159, 1170 
cerebral, in birds, 1278 
in cattle, 1241 
in dog and cat, 1256 
in horse, 1156 
of bladder, 719, 776 
of crura cerebri, 1173 
of intestine, 297 
of liver, 541, 566, 588 
of medulla oblongata, 1159, 1173, 1256 
of nose, 806, 940 
of pons Varolii, 1159, 1171, 1256 
of spleen, 1300 
of stomach in dog, 485 
in horse, 134 
meningeal, 1158 
pulmonary, 859, 953 
spinal, 1185, 1265 
101 


1602 


Hemorrhagic cysts of brain, 1167 
enteritis in cattle, 417 
pancreatitis in dog, 529 
pleurisy, 913 
septicemia, 407 
Hemorrhoids, 293 
Hair balls, obstruction due to, 223 
Haplosporidie, 1150 
“ Hard crop,” 518 
Hard palate, congestion of, 20 
Hares, pseudo-venereal disease in, 370 
strepto-bacillary pseudo-tuberculosis 
in, 218 
Harvest bugs, 1442 
Heart, diseases of, in birds, 1126 
fatty degeneration of, in birds, 1126 
hypertrophy of, in birds, 1126 
rupture of, in birds, 1126 
Heart, diseases of, in cattle, 1098 
dilatation of, in cattle, 1098 
fatty, in cattle, 1107 
foreign bodies in, of cattle, 1110 
hypertrophy of, in cattle, 1106 
rupture of, in cattle, 1110 
tumours of, in cattle, 1110 
valvular disease of, in cattle, 1109 
Heart, diseases of, in dog and cat, 1116 
dilatation of, in dog and cat, 1119 
fatty, in dog and cat, 1120 
foreign bodies in, of dog and cat, 1120 
hypertrophy of, in dog and cat, 1119 
rupture of, in dog and cat, 1120 
tumours of, in dog and cat, 1120 
valvular disease of, in dog and cat, 
1123 
Heart, diseases of, in horss, 1020 
aneurism of, in horse, 1069 
congenital affections of, in horse, 1068 
dilatation of, in horse, 1026 
displacements of, in horse, 1068 
foreign bodies in, of horse, 1071 
hypertrophy of, in horse, 1024 
irregular action of, in horse, 1022 
palpitation of, in horse, 1020 
physical examination of, in horse, 
1004 
special pathological conditions of, in 
horse, 1068 
tumours of, in horse, 1071 
valvular diseases of, in horse, 1051 
wounds of, in horse, 1071 
Heart, diseases of, in sheep and goats, 1113 
foreign bodies in, of sheep and goats, 
1113 
rupture of, in sheep and goats, 1113 
Heart, diseases of, in swine, 1113 
dilatation of, of swine, 1114 
fatty, in swine, 1114 
foreign bodies in, of swine, 1114 
valvular diseases of, in swine, 1115 
Heart-strain, 1026 
Heart-water, 1258 
Heat apoplexy, of cattle, 1245 
of horse, 1234 
of swine, 1250 








SYSTEM OF VETERINARY MEDICINE 


Heatstroke, 1234, 1245, 1250 
‘* Heaves,’’ 893 
Heller’s ring-test for albumin, 668 
test for hemoglobin, 672 
Helminthiasis of the alimentary canal, 


of the muscular and other tissues, 1556 
of the respiratory organs, 1520 
Hemiplegia, 1133 
. laryngeal, 825, 975 
Hepatic cirrhosis in cattle, 568 
in dog and cat, 590 
in horse, 550 
in sheep, 575 
in swine, 577 
Hepatitis, acute parenchymatous, in 
cattle, 566 
in dog and cat, 589 
in horse, 543 
parenchymatous, in horse, 543 
in sheep, 572 
in swine, 576 
chronic interstitial, in cattle, 568 
in dog and cat, 590 
in horse, 550 
in sheep, 575 
in swine, 577 
hyperplastic indurative, in horse, 551 
suppurative, in cattle, 566 
in dog and cat, 566 
in horse, 544 
in sheep, 575 
in swine, 575 
Hernia, diaphragmatic, 992 
due to rupture of mesentery, 231 
of bladder in dog, 781 
in mare, 728 
pelvic, in cattle, 409 
perineal, in dog, 781 
strangulated scrotal, in foals, 223 
through foramen of Winslow, 232 
Meckel’s diverticulum, 233 
High-blowing, 844 
Hodgkin’s disease, 1295 
Hook-worm disease in dog, 1551 
Hooked worms, the, 1516 
** Hoose ”’ in calves, 1523 
in lambs, 1523 
Hornets, 1434 
Horse-pox, 578 
Canadian, 224 
Horse sickness, South African, 1280 
** Hoven,” 351, 430, 431, 437 
Hydremia, 1289, 1290 
in cattle, 1290 
in pig, 1291 
in sheep, 1290 
Hydrargyrism, 20, 321, 459, 1575 
Hydrocephalus, acute, in horse, 1134 
chronic, in horse, 1148 
congenital, 1149, 1152 
external, in horse, 1139 
in cattle, 1240 
in dog, 1255 
internal, in horse, 1148 


INDEX 


Hydrometra, 652 
Hydronephrosis in cattle, 741 
in dog, 767 
in horse, 709 
in sheep, 752 
‘In swine, 754 
Hydropericardium, 1018 
Hydrophobia, 620 
Hydro-pneumothorax, 925 
Hydrops pericardii, 1018 
Hydrothorax in dog and cat, 984 
in horse, 909 
’ Hyperemia, cerebral, 1154, 1240 
mechanical, of kidneys, 681 
of liver, 539 - 
pulmonary, acute, 854 
Hyperthyroidism, 1303 
Hypertrophic cirrhosis of liver, 551 
Hypertrophy of heart, 1024, 1106, 1119 
of mediastinal glands, 996 
Hypoderma bovis, 1428 
Hypoleucocytosis, 1283 
Hypostatic congestion of lungs, 855 
Hypothyroidism, 1305 
Hysteria in dogs and cats, 1277 


it 
icterus, 533 
catarrhal, in the dog and cat, 586 
in horse, 538 
gravis, 537 
infectious, in the dog and cat, 580 
in the dog and cat, 579 
in horse, 533; see also Jaundice 
in new-born animals, 536 
in sheep, 572 
neonatorum, 536 
Tleo-czcal invagination in horse, 259 
Ileo-colic invagination in horse, 259 
Tleum, impaction of, in horse, 217 
stricture of, in dog, 500 
Immobilité, 1148, 1153 
medico-legal aspect of, 1153 
Immunisation in anthrax, 42 
in blackquarter, 55 
in sheep, 58 
in malignant cedema, 19 
in strangles, 822 


Impaction, fecal, of intestine in dog, 496 


of anal pouches in dog, 506 
of czcum in horse, 206 
of colon in cattle, 410 

in dog, 496 

in foals, 221 

in horse, 188 
of crop in birds, 518 
of duodenum in horse, 218 
of ileum in horse, 217 


of pelvic flexure of double colon, 203, 


of rectum in foals, 221 
in horse, 215 
of rumen, 345 
of single colon in foals, 211 
of small intestines in foals, “16 


Interstitial nephritis. 


1603 


Impaction of stomach in dog, 474 


in foals, 106 
in horse, 96 


Imperforate urethra in dog and cat, 788 
Incontinence of urine, 716 
Indigestion, abomasal, in sucklings, 400 


acute, in goats, 438 

in cattle, 387 

in cattle due to foreign bodies in 

rumen and reticulum, 368 

due to overeating, 345 
gaseous or tympanitic, 351 
traumatic, 368 

in dogs, 474 
acute gastric, 474 
chronic, 481 

ingluvial, in birds, 518 

in horse, 96 
acute gaseous intestinal, 179 
acute, with engorgement, 96 
chronic, 149 
intestinal, with surcharge, 188 

in parrots, 520 

in pigs, acute, 449 
due to intestinal surcharge, 452 
gaseous intestinal, 451 

in sheep, 429 


Infectious abortion, 325 


anemia, 927 

bulbar paralysis, 632 
gastro-enteritis in dog, 735 
leucocythemia in birds, 499 
paraplegia, 900 

pleuro-pneumonia of the horse, 825 


Influenza, 8343 


bacteriology, 845 
complications, 856 
course, 860 

differential diagnosis, 861 
etiology, 846 

in dog and cat, 867 
modes of infection, 847 
morbid anatomy, 849 
prognosis, 860 
prophylaxis, 861 
serum treatment, 865 
symptoms, 853 
treatment, 862 


Ingluvial catarrh, 516 


indigestion, 518 


Inhalation pneumonia in cattle, 951 


in dog, 980 
in horse, 884 


Insolation, 1234 
Insufficiency, aortic, in dog, 1124 


in horse, 1051 
cardiac, 1028 
mitral, in dog, 1123 
in horse, 1056 
of pulmonary semilunar valves in dog, 
1 


in horse, 1064 
tricuspid, in dog, 1124 
in horse, 1061 
See Nephritis 


1604 


Interstitial neuritis, 1194 
chronic, of cauda equina, 1205 
Intervertebral discs, degeneration of, 1267 
Intestinal “‘ apoplexy,’’ 280 
catarrh in cattle, 418 
in dogs, 490 
in horse, 265 
in pigs, 454 
in young dogs, 492 
congestion, 280 
indigestion, 188 
irrigation in treatment of impaction 
of colon in horse, 201 
obstruction in birds, 521 
in cat, 513 
in dog, 496 
in horse, 223 
tympany in horse, 179 
Intestines, diseases of, in birds, 520 
inflammation of, in birds, 520 
obstruction of, in birds, 521 
tumours of, in birds, 522 
Intestines, diseases of, in cat, 512 
inflammation of, in cat, 512 
Intestines, diseases of, in cattle, 404 
inflammation of, in cattle, 412 
invagination of, in cattle, 406 
rupture of, in cattle, 412 
strangulation of, in cattle, 409 
tumours of, in cattle, 422 
volvulus of, in cattle, 408 
Intestines, diseases of, in dog, 489 
dilatation of, in dog, 501 
foreign bodies in, of dog, 499 
impaction, fecal, in dog, 496 
invagination of, in dog, 502 
strangulation of, in dog, 501 
stricture of, in dog, 500 
tumours of, in dog, 504 
ulceration of, in dog, 495 
volvulus of, in dog, 502 
Intestines, diseases of, in goats, 439 
Intestines, diseases of, in horse, 157 
abscess of, in horse, 287 
dilatation of, in horse, 289 
displacement with torsion of, in horse, 


displacements of, in horse, 236 
hemorrhage of, in horse, 297 
inflammation of, in horse, 262 
intussusception of, in horse, 257 
invagination of, in horse, 257 
rupture of, in foals, 222 
in horse, 294 
strangulation of, in horse, 231 
stricture of, in horse, 288 
tumours of, in horse, 291 
twists of, in horse, 231, 239, 248 
ulceration of, in horse, 285 
volvulus of, in horse, 240 
Intestines, diseases of, in pig, 415 
inflammation of, in pig, 415 
strangulation of, in pig, 453 
Intestines, diseases of, in sheep, 435 
Intussusception, 257, 406, 502 








ig Ae TASS 
ee _ 


SYSTEM OF VETERINARY MEDICINE 


Inversion of bladder in bitch, 782 
in cow, 758 
in mare, 718 
of rectum in cattle, 423 
in dog, 504 
in horse, 261 
of stomach in dog, 488 
Ixodes ricinus, 1445 


J 


Jacksonian epilepsy, 1213 
** Jagziekte,”’ 9613 
Jaundice, 579 
catarrhal, in dog and cat, 586 
in horse, 538 
enzootic, in dog and cat, 580 
infectious, in dog and cat, 580 
in horse, 533 
in sheep, 572 
malignant, in dog, 1029 
in horse, 537 
protozoal, in trout, 1130 
Java beans, poisoning by, 1583 
Jaw, “ dropped,” in dog, 1270 
Jibbing, 1234 
Johne’s disease, 198, 1312 
Twort and Ingram’s researches 
in, 1818 
Joint-ill, 509 


K 


Kidney, abscess of, in dog and cat, 765, 
acute inflammation of, in dog and cat,. 
759 
amyloid disease of, in dog and cat, 


in horse, 707 
calculus of, in cattle, 742 
in dog and cat, 768, 770 
in horse, 711 
in pig, 755 
in sheep, 752 
““ cardiac,” in horse, 682 
cirrhosis of, in horse, 697 
congestion of, in cattle, 732, 734 
in dog and cat, 759 
cystic disease of, in cattle, 741 
cysts of, in pig, 755 
diseases of, in dog and cat, 757 
fatty degeneration of, in dog and cat, 
766, 767 
floating, in dog and cat, 768 
granular contracted, in dog and cat, 
762 
infarcts of, in cattle, 734 
large white, in dog and cat, 763 
parasites of, in cattle, 743 
in dog and cat, 772, 1556 
polycystic in cattle, 742 
in sheep, 752 
purulent inflammation of, in dog and 
cat, 765 
senile, in dog and cat, 764 
small white, in dog and cat, 763 


INDEX 


Kidney, tumours of, in cattle, 743 
in dog and cat, 771 
in sheep, 752 
white, spotted, in cattle, 734 
“* Kidney worm,” 1562 


Kidneys, acute inflammation of, in birds, | 
789 | Leucocytosis, 1283 


amyloid disease of, in cattle, 740 
chronic inflammation of, in birds, 789 
congestion of, acute, in horse, 677 
chronic, in horse, 681 
in sheep, 751 
cystic disease of, in horse, 710 
diseases of, in birds, 789 
in cattle, 731 
in horse, 660 
in pig, 754 
in sheep, 751 
infarcts of, in horse, 682 
inflammation of, acute, in horse, 686 
chronic, in horse, 692 
in pig, 754, 1556 
in sheep, 751 
large white, in horse, 693 
parasites of, in horse, 714, 1556 
in pig, 756, 1562 
in sheep, 752 
passive congestion of, in horse, 681 
polycystic, in horse, 710 
purulent inflammation of, in horse, 
702 
rupture of, in horse, 683 
small, red, granular, in horse, 697 
‘ surgical,” in horse, 702 
tumours of, in horse, 713 
waxy, in horse, 707 
Koch’s mouse septicemia, 428 


L 
Labio-glosso-laryngeal paralysis in horse, 
1174 


“ Lampas,”’ 20 
Lardaceous liver, 557 
“ Larval pneumonia,” 874 
Laryngeal hemiplegia, 825 
Laryngitis, acute, in cattle, 943 
in dog and cat, 973 
in horse, 814 — 
chronic, in cattle, 944. 
in dog and cat, 974 
croupous, in cattle, 943 
in horse, 817 
in horse, 816 
in swine, 964 
Larynx, diseases of, in birds, 988 
cedema of, in cattle, 944 
in dog and cat, 975 
in horse, 818 
rupture of, in birds, 988 
tumours of, in cattle, 945 
in horse, 819 
Lathyrism, 1583 
Lead, poisoning by, 1569 
Leeches, the, 1481 








1605 


Leeches, the, injurious effects of, 1481 
symptoms and treatment, 1481 
Leishmaniasis in the dog, 1161 


| Leptomeningitis, 1134, 1177 


Leucemia, 1291 
Leucocythemia, infectious, in birds, 494 


Leucopenia, 1284 
Leukemia, 1291 
varieties of, 1292 7 
Leukocythemia, 1291 
Lice, 1435 
injurious effects of, 1436 
symptoms and treatment, 1437 
** Licking disease,”’ 397 
Lightning-stroke, 1236, 1245, 1251 
Ligniére’s anti-distemper serum, 705 
malignant cedema of oxen, 534 
Linguatula tenoides, 1438 
injurious effects of, 1439 
treatment, 1439 
Linguatules, the, 1438 
Linognathus, 1436 
Lip and leg ulceration of sheep, 303 
Lips, “‘ sore,” in lambs, 427 
Lipuria, 674 
Lithiasis, biliary, in cattle, 563 
in dog and cat, 587 
in horse, 547 
in pig, 576 
pancreatic, in cattle, 527 
Liver, diseases of, in birds, 594 
amyloid degeneration of, in birds, 594 
fatty, in birds, 594 
rupture of, in birds, 594 
tuberculosis of, in birds, 594 
tumours of, in birds, 594 
Liver, diseases of, in cattle, 561 
abscess of, in cattle, 566 
actinomycosis of, in cattle, 566 
acute yellow atrophy of, in cattle, 562 
amyloid degeneration of, in cattle, 570 
congestion of, in cattle, 565 
cysts of, in cattle, 571 
fatty, in cattle, 570 
foreign bodies in, of cattle, 564 
inflammation of, acute, in cattle, 566 
nodular necrosis of, in cattle, 567. 
polycystic, in cattle, 571 
rupture of, in cattle, 566 
tumours of, in cattle, 570 
Liver, diseases of, in dog and cat, 578 
abscess of, in dog and cat, 589 
acute yellow atrophy of, in dog and 
cat, 586 
amyloid degeneration of, in dog and 
cat, 592 
cirrhosis of, in dog and cat, 590 
congestion of, in dog and cat, 588 
fatty, in dog and cat, 592 
hemorrhage of, in dog and cat, 588 
inflammation of, acute, in dog and 
cat, 589 
nodular necrosis of, in dog and cat, 
592 


1606 


Liver, rupture of, in dog and cat, 588 
tumours of, in dog and cat, 573 

Liver, diseases of, in horse, 531 
abscess of, in horse, 544 

types of, in horse, 545 
acute yellow atrophy of, in horse, 537 
amyloid or waxy, in horse, 557 
angioma of, in horse, 560 
calcareous degeneration of, in horse, 
558 


** cardiac,’’ in horse, 541 
congestion of, active, in horse, 539 
passive, in horse, 540 
cirrhosis of, in horse, 550 
fatty, in horse, 556 
foreign bodies in, of horse, 550 
hematomata of, in horse, 541 
hemorrhage of, in horse, 541 
inflammation of, acute, in horse, 543 
nutmeg, in horse, 540 
rupture of, in horse, 541 
tuberculosis of, in horse, 560 
tumours of, in horse, 559 
Liver, diseases of, in pig, 576 
cirrhosis of, in pig, 577 
inflammation of, acute, in pig, 576 
enzootic, in young pigs, 576 
Liver, diseases of, in sheep, 572 


acute yellow atrophy of, in sheep, 573 


cirrhosis of, in sheep, 575 

fatty, in sheep, 575 

fluke disease, in sheep, 1509 

inflammation of, acute, in sheep, 572 

pigmentary degeneration of, in sheep, 
515 


““ rot,”’ in sheep, 1509 
tumours of, in sheep, 575 

Lockjaw, 227 

Léffler’s mouse typhus, 479 

Lombriz, 4148 

Loodianah disease, 21 

Louping-ill, 1251 

Lousiness, 1437 

Lumbago, 1401 

Lumbar paralysis, in cattle, 1243 

in goats, 1247 

prurigo, in sheep, 1581 

Lung plague, 559 

Lungs, diseases of, in birds, 987 
emphysema of, in birds, 988 
inflammation of, in birds, 987 

Lungs, diseases of, in cattle, 948 
congestion of, acute, in cattle, 948 
emphysema of, in cattle, 953 | 
inflammation of, in cattle, 949 

Lungs, diseases of, in dog and cat, 978 
congestion of, in dog and cat, 978 
emphysema of, in dog and cat, 981 
inflammation of, in dog and cat, 979 
tumours of, in dog and cat, 982 

Lungs, diseases of, in horse, 853 
abscess of, in horse, 870 
cirrhosis of, in horse, 888 
congestion of, acute, in horse, 854 

hypostatic, in horse, 855 








SYSTEM OF VETERINARY MEDICINE 


Lungs, inflammation of, in horse, 862 
tumours of, in horse, 907 
Lungs, diseases of, in pig, 965 
inflammation of, in pig, 965 
Lupine poisoning, 556, 573 
Lupinosis in horse, 556 
in sheep, 573 
Lymphadenitis, caseous, in sheep, 209 
Lymphangitis, 1381 
epizootic, 1289 
ulcerosa, 220 
Lymphatism, 1306 
Lympho-sarcoma, differentiation from 
Hodgkin’s disease, 1296 
Lymphosporidiosis of trout, 1150 


M 


Maggots in sheep, 1425 
symptoms, 1426 
treatment, 1426. 

Maladie du coit, 1067 

Mal de Caderas, 1061 

Malignant aphtha in sheep, 300 

catarrh of bovines, 529 
jaundice in the dog, 1029 
cedema, 12 
bacteriology, 12 
diagnosis, 17 
etiology, 12 
immunisation, 19 
morbid anatomy, 14 
of cattle (Ligniére’s), 534 
prophylaxis, 19 
sero-therapy, 19 
symptoms, 15 
in dogs, 17 
in horses, 15 
in oxen, 16 
in sheep, 17 
treatment, 19 
anthrax cedema, 1304 
pustule, 21, 1304 
stomatitis, 284 
Mallein, 90 
methods of employment, 90 
typical reaction of, 92 
Malta fever, 902 
Mamuitis, 374 
actinomycotic, 395 , 
bovine, and public health, 39 
gangrenous, of ewes, 398 
of goats, 399 
in the bitch, 402 
in the cow, 374 
in the mare, 400 
purulent, of goats, 399 
tubercular, 136, 393 
Mange, chorioptic, 1477 
follicular, 1453 
microscopic diagnosis of, 1459 
notoedric, 1469 
otodectic, 1478 
psoroptic, in horse, 1471 
in rabbit, 1476 


INDEX 


Mange, psoroptic, in sheep, 1473 
sarcoptic, in dog, 1468 
in goat, 1467 
in horse, 1463 
in ox, 1466 
in pig, 1467 
symbiotic, 1477 
treatment of, 1464, 1469 
Manipur horse disease, 21 
Mastication, difficult, in cattle, 317 
in horse, 12 
Mastitis, 374 
tubercular, 136, 393 
Maxillary sinus, catarrh of, in cattle, 940 
in dog, 972 
in horse, 809 
Maxillitis in cattle, 323 
in dogs, 463 
in horse, 31 
** Measles’’ in ox, 1486 
in pig, 1484 
in sheep, 1487 
' Meat-poisoning in dog, 493 
Mediastinal glands, neoplasms of, 996 
pleurisy, 913 
Mediastinum, diseases of, in cattle, 998 
in dog, 990 
in horse, 996 
Medico-legal aspect of asthma, 851 
of broken wind, 902 
of cardiac diseases, 1066 ; 
of crib-biting and wind-sucking, 
1231 
of grunting, 841 
of immobilité, 1153 
of megrims, 1210 
of a Seek congestion (acute), 
85 
of rheumatic lameness, 1402 
of roaring, 825 
of shivering, 1222 
of stringhalt, 1226 
Mediterranean fever, 902 
Medulla oblongata, diseases of, 1159, 1173 
Megrims, 1207 
Melzna, 297 
Melanomata of spinal cord, 1192 
Melanosis, 1347 
Melophagus ovinus, 1419 
Meni€re’s disease in birds, 1279 
in dog and cat, 1273 
in horse, 1211 
Meningeal hemorrhage, 1158 
Meninges, inflammation of, 1134 
spinal inflammation of, 1177 
Meningitis, acute, in dog and cat, 1253 
in horse, 1134 
course and duration, 1140 
differential diagnosis, 1141 
etiology, 1136 
morbid anatomy, 1137 
symptoms, 1139 
treatment, 1142 
cerebro-spinal, epizodtic, 889 
chronic, in dog and cat, 1254 





Meningitis, chronic, in horse, 1142 


1607 


ossifying, in dog and cat, 1261 


in cattle, 1239 


spinal, acute, in dog and cat, 1260 


in horse, 1177 
chronic, in horse, 1181 
in cattle, 1242 
in swine, 1249 
Meningo-encephalitis, 1130 
Mercurialism, 20, 1575 
Mercurial stomatitis in cattle, 321 
in dog, 459 
in horse, 26 
Mercury, poisoning by, 1575 


Mesenterial emphysema in pig, 452 


Mesentery, emphysematous cysts of, 626 


Metabolism, diseases of, 1308 
Metritis, acute, in bitch, 651 
in sheep, 651 


puerperal, in mare and cow, 638 


chronic, in bitch and cat, 656 
in mare and cow, 652 
mild type of, 647 
non-puerperal, 640 
septic, 639 
Metro-peritonitis, 638 
Microsporidia (cryptocystes), 1131 
Microsporidiosis, 1133 
of honey bee, 1134 
of other species, 1139 
of silkworms, 1137 
Micturition, disturbances of, 715 
Milk fever in cow, 1368 
complications, 1376 
course, 1375 


differential diagnosis, 1377 


etiology, 1371 
history, 1369 


morbid anatomy, 1373 


prognosis, 1376 
prophylaxis, 1379 
sequele, 1376 
treatment, 1378 
Schmidt’s, 1370 
in swine, 1249 
Milk-sickness, 938 


| Mites, follicular, 1452 


mange, 1457 
red, 1440 
injurious effects of; 1440 


Mitral insufficiency in dog and cat, 1123 


in horse, 1056 
stenosis in dog and cat, 1124 
in horse, 1060 
** Monday morning disease,” 1381 
Monilia candida, 19 e 
Monoplegia, 1133 
Moor-ill, 1005, 416 
Moulds, poisoning by, 146 
Mouse, coccidiosis of, 1203 
septicemia, 478 
typhus, 479 
Mouth, aphthous 
lambs, 427 
** broken,” in sheep, 427 


inflammation of, in 


1608 SYSTEM OF VETERINARY MEDICINE 


Mouth, diseases of, in cat, 507 
in cattle, 313 
in horse, 9 
in pig, 444 
in sheep, 425 
Mucor, 146 
Muguet, in birds, 515 
in horse, 18 
“ Mumps ” in dog, 462 
in horse, 26 
Murmurs, cardiac, 1005 
Muscide, 1418 
Musculo-spiral paralysis, 1201 
Myalgia, 1399 
Mycotic gastro-enteritis in dog, 493 
in horse, 145 
stomatitis, 1309, 18 
Myelitis, chronic, 1184 
diffuse, 1183 
disseminated, 1183 
in birds, 1278 
in cattle, 1242 
in dog and cat, 1265 
in horse, 1181 
transverse, 1183 
Myelo-malacia, 1181 
Myiasis, 1424 
Myocarditis in eattle, 1106 
in dog amd cat, 1118 
in horse, acute, 1030 
chronic, 1033 
suppurative, 1031 
Myocardium, diseases of, 1024, 
hypertrophy of, 1024 
ossification of, 1035 
Myxoboliasis tuberosa, 1126 
Myxcedema, 1305 


Myxoid degeneration of facial and tur- 


binated bones, 811 
Myxosporidia (phenocystes), 1119 
Myxosporidiosis of fishes, 1124 


N 
Nagana, 1063 
Nasal catarrh, acute, in cattle, 938 
in dog, 969 
in horse, 799 
chronic, in cat, 971 
in cattle, 904 
in dog, 970 
in horse, 802 
in sheep, 958 
in swine, 963 
malignant, in swine, 963 
cavities, diseases of, in cattle, 938 - 
in dog and cat, 969 
in horse, 799 
in sheep, 958 
in swine, 963 
neoplasms of, in cattle, 940 
in dog and cat, 973 
in horse, 807 
croup in cattle, 938 
in horse, 805 
discharges, chronic, in horse, 803: 





Nasal gleet in horse, 802 
Navel-ill, 509 
Necrobacillosis, 282 

in calf, 284 

in cat, 295 

in dog, 295 

in horse, 289 

in rabbit, 298 

in sheep, 300 


Necrosis, bacillary, 282; sce also Bacillary 


nodular, of liver, in cattle, 567 
in dog and cat, 592 
of pancreas in pig, 528 
Neoplasms of abomasum, 387 
of bladder in cattle, 749 
in dog and cat, 780 
in horse, 727 
of brain in cattle, 1241 
in dog and cat, 1257 
in horse, 1161 
of heart in cattle, 1110 
in dog and cat, 1120 
in horse, 1071 
of intestines in birds, 522 
in cattle, 422 
in dog, 504 
in horse, 291 
of kidney in cattle, 743 
in dog, 771 
in horse, 713 
of larynx in cattle, 945 
in dog, 975 . 
in horse, 819 
of liver in birds, 594 
in cattle, 570 
in dog and eat, 593 
in horse, 559 « 
in sheep, 575 
of lung in dog and cat, 982 
in horse, 907 
of mediastinal glands in cattle, 998 
in dog, 998 
in horse, 996 
of nasal cavities in cattle, 940 
in dog and cat, 973 
in horse, 807 
of cesophagus, in dog, 472 
in horse, 85 
of palate and soft palate in horse, 34 
of pancreas in dog, 530 
in horse, 527 
of peritoneum in cattle, 624 
in dog and cat, 632 
in horse, 614 
of pharynx in cattle, 325 
in dog and cat, 467 
in horse, 52 
of pleura in dog and cat, 985 
in horse, 928 
of spinal cord in horse, 1192 
of stomach in dog, 488 
in horse, 155 
of tongue in horse, 25 
of urethra in cattle, 750 
in horse, 730 


INDEX 


Nephritis, acute, in birds, 789 
in cat, 764 
in cattle, 735 
in dog, 759 
in horse, 686 
chronic, in birds, 789 
in cat, 764 
in cattle, 737 
in dog, 761 
in horse, 693, 697 
fibroplastic, in cattle, 734 
in pig, 754 
in sheep, 751, 752 
purulent, in cat, 765 
in cattle, 739 
in dog, 765 
in horse, 702 
Nephrolithiasis in birds, 789 
in cattle, 742 
in dog and cat, 767, 770 
in horse, 711 
in sheep, 752 
in swine, 755 
Nerve, abducens, diseases of, 1196 
auditory, diseases of, 1271 
cochlear, 1271 
crural, diseases of, 1203, 1243, 1272 
facial, diseases of, 1197, 1243, 1271 
oculo-motor, diseases of, 1196 
optic, diseases of, 1195 
pathetic, diseases of, 1196 
radial, diseases of, 1201, 1272 
recurrent, diseases of, 825, 945, 975 
snpraspAR lar, diseases of, 1200, 


trigeminus, diseases of, 1196, 1269 
vagus, diseases of, 1199, 1272 
- vestibular, diseases of, 1271, 1278 
Nerves, cranial, diseases of, 1195 
peripheral, diseases of, 1193, 1200, 
1243 
Nervous or stiff-legged goats, 1247 
system, diseases of, in birds, 1278 
in cattle, 1238 
in dog and cat, 1252 
in goats, 1247 
in horse, 1128 
in sheep, 1246 
in swine, 1248 
functional diseases of, in cattle, 


in dog and cat, 1272 
in horse, 1207 
Neuralgia of trigeminus, 1197 
Neuritis, interstitial, 1194 
chronic, of cauda equina, 1205 
optic, 1195 
parenchymatous, 1194 
eee without known anatomical basis, 
Nodular necrosis of liver in cattle, 567 
in dog and cat, 592 
of pancreas in pig, 528 
Noma, 17 
Notcedric mange, 1469 





| Obstruction, intestinal. 


1609 


Nutmeg liver, 540 
Nylandev’s test for sugar, 1317 


Nystagmus, 1196 


O 


Oat-hair concretions in intestine, 224 
in stomach, 155 
Obesity, 1342 
See Intestinal ob- 


struction 
esophageal. See (Hsophageal ob- 
struction 
pharyngeal. See Pharyngeal ob- 
struction 


Obstructive colic in foals, 221 
in horse, 188 
Obturator nerve, paralysis of, 1204 
Ochronosis, 1347 
Oculo-motor nerve, paralysis of, 1196 
(Edema, inflammatory, 1381 
malignant, 12 
of glottis, 818 
pulmonary, 858 
(sophagismus in cattle, 337 
in dog, 468 
in horse, 57 
(Esophagitis in cattle, 337 
in dog, 467 
in horse, 54 
in pig, 448 
(Ksophagostomiasis, 1542 
(sophagotomy, 77 
(Hsophagus, diseases of, in cat, 510 
in cattle, 329 
obstruction of, in cattle, 329 
traumatic lesions of, in cattle, 337 
(sophagus, diseases of, in dog, 467 
dilatation of, in dog, 468 
foreign bodies in, of dog, 469 
inflammation of, in dog, 467 
spasm of, in dog, 468 
stenosis of, in dog, 469 
stricture of, in dog, 469 
tumours of, in dog, 472 
Csophagus, diseases of, in horse, 53 
constriction of, in horse, 66 
dilatation of, in horse, 61 
fistulee of, in horse, 83 
foreign bodies in, of horse, 68 
use of probang in treatment 
of, in horse, 76 
inflammation of, in horse, 54 
paralysis of, in horse, 59 
perforation of, in horse, 81 
spasm of, in horse, 57 
stricture of, in horse, 66 
traumatic lesions of, in horse, 81 
tumours of, in horse, 85 
ulceration of, in horse, 83 
wounds of, in horse, 84 
(Esophagus, diseases of, in pig, 448 
(stride, 1427 


(strus ovis, 1429 


effects of, 1431 


1610 


Cstrus ovis, treatment of, 1431 

Oidium albicans, 18 

Oligemia, 1286 

Oligochromemia, 1286 

Oligocythemia, 1286 

Oliguria, 666 

Ollulanus tricuspis, 1550, 1556 

Omasum, atony of, in cattle, 379 
diseases of, in cattle, 376 
impaction of, in cattle, 377, 379 
inflammation of, in cattle, 380 

Omasum, diseases of, in goat, 437 

in sheep, 429 

Omentopexia, 631 

Optic nerve, diseases of, 1195 
neuritis, 1195 

Orbital gland, abscess formation of, in cat, 

509 
“‘ Orf ” in sheep, 300 
Senet spinal pachymeningitis in dog, 
265 


Osteogenesis imperfecta, 1341 
Osteomalacia in cattle, 1330 

in dog, 1331 
Osteomata of spinal cord in dog, 1192 
Osteoporosis, 1318 
Ostrich, infectious paralysis of, 459 
Otodectic mange, 1478 
Otorrhea, parasitic, 1479 
Ovination, 582 
Oxaluria, 674. 
Oxyuriasis in horse, 1533 
Oxyuris curvula, 1528 
Ozena, 802 


le 
Pachymeningitis, chronic ossifying spinal, 
in dog, 1261 
in horse, 1130, 1177 
Pain, abdominal, varieties of, 163 
Palate, congenital defects of, 34 
hard, congestion of, 20 
injuries of, 34 
tumours of, 34 
Palpation of abdomen, 166 
Palpitation, cardiac, 1020 
Pancreas, diseases of, in cattle, 527 
calculi of, in cattle, 527 
inflammation of, in cattle, 527 
Pancreas, diseases of, in dog, 529 
atrophy of, in dog, 529 
inflammation of, in dog, 529 
parasites of, in dog, 530 
tumours of, in dog, 530 
Pancreas, diseases of, in horse, 524 
inflammation of, in horse, 525 
parasites of, in horse, 527 
tumours of, in horse, 527 
Pancreas, diseases of, in pig, 528 
nodular fat necrosis of, 528 
Pancreatic diabetes in dog, 529 
lithiasis in cattle, 527 
Pancreatitis, catarrhal, in cattle, 527 
in horse, 525 
hemorrhagic, in dog, 529 


SYSTEM OF VETERINARY MEDICINE 


Pancreatitis, sclerotic, in dog, 529 
in horse, 526 
suppurative, in dog, 529 
in horse, 525 
‘** Pantas,’’ 416 
Papillomata of spinal cord, 1192 
of tongue, 25 
Paracentesis abdominis in dog, 631 
in horse, 614 
pericardii, 1017 
thoracis, 883, 921 
Paraffin oil, poisoning by, 1580 


‘Paralysis, ante-partum, in cattle, 1243 


crural, 1203, 1243 
. facial, 1197, 1243, 1271 
infectious bulbar, 632 
labio-glosso-laryngeal, 1174 
lumbar, in cattle, 1243 
in goat, 1247 
musculo-spirai, 1201 
post-partum, 1243 
radial, 1201, 1243, 1272 
Paralysis of abducens nerve, 1196 
of auditory nerve, 1271 
of bladder, 717, 749, 775; see also 
Bladder, paralysis of 
of brachial plexus, 1202, 1272 
of cochlear nerve; 1271 
of crural nerve, 1203, 1243, 1272 
of external popliteal nerve, 1203 
of facial nerve, 1197, 1243, 1271 
of gluteal nerve, 1205 
of internal popliteal nerve, 1203 
of motor nerves of eye, 1196 
of obturator nerve, 1204 
of oculo-motor nerve, 1196 
of cesophagus, 59 
of optic nerve, 1195 
of pathetic nerve, 1196 
of pharynx, 47 
of pudic nerve, 1205 
of radial nerve, 1201, 1243, 1272 
of recurrent nerve, 825, 945, 975 
of sacral plexus, 1205 
of sciatic nerve, 1202, 1272 
of supra-scapular nerve, 1200, 1243 
of tongue, 25, 461 
of trigeminus, 1196, 1269 
of vagus, 1199 
of vestibular nerve, 1271, 1278 
progressive bulbar, 1174, 1241, 1247 
Paralytic vertigo in cat, 1273 
Paranephritic abscess, 707 
Paraplegia, 1176 
enzootic, 97 
infectious, 900 
Parasites and parasitic diseases, 1405 
methods by which they produce 
injurious effects, 1408 
Parasitic bronchitis in calves and lambs, 
1522 
canker of the ear, 1479 
gastritis in cattle, 1543 
in horse, 1533 
in pig, 1548 


INDEX 


Parasitic gastritis in sheep, 1543 
mange, 1457 
otorrhea, 1459 
stomatitis in birds, 515 
in horse, 18 
Parotid gland, diseases of, in cattle, 323 
in dog, 464 
in goat, 437 
Parotitis, in cattle, 323 
in dog, 464 
in goat, 437 
in horse, 26 
Parrot septicemia, 472 
Parrots, administration of medicines to, 989 
constipation in, 522 
diarrhoea in, 522 
diet for, 520 
gastritis in, 519 
indigestion in, 520 
psittacosis in, 472 
septic fever in, 472 
“ ship fever ” in, 472 
Parry’s disease, 1303 
Partridge, cholera of, 455 
coccidiosis of, 1181 
Parturient “‘ apoplexy,” 1368 
collapse, 1368 
indigestion, 390, 393, 1377 
paresis, 1368 
Pasteurella, 423 
Pathetic nerve, paralysis of, 1196 
Pelvic hernia in cattle, 409 
Pendulous crop, 517 
Penicillium, 146 
Pericarditis in birds, 1126 
in cattle, 1098 
acute sero-fibrinous, 1098 
traumatic, 371, 1099 
course, 1104 
differential diagnosis, 1104 
etiology, 1099 
morbid anatomy, 1099 
physical signs, 1102 
symptoms, 1101 
treatment, 1105 
in dog and cat, 1116 
acute sero-fibrinous, 1116 
chronic, 1117 
purulent, 1116 
in horse, 1007 
acute sero-fibrinous, 1009 
differential diagnosis, 
1015 
etiology, 1009 
morbid anatomy, 1010 
symptoms, 1012 
treatment, 1016 
chronic adhesive, 1017 
traumatic, 1010 
with effusion, 1009 
in pig, 1113 
acute sero-fibrinous, 1113 
traumatic, 1114 
in sheep and goat, 1113 
pseudo-, in cattle, 1103 


1611 


Pericardium, diseases of, in birds, 1126 
Pericardium, diseases of, in cattle, 1098 
inflammation of, in cattle, 1098 
rupture of, in cattle, 1105 
tumours of, in cattle, 1106 
Pericardium, diseases of, in dog and cat, 


inflammation of, in dog and cat, 1116 
rupture of, in dog and cat, 1118 
tumours of, in dog and cat, 1118 
Pericardium, diseases of, in horse, 1007 
dropsy of, in horse, 1018 
inflammation of, in horse, 1007 
rupture of, in horse, 1019 
Pericardium, diseases of, in pig, 1113 
inflammation of, in pig, 1113 
Pericardium, diseases of, in sheep and 
goat, 1113 
inflammation of, in sheep and goat, 
1113 


Perihepatitis in cattle, 566 


in horse, 543 
Perinephric abscess in cattle, 740 
in horse, 707 
Perinephritic cellulitis in cattle, 740 
Perineuritis, 1194 
Pericesophageal abscess, 470 
Peripheral nerves, diseases of, in cattle, 
1243 
in dog, 1269 
in horse, 1193, 1200 
Perirenal abscess, 707 
Peritoneum, diseases of, in birds, 637 
in cat, 632 
in cattle, 616 
in dog, 626 
in horse, 595 
tumours of, 614, 624, 632, 637 
Peritonism, 605 
Peritonitis, acute, in cattle, 617 
in dog and cat, 626 
in horse, 597 
etiology, 597 
morbid anatomy, 601 
symptoms, 603 
treatment, 607 
chronic, in cattle, 622 
in dog and cat, 628 
diffuse, in horse, 610 
local, in horse, 609 
diffuse fibrinous, in cattle, 617 
in birds, 637 
in pig, 454, 625 
in sheep, 435 
local purulent, in cattle, 622 
puerperal, in cattle, 422 
in horse, 607 
pyogenic, in horse, 605 
septic, in horse, 16, 606 
Perityphlitis in dog, 490 
Pernicious anemia, 1289 
equine, 927 
Petechial fever, 869 
** Petit mal,” 614 
Pharyngeal abscess in cattle, 325 


1612 SYSTEM OF VETERINARY MEDICINE 


? 


Pharyngeal “ diphtheria ’ 
446 


fistula in horse, 42 
Pharyngitis, croupous, 325 
in cattle, 324 
in cat, 510 
in dog, 464 
acute catarrhal, 464 
chronic, 466 
croupous, 466 
phlegmonous, 465 
pseudo-membranous, 466 
in horse, 34 
acute catarrhal, 35 
chronic, 45 
phlegmonous, 40 
pseudo-diphtheritic, 43 
pseudo-membranous, 43 
in pig, 447 
in sheep, 428 
specific, 325 
Pharynx, diseases of, in cattle, 324 
abscess of, in cattle, 325 
inflammation of, in cattle, 324 
tumours of, in cattle, 325 
Pharynx, diseases of, in cat, 510 
Pharynx, diseases of, in dog, 464 
inflammation of, in dog, 467 
tumours of, in dog, 457 
Pharynx, diseases of, in horse, 34 
fistula of, in horse, 42 
foreign bodies in, of horse, 52 
inflammation of, in horse, 35 
paralysis of, in horse, 47 
parasites of, in horse, 49 
tumours of, in horse, 52 
wounds of, in horse, 51 
Pheasants, coccidiosis of, 1180 
infectious enteritis of, 453 
septicemia in young, 455 
Phlebitis, 1094 
Phlebolites, 1096 
Phlegmonous gastritis, 139 
pharyngitis, 40, 465 
Phosphaturia, 674 
Phosphorus, poisoning by, 1576 
Pica, 397 
Picton cattle disease, 569 
Pigeon septicemia, 462 
Piles, 293 
Pink-eye, 843 
Piorkowski’s anti-distemper serum, 705 
* Pip,”’ 515 
Piroplasmosis, 978 
bovine, 981 
canine, 1029 
equine, 1015 
ovine, 1013 
Pituitary gland, tumours of, 1163 
Plague, avian, 484 
cattle, 916 
crayfish and prawn, 1134 
fowl, 484 
swine, 550 
Plenalvia, 345 


in young pigs, | Pleura, diseases of, in cattle, 955 


inflammation of, in cattle, 955 
| Pleura, diseases of, in dog and cat, 983 
dropsy of, in dog and cat, 984 
inflammation of, in dog and cat, 983 
tumours of, in dog and cat, 985 
_ Pleura, diseases of, in horse, 908 
carcinoma of, in horse, 928 
dropsy of, in horse, 927 
inflammation of, in horse, 908 
tumours of, in horse, 928 
Pleural effusion, paracentesis thoracis in, 
in dog, 984 
in horse, 921 
Pleurisy in cattle, 955 
acute sero-fibrinous, in cattle, 955 





dry or adhesive, in cattle, 956 
purulent, in cattle, 956 
Pleurisy in dog and cat, 983 
acute sero-fibrinous, in dog and cat, 
983 
dry, in dog and cat, 983 
purulent, in dog and cat, 984 
Pleurisy in horse, 908 
acute sero-fibrinous, in horse, 908 
auscultation in, 916 
differential diagnosis, 919 
etiology, 908 
friction sounds in, 917 
morbid anatomy, 910 
Pleurisy, chronic, 924 
diaphragmatic, 913 
dry or adhesive, 923 
encysted, 913 
fibrinous, 923 
hemorrhagic, 913 
latent, 918 
mediastinal, 913 
multilocular, 913 








plastic, 923 
purulent, 922 
unilateral, 919 
Pleurisy, paracentesis thoracis in treatment 
of, 921 
physical signs in, 914 
prognosis, 921 
symptoms, 914 
treatment, 920 
Pleurodynia, 1401 
Pleuro-pneumonia contagiosa of bovines, 


infectious, of goats, 962 
Plumbism, 1574 
Pneumoconiosis, 889 
Pneumo-enteritis, epizodtic, of turkeys, 
436 
Pneumonia in birds, 987 
in calves, septic, 496 
in cattle, 949 
broncho-, 950 
chronic, 953 
croupous or lobar, 949 
due to foreign bodies, 951 
inhalation, 951 
lobular, 950 


INDEX 


Pneumonia in dog and cat, 979 
broncho-, 979 
chronic, 981 
croupous, 979 
inhalation, 980 
in horse, 862 
abortive, 874 
“alimentary,” 885 
bacteriology of, 866 
bilateral, 874 
broncho-, 884 
causes of death in, 875 
central, 874 
chronic, 888 
comparison of sporadic and epi- 
zootic types, 863 
complications of, 870, 877 
contagious, 825 
course of, 874 
croupous, 864 
differential diagnosis, 877 
due to foreign bodies, 884 
embolic, 892 
ephemeral, 874 
hypostatic, 855 
inhalation, 884 
lardaceous, 889 
“larval,” 874 
massive, 874 
metastatic, 892 
morbid anatomy, 867 
mortality, 878 
paracentesis thoracis in, 883 
physical signs, 873, 887 
pleuro-, 875 
prognosis, 877 
prophylaxis, 878 
recurrence in, 877 
** ship,” 864, 866 
sudden death in, 875 
symptoms of, 870 
terminations, 875 
traumatic, 888 
treatment of, 879, 888 
counter-irritation in, 881 
importance of fresh air in, 879 
operative measures in, 882 
vaccine, 934 
varieties of, 884 
in lambs, septic, 500 
in pig, 965 
in sheep, 960 
catarrhal, 960 
chronic, 961 
croupous, 961 
Pneumo-pericarditis, epizootic, of turkeys, 


Pneumopericardium, 1019 
Pneumorrhagia, 861 
Pneumothorax in cattle, 957 

in dog and cat, 985 

in horse, 925 
Podagra, 1345 
Poikilocytosis, 1282 
Polariscope test for sugar, 1317 





| 


1613 


Polio-encephalitis, chronic 
cattle, 1241 
in horse, 1174 
diagnosis of, 1568 
Poisoning, accidental, 1572 
due to food, 1582 
moulds, 146 
malicious, 1572 
Poisonous plants, 1581 
Poisons, 1572 
mineral, 1574 
organic, 1577 
Poliomyelitis, 1181 
“ Polyadénome bronchique ” of cat, 981 
Polychromasia, 1282 
Polychromatophilia, 1282 
Polycystic kidney in cattle, 742 
in sheep, 752 
Polycythemia, 1285 
Polyneuritis in fowl, 1278 
Polypi, nasal, in horse, 807 
in dog, 973 
Polypus in stomach of horse, 156 
Polyuria, 666, 1308 
Pons Varolii, diseases of, in dog and cat, 1257 
hemorrhage into, in dog and cat, 
1257 
tumours of, in dog and cat, 1258 
Pons Varolii, diseases of, in horse, 1171 
hemorrhage into, in horse, 1159, 
1171 
tumours of, in horse, 1172 
Popliteal nerve, external, paralysis of, 1203 
internal, paralysis of, 1203 
Post-pharyngeal abscess in cattle, 325 
in horse, 42 
Potassium nitrate, poisoning by, 1576 


inferior, in 


| Potato-poisoning, 1582 


Pouches, anal, diseases of, in dog, 506 
guttural, diseases of, 811; see also Gut- 
tural pouches 
Poultry, asthenia of, 467 
septicemias of, 453 
streptococcic septicemia of, 483 
Prehension, difficulty in, in cattle, 317 
in horse, 13 
Preputial calculi in cattle, 570 
in horse, 730 
Progressive bulbar paralysis in cattle, 1241 
in horse, 1174 
Prolapse of rectum in cattle, 423 
in horse, 261 
of urethra in bitch, 788 
Protozoal diseases of birds, fish, etc., 1118 
gid in rainbow trout, 1130 
jaundice in common trout, 1130 
Psammoma, 1161 
Pseudo-aphthous stomatitis, 15 
Pseudo-diphtheritic pharyngitis in dog, 466 
in horse, 43 
Pseudo-farcy, 220 
Pseudo foot and mouth disease, 785, 1309. 
318 
Pseudo-glanders, 220 
Pseudo-leukemia, 1295 


1614 


Pseudo-membranous enteritis in cattle, 416 
pharyngitis in cattle, 325 
in dog, 466 
in horse, 43 
Pseudo-pericarditis, in cattle, 1103 
Pseudo-rabies, 630 
Pseudo-tubercuolsis, streptobacillary, 217 
in cat, 219 
in fowl, 219 
in hare, 218 
in rabbit, 218 
Pseudo-tuberculosis, 204 
in calf, 208 
in cattle, 205 
in sheep, 209 
streptothricic, in horse, 274 
Psittacosis, 472 
Psoas abscess, 707 
Psoroptic mange, 1471, 1473, 1476 
Ptomaine-poisoning, 493 
Ptosis, 1196 
Ptyalism in cattle, 316 
in horse, 11 
Puccinia graminis, 146 
Pudic nerve, paralysis of, 1205 
Puerperal eclampsia in bitch, 1276 
in cow, 1244 
in mare, 1216 
polyarthritis, 1389 
septicemia, 638 
Pulmonary apoplexy in horse, 855, 861 
congestion, acute, in cattle, 948 
in dog and cat, 978 
in horse, 855 
emphysema in birds, 988 
acute alveolar, in horse, 893 
in cattle, 953 
in dog and cat, 981 
in swine, 967 
chronic alveolar, in horse, 893 
in cattle, 955 
in dog and cat, 982 
interstitial, in horse, 906 
gangrene in horse, 870 
hemorrhage in cattle, 953 
in horse, 859 
hyperemia in horse, 854 
cedema in dog and cat, 978 
in horse, 858 
sclerosis in horse, 888' 
valves, diseases of, in cattle, 1109 
in dog and cat, 1124 
in horse, 1064 
** Pulsation, abdominal,” in horse, 990 
Pulse, types of, 1003 
Purpura hemorrhagica, 869 
bacteriology, 871 
course, 881 
differential diagnosis, 882 
etiology, 870 
in cattle, 887 
intratracheal injection for, 884 
morbid anatomy, 873 
prognosis, 881 


SYSTEM OF VETERINARY MEDICINE 


Purpura hemorrhagica, symptoms, 875 
treatment, 883 
Pustular dermatitis in horses, 224 
Pyzmia, 7 
Pyemic umbilical infection, 509 
Pyelitis in dog, 766 
in horse, 705 : 
Pyelonephritis, bacillary, in cattle, 528, 
740 


in horse, 705 
Pyometra in bitch and cat, 656 
in cow and mare, 652 
Pyonephritis in cattle, 739 
Pyonephrosis in horse, 702 
Pyo-pneumothorax in cattle, 957 
in horse, 925 
Pyrosoma bigeminum, 985 
Pyuria, 672 


Q 


Quail, coccidiosis of, 1181 
disease, 972 
Quarter-ill, 47 


R 


Rabbit, bacillary necrosis of, 298 
influenza of, 448 
septiczemias of, 447, 449 
strepto-bacillary pseudo-tuberculosis 
in, 218 
venereal disease of, 370 
Rabies, 599 
differential diagnosis, 609 
etiology, 601 
experimental inoculation, 604 
in eamel, 619 
in cat, 619 
in cattle, 617 
in deer, 619 
in dog, 604 
in fox, 620 
in horse, 615 
in man, 620 
in pig, 618 
in poultry, 619 
in sheep and goats, 617 
morbid anatomy, 611 
nature of virus, 602 
negri bodies, 612 
prophylactic measures, 621 
pseudo-, 630 
symptoms, 605 
types of, 605 
Rachitis, 1332; see also Rickets 
Radial cramp in dog, 1272 
nerve, paralysis of, in dog, 1272 
in horse, 1201 
Rag-picker’s disease, 1305 
Railroad sickness, 1380 
Raéles, 798 
varieties of, 798 
Ranula in dog and cat, 460 
in horse, 32 


INDEX 


Ray fungus, 258 
Rectal exploration, 167 
Rectum and anal region, diseases of, in 
dog, 504 
Rectum, dilatation of, in horse, 290 
diverticula of, in dog, 501 
impaction of, in horse, 215 
in dog, 504 
prolapse of, in cattle, 423 
in horse, 261 
with invagination, in dog, 503 
in horse, 261 
rupture of, in horse, 295 
stricture of, in dog, 500 
in horse, 288 
tumours of, in horse, 291 
Recurrent nerve, paralysis of, in cattle, 
945 
in dog, 975 
in horse, 825 
Red foot in sheep, 305 
Redwater, British, 1005 
Regurgitation and eructation as symp- 
‘toms, in gastric diseases, 9t 
Renal abscess in dog and cat, 765 
in horse, 702 
calculus in birds, 789 
in cat, 770 
in cattle, 742 
in dog, 768 
in horse, 711 
in pig, 755 
in sheep, 752 
congestion in horse, 679 
disease, general symptoms of, 677. 
dropsy, 709 
sclerosis, 697 
Respiration, types of, 792 
Respiratory organs, diseases of, in birds, 
986 


in cattle, 937 
in dog and cat, 968 
in horse, 790 
vaccine therapy in, 929 
in pig, 963 
in sheep, 958 
sounds, abnormal, 796 
Retention cyst in dog, 460 
of urine, 716, 748, 775 
Reticulum, diseases of, in cattle, 367 
in sheep, 429 
Retropharyngeal abscess, 42 
Rheumatic fever, 1388 
subacute form, 1394 
Rheumatism, 1388 | 
acute articular, in cattle, 1396 
in dog, 1397 
in horse, 1388 
in pig, 1397 
in sheep, 1396 
cardiac complications in, 1393 
chronic, in cattle, 1399 
in dog, 1399 
in horse, 1397 





1615 


| Rheumatism, chronic, in pig, 1399 


in sheep, 1399 
medico-legal aspect of, in horse, 1402 
muscular, in cattle, 1402 
in dog, 1403 
in horse, 1399 
in pig, 1403 
in sheep, 1403 
Rhinitis in horse, 799 
croupous, in cattle, 938 
in horse, 805 
in pig, 963 
infectious, in pig, 963 
Rhododendron, poisoning by, 1581 
Rickets, 1332 
foetal, 1341 
in birds, 1334 
in calves, 1335, 1338 
in dog, 1335 
in foals, 1335 
in lambs, 1335 
in pig, 1338 
Rinderpest, 916 
course, 921 
differential diagnosis, 921 
etiology, 917 
morbid anatomy, 919 
period of incubation, 918 
prophylaxis, 922 
protective inoculation, 922 
symptoms, 920 
Roaring in cattle, 945 
in dog, 975 
in horse, 825 
Bernardini’s views on, 837 
cause of abnormal sound in, 830 
detection of, 834, 838 
differential diagnosis, 837 
etiology, 828 
grunting as a symptom of, 834 
hereditary influence in, 832 
history of, 827 
intermittent, 837 
medico-legal aspect of, 836 
mode of development, 835 
morbid anatomy, 832 
not depending on laryngeal hemi- 
plegia, 826 
spontaneous recoveries in, 835 
sudden deveolpment of, 836 
symptoms of, 833 
temporary, 837 
Thomassen’s views on, 833 
treatment, 839 
operative, 839 
Vermeulen’s views on, 833 
Rosenbach’s test for bile, 537 
** Rot ” liver in sheep, 1509 
Round worms, the, 1517 
of alimentary canal of dog and 
cat, 1549 
of horse, 1527 
of pig, 1546 
of ruminants, 1537 


r 


1616 


Round worms, the, of muscular and other | 
tissues, 1556 
of respiratory organs, 1520 
Roup, catarrhal, 444 
diphtheritic, 319 
Rumen, diseases of, 343 
acute dilatation of, in goat, 438 
atony of, in sheep, 429 
catarrh of, in cattle, 364 
chronic tympanites of, in cattle, 359 
foreign bodies in, of cattle, 368 
of goat, 439 
impaction of, in cattle, 345 
in goats, 438 
inflammation of, in cattle, 345 
tumours of, 367 
tympanites of, in cattle, 351 
in sheep, 432 
Rumenitis, 364 
Rumenotomy in cases of tympanites of 
rumen, 358 
of foreign bodies in rumen and 
reticulum, 379 
of impaction of rumen, 350 
Rumination, remarks on, 339 
Rupture of bladder, 719, 749, 776; see also 


Bladder 

of diaphragm, 992, 995; see also Dia- 
phragm 

of heart, 1069, 1110, 1113, 1120; see 
also Heart 


of intestine, 294, 412; see also Intestine 

of large vessels in thorax and abdo- 
men, 1096 

of liver, 541, 566, 588; see also Liver 

of esophagus, 81, 337; see also 
(Esophagus 

of pericardium, 1019, 1105, 1118; see 
also Pericardium 

of rectum, 295; see also Rectum 

of spleen, 1301; see also Spleen 

of stomach, 120, 337; see also Stomach 

Rusts, poisoning by, 146 


8 


Saccharomyces albicans, 18 
Sacral plexus, paralysis of, 1205 
Salicylic-sulfonic acid test for albumin, 669 
“* Salivary abscess,”’ 31 
glands, diseases of, in cat, 509 
in cattle, 323 
in dog, 462 
in horse, 26 
secretion, arrest of, 12 
Salivation, 11, 316 
mercurial, 1575 
Salmon disease, 946 
Salmonide, furunculosis of, 957 
Salt, common, poisoning by, 1576 
Sand colic, 228 
Sapremia, 5 
Saprolegniace, system of, 1156 
Saprolegniosis of fish, 1152 








SYSTEM OF VETERINARY MEDICINE 


Sarcoptes scabiei, 1463 
Sarcoptic mange, 1463, 1466, 1467, 1468; 
see also Mange 
Sarcosporidiosis, 1139 
“Scab ” in sheep, 1473 
Schmorl’s disease, 299 
Schweinberg disease, 555 
Sciatic nerve, paralysis of, 1202, 1272 
Sclerosis, pulmonary, 888 
renal, 697 
Sclerostomum equinum, 1529 
tetracanthum, 1530 
Scorbutus, 1343 


Seour, white, 501 


Serapie, 1585 
Scurvy, 1343 
in dog, 1344 
in pig, 1344 
Sea-sickness, 1212 
Senecio-poisoning, 569 
Senile kidney in dog and cat, 764 
Septicemia, 1 
bacterial, 1 
hemorrhagica, 407 
of fowl, 420 
of ox, 441 
of sheep, 418 
of duck, 451 
of goose, 437 
of pheasant, 455 
of pigeon, 463 
of rabbits, 447 
of swan, 451 
puerperal, 638; see also Puerperal 
Septic fever in cage birds, 468 
Septico-pyemia, 7 
Septic peritonitis, 606 
pneumonia of calves, 496 
of lambs, 500 
Sero-therapy, anthrax, 45 
influenza, 865 
malignant cedema, 19 
. strangles, 823 
Serum, anti-anthrax, 45 
anti-distemper, Ferry’s, 706 
Ligniére’s, 705 
Piorkowski’s, 705 
anti-tetanic, 243, 245 
treatment of influenza, 865 
of malignant cedema, 19 
of South African horse-sickness, 
1288 
of strangles, 822 
of tetanus, 245 
Sheep, aspergillosis, 1216 
blackquarter, 57 
blue tongue, 1269 
braxy, 1244 
contagious pustular dermatitis, 300 
Johne’s disease, 198 
louping-ill, 1251 
-pox, 583 
spirochetosis, 1238 
venereal diseases, 364 


INDEX 


Sheep “ dips,” 1475 
ked, 1419 
maggot-fly, 1425 
scab, 1473 
‘* Ship fever ’’ in parrots, 472 
pneumonia, 864, 866 
Shivering, 1219 
detection of, 1220, 1222 
intermittent, 1222 
medico-legal aspect of, 1222 
** Shoulder-slip,” 1230 
Silkworms, microsporidiosis of, 1137 
Simulide, 1417 
Sleeping disease of fowls, 482 
Smut fungi, poisoning by, 147 
“ Snuffles” in cat, 971 
in pig, 963 
Sodium chloride, poisoning by, 1571 
“Soft crop,” 516 
Soft palate, congenital defects of, 34 
injuries to, 34 
** Soie,”’ 448 
Sore lips in lambs, 427 
““ Sore throat,’ 34 
South African horse-sickness, 1280 . 
Sows eating their young, 1250 
Spasm of bladder, 718, 775; see also Bladder 
local, of muscles, 1217 
of diaphragm, 990; see also Diaphragm 
of larynx, 818 
of muscles supplied by oculo-motor 
nerve, 1196 
by trigeminus, 1197, 1270 
of cesophagus, 57, 468; see also 
(Esophagus 
Spasmodic colic, 169, 405, 489; see also 
Colic 
Spinal cord and its membranes, diseases of, 
in cattle, 1242 
in dog and cat, 1260 
in horse, 1175 
abscess of, 1189 
compression of, in cattle, 1242 
in dog and cat, 1267 
in horse, 1175 
concussion of, in cattle, 1242 
in dog and cat, 1266 
in horse, 1186 
degeneration of, secondary, in 
dog, 1269 
in horse, 1185 
hemorrhage of, in dog and cat, 
1265 
in horse, 1185 
inflammation of, in cattle, 1242 


in dog and cat, 1265; see also | 


Myelitis 
in horse, 
Myelitis | 
injuries to, in cattle, 1242 
in dog and cat, 1266 
in horse, 1187 
parasites of, 1193 
sclerosis of, in dog, 1269 


VOL. II. 


1181; see 


_ Spinal cord, sclerosis of, in horse, 
118 





also | 





1617 
1184, 


tumours of, in dog and cat, 1267 
in horse, 1192 
hemorrhage, 1185 
meningitis, acute, in cattle, 1242 
in dog, 1260 
in horse, 1177 
in pig, 1249 
chronic, in dog, 1261 
in horse, 1181 
pachymeningitis, chronic, in dog, 1261 
SHE. 1224 
in fowl, 1227 
in goose, 1234 
in horse, 1240 
in ox and calf, 1236 
in pig, 1238 
in sheep, 1238 
Spleen, diseases of, 1299 
acute enlargement of, 1299 
chronic enlargement of; 1299 
hemorrhage of, 1300 
necrosis of, 1301 
purulent inflammation of, 1300 
torsion of, 1301 
tumours of, 1301. 
Splenic apoplexy, 21 
fever, 21 
Stable-fly, 1418 
“ Staggers, mad,” 1129, 1139 
" Staggers, sleepy,” 1129 
“ Staggers, stomach,” 76, 1130 
Status thymico- lymphaticus, 1306 


| Stenocardia, 1072 


Stenosis, aortic, in cattle, 1110 
in dog, 1124 
in horse, 1054 
mitral, in cattle, 1110 . 
in dog, 1124 
in horse, 1060. 
of pulmonary semilunar valves in dog, 
P 1124 
in horse, 1064 
tricuspid, in cattle, 1109 
‘in dog, 1124 
in horse, 1063 
** Stiff sickness,’’ 941 
“ Stifle, dropped,” 1203 
Stephanurus dentatus, 1562 
Stomach, diseases of, in birds, 516 
in cat, 511 
in cattle, 338; see-Rumen, Reticu- 
lum, Omasum, and Abomasum 
in dog, 472 
dilatation of, acute, in dog, AT 4. 
chronic, in dog, 4 
foreign bodies in, of dog, 436 
hemorrhage of, in dog, 485 
inflammation of, acute, in dog, 477 
chronic, in dog, 481 
torsion of, in dog, 486 
tumours of, in dog, 488 
ulceration of, in dog, 484 


102 


1618 SYSTEM OF VETERINARY MEDICINE 


Stomach, diseases of, in horse, 86 
dilatation of, in horse, 128 
foreign bodies in, of horse, 155 
gorged, in horse, 96 
hemorrhage of, in horse, 134 
impaction of, in horse, 96 
inflammation of, acute, in horse, 134 

chronic, in horse, 149 
rupture of, in horse, 120 
tumours of, in horse, 155 
ulceration of, in horse, 131 
Stomach, diseases of, in pig, 449 
in sheep, 429 

Stomatitis, contagious pustular, 596 
mycotic, 1809 
ulcerative, in calves, 284 

in sheep, 300 

Stomatitis in birds, 515 

in cat, 508 
catarrhal, 508 
ulcerative, 509 

in cattle, 318 
desquamative, 318 


differentiation from foot and | 


mouth disease, 320 
erosiva, 318 
mercurial, 321 
in dog, 457 
catarrhal, 457 
follicular, 459 
mercurial, 459 
ulcerative, 458 
in horse, 13 
erythematous (in foals), 15 
gangrenous, 17 
mycotic, 18 
parasitic, 18 
secondary, 14 
simple catarrhal, 13 
ulcerative, 17 
vesicular, 15 
in pig, 444, 
in sheep, 425 
erosiva, 426 
Stomoxys calcitrans, 1418 
Strain of dorso-lumbar region, 1185 
Strangles, 790 
bacteriology, 791 
complications, 812 
course, 815 
differential diagnosis, 815 
etiology, 791 
forms or types, 802 
immunisation, 822 
immunity, 796 
in other animals, 820 
irregular, 812 
modes of infection, 797 
morbid anatomy, 803 
period of incubation, 802 
predisposing causes, 795 
prognosis, 815 
prophylaxis, 816 
sequelze, 814 








Strangles, symptoms, 808 
treatment, 818 
vaccine therapy, 823 
Strangline, 823 
Strangulated scrotal hernia in foals, 223 
Strangulation of intestine in cattle, 409 
in dog, 501 
in horse, 231 
' due to false ligaments, 233 
Strangury, 716 
Streptobacillary pseudo-tubereulosis, 217 
in cat, 219 
in fowl, 219 
in hare, 218 
in rabbit, 218 
Streptothricic pseudo-tuberculosis in horse, 
274 


Streptothrix bovis, 258 
Stricture of duodenum in dog, 500 
of ileum in dog, 500 
of intestine in dog, 500 
in horse, 288 
of cesophagus in dog, 469 
in horse, 66 
of rectum in dog, 500 
of urethra in dog and cat, 787 


| Stringhalt, 1224 


Australian, 1225 
intermittent, 1226 
medico-legal aspect of, 1226 


| Strongylosis, 1534 


Strongylus cervicornis, 1539 
curcumcinctus, 1539 
contortus, 1539 
edentatus, 1530 
equinus, 1529 
jilaria, 1521 
gracilis, 1540 
micrurus, 1520 
rufescens, 1521 
tetracanthus, 1530 
vulgaris, 1530 
Struma, 1302 
Strychnine, dosage for birds, 514 
poisoning by, 1578 
Stuttgart disease of dog, 735 
‘“* St. Vitus’s dance,”’ 1216 
Subacute impaction of double colon, 188 
of pelvic flexure of double colon 
in horse, 203 
of single colon, 211 
Submaxillary adenitis, 31 
Sunstroke, 1234, 1245, 1250 
Superpurgation, 303 
Suppurative hepatitis, 544, 566, 575 
nephritis, 702, 739, 765 
pancreatitis in dog, 529 
splenitis, 1300 
Supra-pharyngeal abscess, 42 
Suprarenal bodies, colloid cysts of, 1307 
diseases of, 1307 
tumours of, 1307 
Supra-scapular nerve, paralysis of, 1200 
Surra, 1081 


INDEX 


Surra in ass, 1099 
in camel, 1105 
in cattle, 1100 
in dog, 1103 
in elephant, 1104 
in guinea-pig, 1106 
in horse, 1094 
in mule, 1102 
in rabbit, 1106 
in sheep and goat, 1103 
treatment, 1107 
Swan septicemia, 451 
Swine erysipelas, 551 
bacteriology, 552 
differential diagnosis, 556 
morbid anatomy, 553 
prophylaxis, 556 
protective inoculation, 557 
symptoms, 554 
fever, 538 
bacteriology, 544 
differential diagnosis, 545 
etiology, 539 
morbid anatomy, 542 
prophylaxis, 547 
protective inoculation, 548 
symptoms, 543 
plague, 550 
-pox, 591 
Symbiotic mange, 1477 
Symphysis, cardiac, in cattle, 1105 
in horse, 1012 
‘“ Symptomatic ” anthrax, 47 
Syringomyelia, 1268 


ay 
Tabanide, 1417 
Tachycardia, 1021 
Teenie, 1495 
Takosis, 440 
Tapeworms, the, 1495 
of cat, 1504 
of dog, 1501 
of horse, 1498 
of rabbit, 1505 
of ruminants, 14.99 
“Tapping.” See Paracentesis 
Teeth, abnormal conditions of, in horse, 10 
defective, in sheep, 427 
Teleangiectasis maculosa, 565 
Test for albumin, ferrocyanide of potas- 
sium and acetic acid, 668 
heat and nitric acid, 668 
Heller’s ring, 668 
magnesium -nitric, 668 
metaphosphoric acid, 669 
Millard’s fluid, 668 
salicylic-sulfonic acid, 669 
Spiegler’s, 669 
trichloracetic acid, 669 
for bile, Gmelin’s, 535 
Rosenbach’s, 535 
for hemoglobin, 672 
Heller’s, 672 








1619 


| Test for sugar, Fehling’s, 1316 


fermentation, 1316 
Heller’s, 1316 
Nylander’s, 1317 
polariscope, 1317 
Trommer’s, 1316 
Tests for albumin in urine, 668 
for bile in urine, 535 
Tetanus, 227 
bacteriology, 228 
differential diagnosis, 241 
etiology, 228 
idiopathic, 233 
in cattle, 239 
in dog, 240 
in horse, 227 
in pig, 244 
in sheep, 240 
modes of infection, 231 
morbid anatomy, 234 
period of incubation, 235 
prognosis, 239 
prophylaxis, 242 
relapses in, 1315 
serum treatment, 245 
symptoms, 285 
treatment, 243 
types, 235 
Tetany, 248 
Texas fever, 983 
Therapy, vaccine, as applied to respiratory 
. diseases, 929 
Thermic fever, 1234 
Thick wind, 843 
Three-day sickress, 944 
Thrombo-embolic colic, 280 
Thrombosis in cattle, L111 
in horse, 1084 
of axillary artery in horse, 1088 
of carotid artery in horse, 1089 
of cavernous sinus in horse, 1091 
of cerebral vessels in horse, 1160 
of iliac artery in horse, 1084 
of nasal veins in horse, 1092 
of portal vein in horse, 1092 
of posterior aorta in horse, 1084 
of pulmonary artery in horse, 1090 
of renal artery in horse, 1090 | 
of veins of extremities in horse, 1092 
of penis in horse, 1092 
of vena cava in. horse, 1090 
of vessels of brain, in cattle, 1241 
in dog, 1258 
Thrush in birds, 515 
in horse, 18 
Thymus gland, diseases of, 1306 
Thyroid gland, diseases of, 1302 
tumours of, 1302 
Tibia, cramp of muscles of, 1203 
Ticks, 1444 
argasid, 1441 
injurious effects of, 1448 
remedial measures, 1450 
Tongue, bifid, 26 


1620 


Tongue, diseases of, in dog, 461 
inflammation of, in dog, 461 
paralysis of, in dog, 461 

Tongue, diseases of, in horse, 21 
congenital defects of, in horse, 26 
foreign bodies in, of horse, 24 
inflammation of, in horse, 21 
new growths in, of horse, 25 
wounds of, in horse, 28 

Tongue, diseases of, in pig, 446 

Tongue, diseases of, in sheep, 428 

Tonsillitis in cat, 510 
in dog, 463 
in horse, 33 

Tonsils, calculi of, in horse; 33 
diseases of, in cat, 510 

in dog, 463 
in horse, 33 

Torsion of abomasum, 387 
of colon in horse, 243 
of intestine in dog, 502 

in horse, 239 
in pig, 453 
of smal! colon in horse, 256 
of spleen in dog, 1301 
of stomach in dog, 486 
with displacements of intestines, 239 

Torticollis, 1401 

Toxemic gastritis in dog, 477 

Toxic gastritis in horses, 141 

Toxi-infectious icterus, 537 

Trachea, entrance of food into, in birds, 988 

Traumatic gangrene, 15 
indigestion in cattle, 368 
injuries to peripheral nerves, 1193 

Trematodes of the dog and cat, 1514 
of the horse, 1506 
of the Ox, 1507 
of the pig, 1513 
of sheep, 1509 
“‘Trembles ” in sheep, 1246, 1586 
Trichinella spiralis, 1563 
Trichinosis, 1563 
Trichodectes, 1436 
‘Tricuspid insufficiency in cattle, 1109 
in dog, 1124 
in horse, 1061 
stenosis in cattle, 1109 
in dog, 1124 
in horse, 1063 

Trigeminus, neuralgia of, 1197 
paralysis of, 1196, 1269 
spasm of muscles ‘supplied by, 1270 

Trichostrongylus axei, 1533, 1540 

Trismus, 227 
due to lesions of the fifth nerve, 1270 

Trommer’s test for sugar, 1316 

“ Trotting ” disease in sheep, 1246, 1586 

Trypanosoma brucei, 1063, 1316 
congolense, 1053 
dimorphon, 1054 
equinum, 1061 
equiperdum, 1067 
evansi, 1081, 1089 











SYSTEM OF VETERINARY MEDICINE 


| Trypanosoma gambiense, 1058 


hippicum, 1053 
nanum, 1055 

pecaudi, 1055 
rhodesiense, 1060, 1316 
soudanese, 1052 
theilert, 1057 
uniforme, 1057 
venezuelense, 1052 
vivax, 1056, 1316 


Trypanosomiasis, 1039 


of birds, 1113 
of fish, 1115 
Tsetse-fly disease, 1063 
Tubercle, degenerative changes, 124 
bacillus, 110 
modes of dissemination, 128 
morphology, 110 
occurrence, 111 
resistance and vitality, 111 
role played by, 125 
staining reaction, 110 
types of, 112 
avian, 116 
bovine, 112 
human, 114 
structure of, 122 
Tuberculin, 145 
directions for employment of, 146 
test, conjunctival, 152 
cutaneous, 153 
epidermic, 154 
fraudulent employment of, 150 
intradermic, 155 
mixed methods, 155 
ophthalmo-cutaneous, 154 
precautions necessary, 148 
Tuberculosis, 105 
anatomical forms of, 126 
avian, 187 
lesions, 188 
symptoms, 189 
bacteriology, 116 
communicability from animals to man, 
193 
congenital, 118, 139 
etiology, 110 
generalised, 130 
geographical distribution, 108 
hereditary transmission, 118 
history, 106 
in carp, 970 
in cat, 184 
diagnosis, 186 
lesions, 184 
symptoms, 184 
in cattle, 132 
diagnosis, 143 
bacteriological, 145 
clinical, 143 
tuberculin by, 145 
differential diagnosis, 143 
lesions, 132 
symptoms, 140 — 


- INDEX 


Tuberculosis in dog, 174 
diagnosis, 182 
lesions, 175 
symptoms, 179 
treatment, 183 
tuberculin test, 182 
in donkey, 173 
in goat, 163 
in horse, 164 
differential diagnosis, 173 
lesions, 167 
symptoms, 171 
tuberculin test, 173 
in sheep, 160 
differential diagnosis, 161 
lesions, 160 
symptoms, 161 
tuberculin test, 161 
in swine, 156 
differential diagnosis, 158 
lesions, 157 
symptoms, 158 
tuberculin test, 159 
infection by ingestion, 119 
by inhalation, 118 
by inoculation, 121 
latent, 121 
rare modes of, 121 
local, 130 
miliary, acute, 126 
chronic, 126 
modes of infection, 118 
morbid anatomy, 122 
occurrence, 108 
prophylaxis, 190 
Bang’s method, 190 
Ostertag’s method, 190 
protective inoculation, 192 
cape 2 inflammatory processes, 
3 
suppuration, 125 
udder, of the, 136, 393 
Tuberculous butter, 196 
cheese, 196 
meat, 194 
milk, 195 
Tumours. See Neoplasms 
Turbinated bones, disease of, 810 
myxoid degeneration of, 811 
Turkeys: coccidiosis (blackhead), 1181 
bighead in, 436 
epizootic dysentery, 464 
pneumo-enteritis, 436 
pneumo-pericarditis, 433 
infectious entero-hepatitis, 1181 
septicemia of, 465 
Tympanites of guttural pouch, 813 
of rumen, acute, in cattle, 352 
chronic, in cattle, 359 
in goat, 437 
in sheep, 430 ns ar 
Tympanitic indigestion in cattle, 351 
Tympany, acute gastric, in the dog, 475 
in the horse, 108 





1621 


Tympany, acute gastric, in the horse, use 
of stomach tube in, 118 
intestinal, in the horse, 179 
use of trocar and cannula in, 
185 
Typhlitis in the dog, 490 
Typhus, canine, 735 


U 


Ulcer, duodenal, in dog, 495 
in horse, 286 
gastric, in dog, 484 
in horse, 131 
of abomasum in cattle, 386 
Ulceration of intestine in dog, 495 
in horse, 285 
of cesophagus in horse, 83 
of stomach in dog, 484. 
in horse, 131 
Ulcerative enteritis in cattle, 417 
gastritis in dog, 484 
lymphangitis, 88, 223 
stomatitis in calves, 284 
in dog, 458- 
in horse, 17 
in sheep, 300 
Ulcerous lymphangitis, 220 
Uneinariosis, 1551 
Uremia, 675 
Ureters, diseases of, 714 
Urethra, diseases of, in cattle, 750 
Urethra, diseases of, in dog and cat, 782 
calculi of, in cat, 783 
in dog, 782 
impaction of, by calculi, in dog and 
cat, 785 
imperforate, in dog, 788 
parasites of, in dog, 788 
prolapse of, in bitch, 788 
stricture of, in dog, 787 
Urethra, diseases of, in horse, 729 
calculi of, in horse, 729 
polypus of, in horse, 730 
tumours of, in horse, 730 
Urethral calculi in cat, 783 
in cattle, 750 
in dog, 782 
in horse, 729 
in sheep, 753 
Urinary calculi in pig, 755 
organs, diseases of, in birds,’ 789 
in cattle, 731 
in horse, 660 
in pig, 754 
in sheep, 751 
Urine, albumin in, 667 : 
bile salts and pigments in, 533 
blood in, 670 
source of, 671 
epithelium in, 673 
fat in, 674 
hemoglobin in, 671 
incontinence of, 716 


1622 


Urine, morbid conditions in connection 
with, 666 | | t 
normal, characters of, in cattle, 732 
in dog, 758 
in horse, 665 
in pig, 754 
in sheep, 751 . 
organised casts in, 672 
oxalates in, 674 
phosphates in, 674 
pus in, 672 
sugar in, 1313 
Ortilago carbo, 147 
maidis, 147 
Uterus, inflammation of, acute, in bitch, 
651; see also Metritis 
in mare and cow, 638; see 
also Metritis 
in sheep, 651; see also Metritis 
chronic, in bitch, 656; see also 
Metritis 
in mare and cow, 652; see 
also Metritis 


Vv 
Vaccines: anthrax, 42 
blackquarter, 55 
blue-tongue, 1279 
braxy, 1250 
distemper, 704 
Copeman’s, 704 
Ferry’s, 706 
Ligniéres’, 704 
Phisalix’s, 704 
heartwater, 1256 
Johne’s disease (diagnostic), 1813 
louping-ill, 1256 
sheep-pox, 588 
strangles, 823 
tuberculosis (von Behring’s bovo- 
vaccine), 192 
Vaccine therapy as applied to respiratory 
diseases in horse,. 929 
Vnginitis, gangrenous, 356 
granular, 349 
vesicular, 362 
Vagus, paralysis of, 1199 - 
Valvular disease of heart, chronic, in birds, 
1127 
in cattle, 1109 
in dog and cat, 1123. 
in horse, 1051 
lesions, combined, 1064 
congenital, 1069 
Varicella, 576 
Varicose veins, 1095 
Variola, 570 - 
anserum, 595 
avian, 595 
Canadian, 224. 
canina, 592 
caprina, 589 
columbarum, 595 








s 


SYSTEM OF VETERINARY MEDICINE 


_ Variola equina, 578 


gallinarum, 595 
ovina, 582 
serosa, 592 
suilla, 591 
vaccina, 571 
Varix, 1095 
Veins, inflammation of, 1094 
Venereal catarrh in fowl, 371 
in rabbit, 370 
disease in sheep, 364 
pseudo-, in hare, 370 
specific, in dog, 366 
granuloma, in dog, 367, 
Ventricles of brain, chronic dropsy of, 
1148 
Verminous aneurism, colic due to, 280 
Vertigo, ‘‘ abdominal,” 145 
in dog and cat, 1272 
in horse, 1207 q 
paralytic, in cat, 1273 
Vesical calculi in cattle, 748 
in dog and eat, 778 
in horse, 724 
in pig, 755 
in sheep, 752 
hematuria in cattle, 745 
Vesicular exanthema of cattle, 361 
of horses, 359 
stomatitis, 15 
vaginitis, 362 
Vestibular nerve, paralysis of, in birds, 
1278 


in dog and cat, 1271 
Volvulus and displacement of large colon, 


and torsion in pig, 453 

in cattle, 408 

in dog, 502 

in form of knots, 257 

in horse, 239 

of small intestine, 240 
Vomice, tuberculous, 127 
Vomition in cattle, 342 

in horse, 91 ace 

in relation to rupture of stomach, 
92 
in pig, 450 


W 


Warble-flies, 1428, 1430 é 
‘* Warbles ”’ in cattle, 1430, 1431 
Wasps, 1434 
Water-pox, 592 
Waxy kidney in cattle, 740 
in dog and cat, 766 
in horse, 707 
liver in dog and cat, 592 
in horse, 587 
Weaving, 1234 
“< Weed,” 1381 
Whistling, 820 
detection of, 822 


INDEX 1623 


Whistling in connection with examination | ‘‘ Wood-evil,’’ 416 


of horses as to soundness, 821 
intermittent, 823 
temporary, 821 
White scour, 501 
in lambs, 434 
spotted kidney in cattle, 734 
“ Wind colic,”’ 179 
Wind-sucking in cattle, 1244 
in horse, 1227 
medico-legal aspect of, 1231 
views of M. Pécus on, 1228 
Wind, “‘ thick,” 843 
“* Wooden tongue,” 257 





Wool-eating in sheep, 432 
Wool-sorter’s disease, 21, 1305 


x 


Xerostomia in cattle, 317 
in horse, 12 


ae 
Yew-tree, poisoning by, 1581 


Z 


| Zinc sulphate, poisoning by, 1577 


Bailliére, Tindall and Cox, 8, Henrietta Street, Covent Garden 








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Abridged List of Veterinary Works 


PUBLISHED BY 


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HOARE’S System of Veterinary Medicine. 
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